Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects (Health Economics, Policy and Management)

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Foreword......Page 11
Acknowledgements......Page 13
List of contributors......Page 14
Editors......Page 17
Boxes......Page 18
Figures......Page 19
Tables......Page 23
PART I Principles of performance measurement......Page 25
Introduction......Page 27
What is performance measurement for?......Page 29
Defining and measuring performance......Page 32
Statistical tools for analysing and summarizing performance measures......Page 36
Performance measurement in challenging domains......Page 38
Health policy and performance measurement......Page 40
References......Page 44
PART II Dimensions of performance......Page 49
Introduction......Page 51
Does health care contribute to population health?......Page 52
How much does health care contribute to population health?......Page 54
Ischaemic heart disease......Page 57
Perinatal mortality......Page 62
Cancer survival......Page 64
Concept of avoidable mortality......Page 67
Tracer concept......Page 72
The way ahead......Page 74
References......Page 75
Annex 1 Summary measures of population health......Page 83
Uses of PROMs......Page 87
Generic instruments......Page 89
Utility instruments......Page 90
Individualized instruments......Page 91
Evaluating PROMs......Page 92
Evidence to aid choice of instrument......Page 96
Disease-specific versus generic instruments......Page 97
Cognitive barriers......Page 99
Logistic and resource barriers......Page 101
Current and future issues......Page 103
Policy implications......Page 105
References......Page 106
State-of-the-art development of clinical process measures......Page 111
Selecting topics......Page 112
Reviewing clinical evidence......Page 113
Identifying clinical process indicators......Page 116
Data sources......Page 118
Development of measures......Page 120
Creating scoring methods......Page 122
Accreditation......Page 126
Public reporting......Page 127
Payment incentives......Page 129
Best uses of process measurement......Page 130
Recommendations for developing countries......Page 131
Directions for future research......Page 132
References......Page 134
Some preliminaries......Page 138
The basics......Page 140
Empirical studies......Page 144
The basics......Page 147
Empirical studies......Page 148
Is health spending involuntary?......Page 150
Asset sales, dissaving and borrowing......Page 151
Intertemporal considerations......Page 155
Conclusions......Page 157
References......Page 159
Introduction......Page 162
Responsiveness operationalized as a population health concept......Page 163
Spheres of health events......Page 164
Combining health events and user roles – interactions......Page 165
Responsiveness and equity in access......Page 166
Equity considerations for responsiveness survey design......Page 169
Responsiveness questionnaires......Page 170
Feasibility......Page 174
Reliability......Page 176
Validity......Page 179
Calculating the measures......Page 181
Interpreting the measures......Page 184
All countries......Page 185
European countries......Page 186
European countries......Page 188
Ambulatory health services......Page 190
Health system characteristics and responsiveness......Page 192
Common concerns......Page 196
Implementing change......Page 197
Responsiveness measurement and future research......Page 198
Prospects for measuring responsiveness......Page 199
References......Page 200
Introduction......Page 211
Defining equity, access and need......Page 212
What objective of equity do we want to evaluate?......Page 214
How to define access?......Page 216
How to define need?......Page 218
Regression method......Page 223
The ECuity method: concentration index......Page 225
Policy implications and directions for future research......Page 233
References......Page 238
Introduction......Page 246
Conceptual issues......Page 247
Production function – relationship between inputs and outputs......Page 248
Distinguishing productivity and efficiency......Page 251
Defining, measuring and valuing output......Page 254
Defining the quantity of output......Page 255
Defining the quality of output......Page 256
Valuing outputs......Page 257
Defining inputs......Page 258
Labour inputs......Page 259
Health system level......Page 260
3.2 Disease oriented approach......Page 261
Defining comparable organizations......Page 264
Identifying the production frontier......Page 265
Opportunities for meso-level efficiency analysis......Page 267
Conclusion......Page 268
References......Page 269
PART III Analytical methodology for performance measurement......Page 273
Introduction......Page 275
Rationale for risk adjustment......Page 277
Consequences of failing to risk adjust......Page 279
Risk adjustment for different performance measures......Page 282
Outcome versus process measures......Page 283
Measures involving patient preferences......Page 286
Composite measures......Page 288
Conceptualizing risk factors......Page 290
Administrative data......Page 292
