Performance Measurement for Health System Improvement

Transcription

1 Peter C. Smith is Professor of Health Policy at the Imperial College Business School. Elias Mossialos is Professor of Health Policy at the London School of Economics and Political Science, Co-Director of the European Observatory on Health Systems and Policies and Director of LSE Health. Irene Papanicolas is Research Associate and Brian Abel Smith Scholar, LSE Health, London School of Economics and Political Science. Sheila Leatherman is Research Professor at the Gillings School of Global Public Health, University of North Carolina and Visiting Professor at the London School of Economics and Political Science. PRAISE QUOTES TO FOLLOW Performance Measurement for Health System Improvement Experiences, Challenges and Prospects Performance Measurement for Health System Improvement Technical material is presented in an accessible way and is illustrated with examples from all over the world. Performance Measurement for Health System Improvement is an authoritative and practical guide for policy makers, regulators, patient groups and researchers. Smith, Mossialos, Papanicolas and Leatherman In a world where there is increasing demand for the performance of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. It examines the various levels at which health system performance is undertaken, the technical instruments and tools available, and the implications using these may have for those charged with the governance of the health system. Peter C. Smith, Elias Mossialos, Irene Papanicolas and Sheila Leatherman HEALTH ECONOMICS, POLICY AND MANAGEMENT Designed by Zoe Naylor

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4 Index 709 access, defining access equity CI defining access defining need definitions ECuity method egalitarianism empirical studies future research health systems libertarianism measuring methods, equity analysis objective policy implications principles regression method responsiveness SAH 195 7, 211 access inequalities, mental health services accountability goals 675 Hungary 520 international comparisons 644 performance measurement 5 8, 18 targets accreditation clinical process measures NCQA quality improvement acute hospitals, star ratings, composite indicators 357 administrative data coronary artery bypass graft (CABG) surgery deaths risk adjustment age-standardized mortality rates by cause, population health 61 ambulatory care responsiveness expenditure international comparisons America s Best Hospitals, composite indicators 360 asset sales, financial protection assumptions financial protection outcome measures performance measurement attribution performance measurement risk factors attribution bias key considerations 686 performance measurement potential effects RCTs recommendations reducing risk volume-outcome relationship attribution problem, performance measurement attribution theory, fundamental attribution error audit Canada 622 Denmark 622 Netherlands quality improvement United States 621 Australia education 617 outcome measures outreach 617 quality improvement 621 avoidable mortality, population health 43 8, 51 Behavioral Healthcare Performance Measurement System (BHPMS) mental health services 453, 454 risk adjustment 453, 454 behaviour targeted by incentives , benchmarking Canada Finland international comparisons international examples intra-facility management RAI United States BHPMS see Behavioral Healthcare Performance Measurement System

5 710 Index billing data, data sources 95 borrowing, financial protection breast cancer, cancer survival 42 3, 44 Canada audit 622 benchmarking, long-term care, elderly people CCC CCRS education 617 feedback outreach 617 quality improvement 622 RAI cancer survival breast cancer 42 3, 44 international comparisons 40 3 population health 40 3 cardiac surgery see also coronary artery bypass graft (CABG) surgery deaths clinical surveillance statistical chart options case study EPA-PM organizational efficiency performance measurement primary care QOF VA catastrophic expenditures defining empirical studies financial protection international comparisons spending gap categorization schemes EHRs patient safety causality key considerations 686 performance measurement potential effects RCTs recommendations reducing risk volume-outcome relationship CCC see Complex Continuing Care CCRS see Continuing Care Reporting System Center for Health Systems Research and Analysis (CHSRA), longterm care, elderly people 479 Centers for Medicare and Medicaid Services (CMS) clinical process measures , quality indicators challenges, public reporting 543 challenging domains chronic disease/care mental health performance measurement primary care chance, performance measurement choosing performance measures, policy making chronic disease/care ageing of populations assessing performance challenging domains 15 diabetes 407, growing importance health system perspective high-performing health systems implications population health risk adjustment CHSRA see Center for Health Systems Research and Analysis CI see Concentration Index citizens, information requirements 5 8 clinical data, risk adjustment clinical outcomes, public reporting clinical practice guidelines, clinical process measures 91 2 clinical process measures accreditation advantages 106 7

