May 15, 2012
The aim of this guide is to encourage users of international comparisons of health and health care data to consider some of the factors that can influence variation between countries, and to assist them in interpreting the results. Drawing on a range of examples—using health and health care data for Organisation for Economic Co-operation and Development (OECD) countries—this guide highlights the types of question to consider about data quality, the basis for country selection and the techniques used to present the results. It is a general guide, and considering each of the factors presented here may not always be possible.
Posted in READ Portal, Reports & Papers, Uncategorized | Tagged with Benchmarking, Indicators, Statistics & numerical data | No Comments
May 8, 2012
In this paper, we discuss the current capacity for governments and their health information and quality agencies to report on the performance of their health systems. We also provide international and Canadian examples of governments that are using improved performance reporting mechanisms to support their health care priorities and goals. To do this, they rely on strategic health plans to guide service implementation, complemented by reporting frameworks that use health indicators to monitor performance over a set period of time, and report their achievements regularly to the public. The strategic plans are revised regularly in light of changing political, economic, and social circumstances within each jurisdiction. In some cases, governments have begun using performance-based funding programs as a way to drive performance improvement and achievement of their health care objectives.
As a country, how can we improve the way we set goals and measure changes to health care and the health of Canadians? How do we make sure that activities are focused on achieving positive results? How do we improve accountability for achieving these results, especially in light of the significant public resources employed in the delivery of health care in Canada? These questions predate the existing health accords and remain to be answered.
This paper is intended to raise the profile of performance reporting in Canada’s health care system and to increase our collective understanding of the opportunities to improve it in the interest of better accountability.
Posted in 2014 Health Accord, READ Portal, Reports & Papers | Tagged with Canada, Indicators, Quality assessment | No Comments
May 7, 2012
“This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation.”
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Health care costs, Indicators, Quality assessment | No Comments
April 6, 2012
“The Project for an Ontario Women’s Health Evidence-Based Report (POWER) has taken a comprehensive look at health inequities in Ontario associated with income, education, race/ethnicity, where one lives, and how these differ by gender. In doing so, we documented sizable and modifiable health inequities across multiple measures. We have also demonstrated that the social determinants of health affect the health of women and men differently. It is well-known that social factors—rather than medical care or health behaviours—are the primary drivers of health and health inequities. The social determinants of health influence both physical and mental health. Furthermore, the social determinants of health, which work through many complex and intertwining pathways, are not evenly distributed across the population. The POWER Study Framework emphasizes the importance of these social factors, while recognizing that the way we shape our health care services and community resources can mediate the effects of the social determinants of health.
Prior reports have examined the burden of illness in the population, access to health care services, cancer, cardiovascular disease, depression, musculoskeletal conditions, diabetes, reproductive health, and HIV infection by assessing variation in performance on a broad set of evidence-based indicators of population health and health system performance. We identified many opportunities for intervention and improvement, and we worked closely with decision makers across the province to ensure that our objective findings would be used to inform practice an policy. In this chapter, we synthesize prior analyses that examined the health of low-income, minority, and immigrant women, and enrich this by reporting additional indicators of the social determinants of health and immigrant women’s health. In doing so, we paint a powerful picture of the health needs of populations at risk, how these differ among women and men in different groups, and highlight the role of the social determinants of health.”
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April 2, 2012
“ISSUE: Are there differences between Ontario’s primary care models in who they serve and how often their patients/clients go to the emergency department (ED)?
STUDY: This study examined patients/clients enrolled in: Community Health Centres (CHCs, a salaried model), Family Health Groups (FHGs, a blended fee-for-service model), Family Health Networks (FHNs, a blended capitation model), Family Health Organizations (FHOs, a blended capitation model), Family Health Teams (FHTs, an interprofessional team model composed of FHNs and FHOs), ‘Other’ smaller models combined, as well as those who did not belong to a model. Electronic record encounter data (for CHCs) and routinely collected health care administrative data were used to examine sociodemographic composition, patterns of morbidity and comorbidity (case mix) and ED use. ED visits rates were adjusted to account for differences in location and patient/client characteristics.
KEY FINDINGS
- Compared with the Ontario population, CHCs served populations that were from lower income neighbourhoods, had higher proportions of newcomers and those on social assistance, had more severe mental illness and chronic health conditions, and had higher morbidity and comorbidity. In both urban and rural areas, CHCs had ED visit rates that were considerably lower than expected.