Medical records or clinical data......Page 297
Information directly from patients or consumers......Page 299
Statistical considerations......Page 300
Plea for transparency......Page 303
Conclusions......Page 304
References......Page 305
Clinical surveillance: important aspects of the data......Page 310
Throughput of providers and health-care facilities......Page 311
Dimensionality of the data......Page 312
Statistical chart options......Page 313
Example data: cardiac surgery......Page 314
Shewhart charts, scan statistics and MAs......Page 316
EWMAs......Page 318
Sets method......Page 321
Cumulative O – E and CUSUM charts......Page 324
Example data: Harold Shipman......Page 328
Conclusions......Page 330
References......Page 331
Introduction......Page 335
Assumptions underlying performance measurement......Page 337
The vagaries of chance in health-care performance measurement – random error......Page 340
Systematic error in health-care performance measurement......Page 342
Confounding in health-care performance measurement......Page 343
Complexity in health-care performance measurement......Page 344
Provider locus of control......Page 346
Attribution theory and fundamental attribution error......Page 348
Causality and attribution bias in health-care performance measurement......Page 349
Who is at risk from causality and attribution bias?......Page 350
What are the potential effects of causality and attribution bias on health-care quality and equity?......Page 351
Methods to reduce causality and attribution bias in health-care performance measurement......Page 352
Critique from the standpoint of complexity theory......Page 356
Conclusions......Page 357
References......Page 359
Introduction......Page 363
Why use composite indicators to measure performance?......Page 364
Methodological issues and experience of using composite measures in health care......Page 365
Choosing units to assess and organizational objectives to encompass......Page 366
Data availability......Page 369
Type of indicators......Page 371
Collinearity between indicators......Page 372
Combining indicators to create a composite......Page 373
Transformation of individual indicators......Page 374
Weighting......Page 376
Application of decision rules......Page 380
Interpretation and use of composite indicators......Page 382
Conclusions......Page 386
References......Page 388
PART IV Performance measurement in specific domains......Page 393
Defining primary care......Page 395
Importance of measuring performance in primary care......Page 397
Quality of care for individual patients......Page 399
Overview of quality improvement strategies in primary care......Page 400
Underlying conceptual framework......Page 402
Case studies of performance measurement in primary care......Page 407
Case study 1: Quality and Outcomes Framework......Page 408
Case study 2: Veterans Health Administration......Page 412
Case study 3: European Practice Assessment......Page 416
Where should performance measures be used?......Page 418
Is there an optimal way of improving performance?......Page 419
Unintended consequences of performance measurement......Page 420
Future challenges......Page 421
References......Page 423
Growing importance of chronic disease......Page 430
Implications of the growth in chronic disease......Page 434
Assessing performance: different dimensions......Page 436
The health system perspective......Page 439
Towards high-performing health systems......Page 443
References......Page 445
Introduction......Page 450
Performance measurement in mental health......Page 452
Challenges in measuring health outcomes......Page 455
Australia......Page 456
England......Page 458
Netherlands......Page 459
Readmission rates......Page 460
Suicide......Page 462
Physical health problems......Page 463
Is there any evidence that outcome measurement leads to service improvement?......Page 464
Process measures......Page 465
Service-user experiences......Page 466
Use of guidelines......Page 468
Inequalities in access and utilization......Page 470
Productivity measurement......Page 473
Risk adjustment......Page 476
Expanding the dimensions of performance assessment......Page 477
Performance data and IT......Page 479
Conclusions......Page 481
References......Page 485
Introduction......Page 496
Origin of the RAI in the United States......Page 497
Reliability and validity of the MDS......Page 499
Policy applications of the RAI......Page 500
Casemix reimbursement......Page 501
Creating quality indicators to monitor provider performance......Page 502
Nursing Home Compare in the United States......Page 505
Benchmarking initiatives involving interRAI data in Canada......Page 507
RAI benchmarking project in long-term care......Page 511
Benchmarking in intra-facility management......Page 514
Nursing home performance measurement in Swiss cantons: Q-Sys approach......Page 515
Summary and implications......Page 517
Policy challenges......Page 518
Research needs......Page 520
Conclusions......Page 521
References......Page 522
PART V Health policy and performance measurement......Page 531