6 Index 711 benefit design 105 billing data 95 clinical practice guidelines 91 2 CMS 104 constructing process measures 94 8 cross-national comparisons 109 data sources 94 6 developing countries recommendations 107 8, 109 development of measures eligible population 96 8 evidence, process indicators 92 4 evidence, reviewing clinical future research IGZ 104 inclusion criteria indicators 92 4 integration 109 limitations 110 medical records 94 5 MN Community Measurement NCQA OECD 103 pay-for-performance programmes payment incentives population, eligible 96 8 principles 91 2 priority areas 88 9 public reporting QOF 105 RAND/UCLA Appropriateness Method 92 4 reviewing clinical evidence risk adjustment 101 schemes in operation scoring methods scoring table 101 state-of-the-art development 87 strategies 89 92, 109 survey research 95 6 topics selection 88 9 uses, best clinical surveillance cardiac surgery cumulative O E and CUSUM charts data aspects dimensionality of the data example data moving average (MA) overdispersion amongst outcomes 288 patient demographics 287 patient safety scan statistics sets method Shewhart charts Shipman, Harold statistical chart options throughput of providers and healthcare facilities clinical trials, PROMs 64 CME see continuing medical education CMS see Centers for Medicare and Medicaid Services Cobb-Douglas production function coded fields use, EHRs Commonwealth Fund National Scorecard, composite indicators community characteristics, health outcomes comparisons, international see international comparisons Complex Continuing Care (CCC) Canada complexity, performance measurement complexity theory, critique composite indicators see also composite measures acute hospitals, star ratings 357 advantages 689 aggregation America s Best Hospitals 360 choosing collinearity combining indicators Commonwealth Fund National Scorecard data availability decision rules disadvantages 689 domains 342 5

7 712 Index composite indicators (contd) ECHCI 342 4, 346 FA 349 financial incentives Healthcare Commission ratings 342 4, HealthGrades rankings 360 Hospital Compare 360 hospitals, acute, star ratings 357 interpretation league tables 364 Maclean s magazine methodological issues NHS organizational objectives PCA 349 reasons for SQUID statistical methods transformation of individual indicators types units use weighting World Health Report composite measures see also composite indicators performance measurement risk adjustment Concentration Index (CI), access equity conceptual framework international comparisons performance measurement conceptualizing risk factors, risk adjustment confounding, performance measurement 319 congenital anomalies, perinatal mortality 39 consortia, quality improvement Continuing Care Reporting System (CCRS) Canada continuing medical education (CME), education coronary artery bypass graft (CABG) surgery deaths administrative data risk adjustment 257, countries comparisons see international comparisons cross-departmental targets cross-national comparisons, clinical process measures 109 cumulative O E and CUSUM charts clinical surveillance statistical chart options data aspects, clinical surveillance data availability, composite indicators data collection, integration data comparability, international comparisons 651 data dimensionality, clinical surveillance data envelopment analysis (DEA), mental health services 451 data exchangeability, EHRs 576 data, nationally representative, international comparisons 661 data options/implications, risk adjustment data, performance, mental health services data quality, EHRs data reliability, EHRs 577 data sources administrative data billing data 95 clinical process measures 94 6 medical records 94 5 survey research 95 6 data sources variability, international comparisons data storage/exchange, information infrastructure 555 DEA see data envelopment analysis decision rules, composite indicators defining, health systems 28 defining and measuring performance 8 12 demographic issues see population... Denmark audit 622 feedback 622

8 Index 713 public reporting quality improvement 622 depression, mental health services 450 developing countries recommendations, clinical process measures 107 8, 109 diabetes chronic disease/care 407, health system perspective provider locus of control tracer concept dimensions, performance measurement disability weighting, population health 60 disease-oriented approach, productivity disease-specific instruments vs generic instruments 73 5 PROMs 67, 73 5 disease-specific survival, population health 62 dissaving, financial protection ECHCI see Euro-Canada Health Consumer Index ECuity method, access equity education Australia 617 Canada 617 CME England 617 outreach quality improvement Sweden 618 United States 618 efficiency defining meso-level analysis organizational efficiency cf productivity efficiency measurement, quality indicators 633 egalitarianism, access equity EHRs see electronic health records elderly people s long-term care see electronic health records (EHRs) see also information technology (IT); medical records capabilities categorization schemes challenges coded fields use data exchangeability 576 data quality data reliability 577 follow-up 567 future health-care effectiveness health-care efficiency 568 health-care equality information infrastructure issues concerning use of electronic data key data elements 562 missed opportunities patient privacy patient safety penetration , 576 policy issues risk adjustment transitions 567 types uses empirical studies access equity catastrophic expenditures England see also United Kingdom education 617 outcome measures outreach 617 public reporting 545 English health system see also United Kingdom Health of the Nation PSAs targets EPA-PM see European Practice Assessment Practice Management equity access. see access equity health systems 11 error, performance measurement fundamental attribution error random error systematic error type I and II errors

