Healthcare quality indicators

The European Commission considers the success of the OECD's Health Care Quality Indicators Project (HCQI) with the participation of all EU Member States to be a matter of priority. The European Commission provides financial support for this OECD Project in the framework of the Community Public Health Programme.

According to the Agreement between the European Commission and OECD, the OECD Health Care Quality Indicators Project (HCQIP) is an integral part of the activities of the EU in the areas of health indicators and health systems. The objective of the HCQIP is to establish international definitions for, and to collect data on, a limited number of recognised quality indicators for which data are readily available in a number of countries, as well as setting up panels of experts to identify additional, evidence-based Quality Indicators in five key areas of health care (cardiac care, diabetes, mental health, primary care/prevention and health promotion, and patient safety), with a view to proceeding towards a more comprehensive coverage of the quality of health care. According to the European Commission/OECD Agreement, the OECD should involve the EU countries that are not members of OECD into the HCQIP.

The Health Care Quality Indicators Project (HCQI) responds to the growing interest on the part of healthcare policy-makers and researchers in OECD countries in measuring and reporting the quality of medical care. 'Quality indicators' (QIs) here means: indicators of the technical quality with which medical care is provided, i.e. measures of health outcome or health improvement attributable to medical care (changes in health status attributable to preventive or curative activity). Such measures could be said to represent the 'value' side of the 'value for money' equation in health care - a key issue in measuring the performance of health systems.

Many OECD countries have already instituted national strategies to begin collecting technical quality indicators, often for benchmarking purposes in a performance measurement setting. These efforts have led to a great deal of progress in implementing quality indicators at the level of providers, such as hospitals or physicians. However, such national activities do not lead, except by accident, to internationally comparable QIs. This is because there is a lack of international agreement on which indicators are the most promising, and also the fact that there are many definitions of each indicator that could be adopted. Hence, so far there is little possibility for international benchmarking of the quality of health care. This deprives national policy-makers of the opportunity to compare the performance of their health care delivery systems against a peer group.

The Health Care Quality Indicators Project was guided by an expert group made up of representatives from OECD countries participating in the project. At present, this group includes representatives from 23 countries, all of whom have given generously of their time in providing input and guidance for this paper. This group was chaired by Arnie Epstein (Harvard University).

OECD recommendations for health care quality indicators

In October 2004, five technical papers were released with the recommendations of five Expert Panels on additional indicators in five priority areas. The Panels made recommendations for health care quality indicators in the areas of:

• Cardiac care
See OECD document Selecting Indicators for the Quality of Cardiac Care at the Health Systems Level in OECD Countriespdf

• Diabetes care
See OECD document Selecting Indicators for the Quality of Diabetes Care at the Health Systems Level in OECD Countriespdf

• Primary care and prevention
See OECD document Selecting Indicators for the Quality of Health Promotion, Prevention and Primary Care at the Health Systems Level in OECD Countriespdf

• Mental health
See OECD document Selecting Indicators for the Quality of Mental Health Care at the Health Systems Level in OECD Countriespdf

• Patient safety
See OECD document Selecting Indicators for Patient Safety at the Health Systems Level in OECD Countriespdf
See OECD document Selecting Health Care Quality Indicators Project
Patient safety data systems in the OECD: A report of a joint Irish Department of Health - OECD conferencepdf(357 KB)

Two conceptual papers on the HCQIP were published by OCDE in March 2006. These papers represent an attempt to set out a conceptual framework for the OECD's Health Care Quality Indicator (HCQI) Project. The project has been divided into two phases. The initial phase concentrated on 17 important and readily available indicators of effectiveness of care. Future indicators to be considered in the second phase of work will look at a broader set of clinical conditions and other dimensions of health care quality.

Two main issues are tackled: what concepts, or dimensions, of quality of health care should be measured and how, in principle, should they be measured. The need for a conceptual framework for the Project was expressed by a large group of participating countries. In interviews conducted by the OECD Secretariat with member countries in April and May 2005, country experts and delegates to the Group on Health reiterated the need for a framework for the OECD's health care quality work. Countries stated that the framework: a) should be based on country experience and b) could be used to guide both current and future work by the OECD in health care quality measurement and monitoring.

See OECD document Health Care Quality Indicators Project Conceptual Framework Paperpdf
See OECD document Health Care Quality Indicators Project Initial Indicators Reportpdf


The Euphoric project aims, among others, at benchmarking the outcomes of selected health performances, exchange information on quality standards, best practice and effectiveness in public health.

In this context, the project is thus addressing the issue of Health Care Quality Indicators and a first deliverable has been produced such including work. The project will further include 2 pilot studies, focusing on the cardiovascular and orthopaedics area.

You can find more at www.euphoric-project.eu and http://ec.europa.eu/health/archive/ph_projects/2003/action1/action1_2003_30_en.htm