Introduction......Page 533
Targets in the English health system......Page 534
An example: 2004 PSAs for the Department of Health......Page 536
Discussion......Page 542
Who should choose the targets?......Page 543
What targets should be chosen?......Page 546
When should outcomes be used as a basis for targets?......Page 547
How should targets be measured and set?......Page 548
How should cross-departmental targets be handled?......Page 551
How should attainment be scrutinized?......Page 552
How should departmental objectives be transmitted to local organizations?......Page 553
Conclusions......Page 554
References......Page 558
Introduction......Page 561
Public reporting: effect on selection pathway......Page 562
By health plans or individual providers......Page 563
Public reporting: effect on clinical outcomes......Page 564
Public reporting: potential for unintended consequences......Page 565
Evidence about public reporting......Page 566
HEDIS......Page 567
Hospital Compare......Page 568
Unit of Patient Evaluation......Page 569
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)......Page 570
Netherlands......Page 571
References......Page 572
Infrastructure of health information network......Page 576
Penetration of health IT......Page 582
Health-care effectiveness......Page 585
Patient safety......Page 589
Health-care equality......Page 592
Data quality......Page 593
Patient privacy......Page 596
Key policy issues......Page 597
The future......Page 598
Conclusions......Page 599
Challenge 2: ensure data exchangeability......Page 600
References......Page 601
Introduction......Page 606
Theoretical framework......Page 607
Target entity......Page 608
Types of incentive......Page 609
Extrinsic and intrinsic incentives......Page 611
Behaviour targeted by the incentive......Page 612
Certainty of incentive application......Page 614
Base of comparison: relative versus absolute performance measures......Page 615
Health plan to provider organization incentives......Page 616
Physician organization-based (group-level) selective incentive studies......Page 618
Hospital-based selective incentive studies......Page 619
Individual physician-based selective incentive studies......Page 621
Unintended consequences of performance incentives......Page 622
Nature of the incentive (reward versus penalty)......Page 623
Type of incentive......Page 624
Nature of behaviour subject to incentive......Page 625
Certainty, frequency and duration of incentive......Page 626
Implications for research and policy in performance incentive design......Page 627
References......Page 629
Quality assurance, quality improvement and performance measurement......Page 637
Education......Page 639
Audit, profiling and feedback......Page 642
Accreditation and recertification......Page 647
Publicly released performance data......Page 649
Providers' response to report cards......Page 650
Pay for performance......Page 652
Quality measurement to encourage professional participation......Page 654
Policy questions and future challenges for performance measurement and professionals......Page 655
How can physicians be encouraged to utilize performance measurement and engage more actively in quality improvement?......Page 656
How to create consortia to better map performance and provide consistent signals?......Page 657
When financial incentives are tied to publicly reported data, what are the most appropriate targets (attainment or improvement) and what are the levers that will prompt change most effectively (the magnitude of the incentive or professional ethos)?......Page 658
References......Page 659
Introduction......Page 665
Increased interest in international health system comparisons......Page 668
Scope of international health system comparisons......Page 669
Methodological issues in conducting international health system comparisons: lessons from the OECD experience......Page 676
Specifying indicators using internationally standardized definitions......Page 679
Controlling for differences in population structures across countries......Page 680
Adjusting for differences in information systems’ ability to track individual patients......Page 681
Controlling variability of data sources......Page 682
Identifying nationally representative data......Page 685
Turning international health system comparisons into health system performance management......Page 686
Translating performance information for policy-makers......Page 688
Benchmarking health system performance......Page 689
Conclusions......Page 691
References......Page 692
PART VI Conclusions......Page 697
6.1 Conclusions......Page 699
Conceptual framework......Page 700
Integrate with IT and routine data collection......Page 701
Design for international comparability......Page 702
Choosing performance measures......Page 703
Statistical issues......Page 708
Incentives and performance information......Page 712
Politics of performance measurement......Page 721
Stewardship perspective on performance measurement......Page 723
References......Page 728
Index......Page 731