9 714 Index Euro-Canada Health Consumer Index (ECHCI) composite indicators 342 4, 346 data availability 346 European Practice Assessment Practice Management (EPA-PM), case study EuroQol (EQ-5D), PROMs 66 evaluating PROMs public reporting 542 evidence, public reporting 542 exponentially weighted moving average (EWMA), statistical chart options factor analysis (FA), composite indicators 349 FDA see Food and Drug Administration feasibility PROMs 72 survey design feedback Canada 622 Denmark 622 Netherlands quality improvement United States 619, 621 financial incentives, composite indicators financial protection asset sales assumptions borrowing catastrophic expenditures dissaving health insurance impoverishing expenditures international comparisons 120 3, intertemporal considerations involuntary health spending measuring out-of-pocket spending Finland benchmarking information infrastructure RAI Food and Drug Administration (FDA), PROMs 80 1 future, population health 50 1 future challenges performance measurement 397 8, primary care future issues, PROMs future priorities policy making lessons recommendations future research access equity clinical process measures generic instruments vs disease-specific instruments 73 5 PROMs 65 6, 73 5 Germany information infrastructure 556 public reporting goals accountability 675 health systems 8 10, 27 incentives government, information requirements 5 8 guidelines mental health services process measures HALE see healthy life expectancy at birth hard-to-measure areas, including 678 HCQI project, OECD 647, 652 7, 661, health care contribution population health quantitative indicators 30 3 health-care effectiveness, EHRs health-care efficiency, EHRs 568 health-care equality, EHRs health events responsiveness types 140 users roles 141 health insurance 10 financial protection 134 5

10 Index 715 Health of the Nation English health system targets weaknesses 511 health outcomes see also outcome measures; patientreported outcome measures (PROMs) community characteristics defining 231 health plan to provider organization incentives health plans, public reporting health system characteristics, responsiveness health system level, productivity health system perspective chronic disease/care diabetes health systems access equity defining 28, efficiency equity 11 goals 8 10, 27 high-performing inputs/outputs objectives 8 12, 677 population health production function productivity 11 12, responsiveness Health Utilities Index (HUI), PROMs 66 7 Healthcare Commission ratings, composite indicators 342 4, HealthGrades public reporting 544 rankings, composite indicators 360 healthy life expectancy at birth (HALE), population health 62 HEDIS accreditation public reporting quality improvement 623 4, 626 recertification high-performing health systems, chronic disease/care hospital-based incentives Hospital Compare composite indicators 360 public reporting 544 Hospital Quality Alliance (HQA), quality improvement 625 hospitals acute, star ratings, composite indicators 357 public reporting 539 HQA see Hospital Quality Alliance HUI see Health Utilities Index human rights, mental health services 458 Hungary accountability 520 targets 520 ideal qualities, performance measurement 380 IGZ see Netherlands Health Care Inspectorate impoverishing expenditures, financial protection IMR see infant mortality rate incentives see also pay-for-performance programmes base of comparison behaviour targeted by , certainty certainty of application clinical process measures definitions 583 distinctions 583 duration 591, empirical evidence evidence summary extrinsic 587 8, 601 financial type frequency 591, health plan to provider organization hospital-based implications, research/policy individual physician-based intrinsic magnitude 590 nature of 584, non-financial type 585 6

11 716 Index incentives (contd) outcomes-based performance measurement 19, 361 2, physician organization-based policy goals policy making lessons quality improvement relative vs absolute performance measures rewards vs penalties 584, size 602 target entity 584 5, 600 targets theoretical framework types 585 6, 600 unintended consequences variations individual patients international comparisons quality of care individual physician-based incentives individual providers, public reporting individualized instruments, PROMs 67 8 individuals vs institutions, quality improvement 632 infant mortality rate (IMR), population health 61 information infrastructure see also information technology (IT) data storage/exchange 555 EHRs Finland 556 Germany 556 local/regional 554 quality assessment 554 requirements 553 United Kingdom United States 556 information requirements, stakeholders 5 8 information technology (IT) 17, see also electronic health records (EHRs); information infrastructure challenges future information infrastructure integration issues concerning use of electronic data mental health services penetration performance data policy issues infrastructure, health information see information infrastructure inpatient health services expenditure international comparisons responsiveness 164 6, 168, 169 inputs capital inputs 236 defining labour inputs institutions vs individuals, quality improvement 632 insurance, health see health insurance international comparisons accountability 644 ambulatory care responsiveness benchmarking cancer survival 40 3 catastrophic expenditures classification conceptual framework data comparability 651 data, nationally representative 661 data sources variability designing for financial protection 120 3, increased interest indicators individual patients inpatient health services ischaemic heart disease 33 8 methodological issues mortality 33 8 mutual learning 645 nationally representative data 661 performance measurement 19 20, performance standardization perinatal mortality policy making population differences 656 7