- FHGs and ‘Other’ models had sociodemographic and morbidity profiles very similar to those of Ontario as a whole, but FHGs had a higher proportion of newcomers, likely reflecting their more urban location. Both urban and rural FHGs and ‘Other’ models had lower than expected ED visits.
- FHNs and FHTs had a large rural profile, while FHOs were similar to Ontario overall. Compared with the Ontario population, patients in all three models were from higher income neighbourhoods, were much less likely to be newcomers, and less likely to use the health system or have high comorbidity. ED visits were higher than expected in all three models.
- Those who did not belong to one of the models of care studied were more likely to be male, younger, make less use of the health system and have lower morbidity and comorbidity than those enrolled in a model of care. They had more ED visits than expected.”
Posted in READ Portal, Reports & Papers | Tagged with Canada, Emergency service, Indicators, Statistics & numerical data | No Comments
March 21, 2012
“This toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ, and support your use of them to successfully improve quality and patient safety in your hospital. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge. The toolkit is a general guide to using improvement methods, with a particular focus on the QIs.
The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”
Posted in Multimedia, READ Portal | Tagged with Indicators, Patient-centered care, Process improvement, Quality improvement, Safety | No Comments
March 19, 2012
“Putting Health in context: What is health? For some, health means the absence of disease and pain; for others, it is a general feeling of wellness. The World Health Organization (WHO) defines health more broadly: ‘the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’
This broad definition aligns with the Conference Board’s overarching goal in benchmarking Canada’s performance—to measure quality of life in Canada and in its peer countries. Most Canadians would agree that without health, quality of life is severely compromised.
How do we measure health performance?: To measure health performance, we evaluate Canada and 16 peer countries on the following 11 report card indicators: life expectancy; self-reported health status; premature mortality; mortality due to cancer; mortality due to circulatory disease; mortality due to respiratory disease; mortality due to diabetes; mortality due to diseases of the musculoskeletal system; mortality due to mental disorders; infant mortality; and mortality due to medical misadventures.
It is important to note that the Conference Board is not attempting to rate Canada’s health care system. Although the health care system has an impact on the health status of a population, our goal is to evaluate the health status of Canadians and of their peers in other countries.
“
Posted in Multimedia, READ Portal | Tagged with Canada, Chronic disease, Indicators, Prevention and control | No Comments
August 25, 2011
As private and public employers strive to improve workforce health and control healthcare costs, the patient centered medical home (PCMH) is emerging as an important strategic component
to achieve these goals. The PCMH enables clinicians to deliver better quality care more efficiently. Central attributes of the PCMH include a holistic, team-based approach to primary care that is accessible, coordinated, and comprehensive. PCMH incorporates re-engineering of office processes and payment systems to reward an ongoing primary care physician-patient relationship and high-quality, coordinated care. Through better informa- tion management, use of guidelines and coordinated care, PCMH can contribute to better quality of care, which, in turn, drives cost reductions through avoided hospitalizations and emergency department visits.
While employer interest in PCMH continues to rise, an important issue facing employers concerns the measurement of value of PCMH implementation. From a pragmatic perspective, this information is necessary to help justify initial and ongoing employer investments in PCMH. And despite this observation, there is no consensus regarding specific measures or metrics to evaluate PCMH program effectiveness.
Posted in READ Portal, Reports & Papers | Tagged with Cost effectiveness, Indicators, Patient-centered care, Program evaluation | No Comments
August 24, 2011
Background: Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions.
Methods: In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%.
Results: Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval [CI] 12.5%–14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%–19.1%; 2.2% of those discharged, 95% CI 1.8%–2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%–22.5%; χ2 = 92.9, p < 0.001); the proportion ofreadmissions deemed avoidable did not showsignificant variation by hospital (range 1.2%–3.7%; χ2 = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41).
Interpretation: Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission.
Posted in Journal Articles, READ Portal | Tagged with Indicators, Quality improvement | No Comments
July 19, 2011
This 2011 paper from the Health Council of Canada presents a detailed explanation of the purpose and use of health indicators. Health indicators are measurement tools that help people compare and understand the Canadian health system, and is targeted towards every stakeholder within the system, from patients to health care professionals. The purpose of this guide is to help answer questions such as: “How can I use health indicators to guide my decisions? What should I watch out for, and what do I need to know to use them well?”
Posted in READ Portal, Reports & Papers | Tagged with Canada, Indicators | No Comments
