HEALTH CARE QUALITY INDICATORS PROJECT INITIAL INDICATORS REPORT

DELSA/HEA/WD/HWP(2006)2
OECD HEALTH WORKING PAPERS
HEALTH CARE QUALITY INDICATORS
PROJECT
INITIAL INDICATORS REPORT
Soeren Mattke, Edward Kelley, Peter Scherer,
Jeremy Hurst, Maria Luisa Gil Lapetra
and the HCQI Expert Group Members
22

Unclassified DELSA/HEA/WD/HWP(2006)2
Organisation de Coopération et de Développement Economiques
Organisation for Economic Co-operation and Development
09-Mar-2006
___________________________________________________________________________________________
English text only
DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS
GROUP ON HEALTH
Health Working Papers
OECD HEALTH WORKING PAPERS NO. 22
HEALTH CARE QUALITY INDICATORS PROJECT
INITIAL INDICATORS REPORT
Soeren Mattke, Edward Kelley, Peter Scherer,
Jeremy Hurst, Maria Luisa Gil Lapetra
and the HCQI Expert Group Members
JT03205353
Document complet disponible sur OLIS dans son format d'origine
Complete document available on OLIS in its original format
DELSA/HEA/WD/HWP(2006)2 Unclassified
English text only

DELSA/HEA/WD/HWP(2006)2
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ACKNOWLEDGEMENTS
1. The Health Care Quality Indicators Project was guided by an expert group made up of
representatives from OECD countries participating in the project. Presently, this group includes
representatives from 23 countries. This group was chaired by Arnie Epstein (Harvard University). The
countries listed below who make up the HCQI Expert Group.
• Australia
• Austria
• Canada
• Czech Republic
• Denmark
• Finland
• France
• Germany
• Iceland
• Ireland
• Italy
• Japan
• Mexico
• Netherlands
• New Zealand
• Norway
• Portugal
• Slovak Republic
• Spain
• Sweden
• Switzerland
• United Kingdom
• United States
2. The authors would like to acknowledge the input provided by Peter Hussey, Elizabeth Coté,
Leighna Kim, Emily Rosenoff and Sandra Garcia Armesto in the many reviews and improvements made to
this paper during its production. We would also like to recognise the technical support provided by Gaëlle
Balestat and Lihan Wei as well as the leadership of Victoria Braithwaite in the production of this working
paper.
3. The OECD Secretariat would also like to acknowledge that the HCQI Project was in part supported
by The Commonwealth Fund, a national, private foundation based in New York City that supports
independent research on health and social issues. The views presented here are those of the authors and not
necessarily those of The Commonwealth Fund, its director, officers, or staff.

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SUMMARY
4. The OECD Health Care Quality Indicator (HCQI) Project was started in 2001. The long-term
objective of the HCQI Project is to develop a set of indicators that can be used to raise questions for further
investigation concerning quality of health care across countries. It was envisioned that the indicators that
were finally recommended for inclusion in the HCQI measure set would be scientifically sound, important at
a clinical and policy level and feasible to collect in that data would be available and could be made
comparable across countries. It was also envisioned that the indicators would not enable any judgement to be
made on the overall performance of whole health systems. In essence, they should be used as the basis for
investigation to understand why differences exist and what can be done to reduce those differences and
improve care in all countries.
5. The HCQI project has built on two pre-existing international collaborations organised by the
Commonwealth Fund of New York (five countries) and The Nordic Minister Council Working Group on
Quality Measurement (six countries).1 It now involves 23 countries and has spanned nearly four years of
work. All of the original 23 participating countries, with one exception, have remained active participants
through the course of the project.
6. The project has been divided into two phases. The initial phase, for which this report serves as the
summary report, concentrated on 17 important and readily available indicators of effectiveness of care.
Currently, all of the participating countries with one exception have submitted data on at least five of these
indicators and twelve of the seventeen indicators have data from 15 countries or more. Future indicators to
be considered in the second phase of work will consider a broader set of clinical conditions and other
dimensions of health care quality.
7. Part I of this report summarises the purpose and history of the project, the methods employed and
the results attained.
8. Part II of this report summarises findings from detailed analysis carried out by the OECD in the
Spring and Summer 2005 on a set of five questions posed by country experts during the December 2004
HCQI Expert Group meeting in Paris. These data-based questions focus on data comparability issues across
countries on particular indicators. These questions are listed below and are summarised in a research format
in Part II.
• What is the appropriate reference population for age adjustment?
• What is the impact of different policies for handling missing data?
• What is the impact of notification policies on cases of vaccine-preventable disease?
• What is the impact of variation in coding practices (for asthma)?
• What is the effect of unique identifiers when dealing with mortality rates?
9. Part III of this report reviews the detailed information on scientific soundness, importance,
availability of data and the international comparability of the data for indicators recommended for inclusion
in an initial OECD Health Care Quality Indicators set. The paper also reviews in detail those indicators that
are not currently recommended for inclusion in an initial indicator set. This paper, therefore, presents two
1. The Commonwealth Fund’s International Working Group on Quality Indicators included the United States,
the United Kingdom, Canada, Australia and New Zealand. The Nordic Minister Council Working Group on
Quality Measurement includes Greenland, Sweden, Norway, Finland, Iceland and Denmark

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groups of indicators, those recommended for retention and those not recommended for retention. Indicators
that are not currently being recommended for retention are not necessarily being recommended for exclusion
from future OECD HCQI consideration. A number of these indicators are generally viewed as scientifically
sound, however data availability and comparability may not be up to standard currently. Therefore these
indictors are not currently appropriate for international comparisons. The indicators recommended for
retention in an initial HCQI indicator set are listed below.
• Breast Cancer Survival
• Mammography Screening
• Cervical Cancer Survival
• Cervical Cancer Screening
• Colorectal Cancer Survival
• Incidence of Vaccine Preventable Diseases
• Coverage for basic vaccination
• Asthma mortality rate
• AMI 30-day case fatality rate
• Stroke 30-day case fatality rate
• Waiting time for femur fracture surgery
• Influenza vaccination for adults over 65
• Smoking rates