Policymakers and researchers in the U.S. and in other industrialized countries are increasingly looking to international quality indicators to assess the technical quality of their respective national health care delivery systems.

"With international benchmarks, countries with problem areas in their health care systems could learn from others that excel in those areas," explained HSPH alumnus Soeren Mattke, who directs the Health Care Quality Indicators (HCQI) Project. The Paris-based Organization for Economic Cooperation and Development (OECD) launched the project last year. The OECD is an international organization that helps its 30 member governments address social, economic, and governance challenges of globalization.

The HCQI Project aims to establish internationally comparable quality measures and to use those measures to collect and publicize data on health outcomes and improvements from medical care. Technical experts comprised of physicians, economists, and other researchers from 20 OECD participating member nations meet semi-annually to discuss the project’s goals. They are joined by about 20 representatives, mostly economists, from international organizations such as the World Health Organization, the European Commission and the World Bank, as well as from research institutions, such as the International Society for Quality in Health Care.

Arnold Epstein, chair of the Department of Health Policy and Management at HSPH, also chairs the HCQI meetings of technical experts.

The HCQI Project is now building on the work of two international collaborations that have convened in recent years to establish common health care quality indicators: the New York-based Commonwealth Fund (representing Australia, Canada, New Zealand, the United Kingdom, and the United States), and the Nordic Council of Ministers (from Denmark, Finland, Iceland, Norway, and Sweden). Last year the members of these collaborations and ten additional OECD countries (Austria, Germany, France, Ireland, Italy, Japan, the Netherlands, Portugal, Spain, and Switzerland) joined forces to develop a comprehensive health care quality reporting system for all OECD member countries.

Achieving consensus among this large and diverse group is not easy. Data availability, definitions, and collection strategies, as well as measurement priorities, differ widely.

For example, the definition of a seemingly straightforward indicator such as measuring death rates at a hospital within 30 days of admission after heart attack requires agreement from each stakeholder. In their calculations, some countries include people who arrive at hospitals already dead after a heart attack. Other countries do not. Some countries track the death rates of patients after discharge, but others cannot and have argued that in-hospital death rates can be extrapolated to make reasonable comparisons to death rates monitored after discharge.

At its first technical experts’ meeting in January in Paris, the HCQI Project members identified thirteen indicators proposed by the Commonwealth Fund and Nordic Council for further evaluation of scientific evidence and data comparability. The indicators included ‘outcome measures,’ such as acute myocardial infarction survival rates, and ‘process measures,’ such as cervical cancer screening rates. The expert panel recommended further study of six priority areas in which to identify additional indicators: cardiac care, diabetes, mental health, primary care, prevention/health promotion, and patient safety.

--Mark Dwortzan