12 Index 717 responsiveness retrospective completeness, time series 662 scope standardization, definitions standardization of performance strategy development WHS groupings The world health report 2000; international developments mental health performance measurement , outcome measures international examples benchmarking intertemporal considerations, financial protection involuntary health spending, financial protection Ireland mental health services 443 process measures 443 ischaemic heart disease international comparisons 33 8 mortality 33 8 population health 33 8 IT see information technology league tables, composite indicators 364 lessons, policy making see policy making lessons libertarianism, access equity life expectancy, population health 61 benchmarking Canada CCC CCRS challenging domains 16 CHSRA 479 CMS 474, Finland implications international examples MDS monitoring Nursing Home Compare policy challenges Q-Sys approach quality indicators RAI research needs RUG 477 summary Switzerland United States Maclean s magazine, composite indicators macro-level analysis, productivity macro-level production function McKeown, Thomas, population health McKinsey health-care productivity study MDS see Minimum Data Set medical records see also electronic health records (EHRs) data sources 94 5 risk adjustment Medicare/Medicaid see Centers for Medicare and Medicaid Services (CMS) mental health challenging domains costs 426 Mental Health Information and Determinants for the European Level (MINDFUL), mental health services 460 mental health services access inequalities BHPMS 453, 454 challenges data, performance DEA 451 depression 450 expanding the dimensions of performance assessment guidelines human rights 458 international developments, performance measurement , 458 9

13 718 Index mental health services (contd) Ireland 443 IT MINDFUL 460 monitoring 458 outcome measures 429, performance data performance measurement physical health problems process measures productivity measurement readmission rates risk adjustment schizophrenia service-user experiences spending 451 suicide utilization inequalities WHO developments 460 meso-level analysis, organizational efficiency meso-level production function MINDFUL see Mental Health Information and Determinants for the European Level Minimum Data Set (MDS) reliability validity MN Community Measurement, clinical process measures mortality avoidable 43 8, 51 infant mortality rate (IMR) 61 international comparisons 33 8 ischaemic heart disease 33 8 neonatal mortality 49 perinatal mortality 38 40, 62 moving average (MA) clinical surveillance statistical chart options National Audit Office, targets 525 National Committee for Quality Assurance (NCQA) accreditation clinical process measures HEDIS need, defining neonatal mortality, tracer concept 49 Netherlands audit feedback outcome measures 435 public reporting quality improvement 621, Netherlands Health Care Inspectorate (IGZ), clinical process measures 104 NHS, composite indicators Norway, public reporting 548 Nursing Home Compare RAI objectives access equity health systems 8 12, 677 this book s 4 5 OECD see Organisation for Economic Co-operation and Development operative procedures, quality improvement 621 optimal way of improving performance Organisation for Economic Cooperation and Development (OECD) Ageing-Related Disease (ARD) Project clinical process measures 103 HCQI project 647, 652 7, 661, international comparisons, conceptual framework international comparisons, methodological issues organizational efficiency case study comparable organizations exogenous production constraints 243 meso-level analysis production frontier VA out-of-pocket spending, financial protection outcome indicators 682 4

14 Index 719 outcome measures 9 10 see also patient-reported outcome measures (PROMs); Quality and Outcomes Framework (QOF) assumptions Australia challenges England international developments mental health services 429, Netherlands 435 performance measurement physical health problems vs process measures, risk adjustment readmission rates service improvement suicide targets United States 436, 437 outcomes, overdispersion amongst 288 outcomes-based incentives outcomes, clinical, public reporting outcomes evidence, PROMs 65 output defining health outcomes, defining 231 measuring patient classification systems 232 quality quantity valuing outputs/inputs health systems production function outreach Australia 617 Canada 617 education England 617 Sweden 618 United States 618 pathology, quality improvement 621 pathways, public reporting patient classification systems, output 232 patient demographics, clinical surveillance 287 Patient Generated Index, PROMs 68 patient outcomes, risk adjustment 254 patient preferences measures, risk adjustment patient privacy, EHRs patient-reported outcome measures (PROMs) 9, see also health outcomes; outcome measures acceptability 71 2 barriers to implementation 75 8 choosing an instrument 72 5 clinical trials 64 cognitive barriers 75 7 costs 78 current issues disease-specific instruments 67, 73 5 disease-specific instruments vs generic instruments 73 5 EuroQol (EQ-5D) 66 evaluating evidence to aid choice of instrument 72 5 FDA 80 1 feasibility 72 future issues generic instruments 65 6, 73 5 generic instruments vs diseasespecific instruments 73 5 individualized instruments 67 8 interpretability 71 logistic barriers 77 8 outcomes evidence 65 Patient Generated Index 68 policy implications 80 1 precision 70 1 PROMIS initiative reliability 68 9 reproducibility 69 resource barriers 77 8 responsiveness 70 short-form 36 (SF-36) 65 6 survey research 64 time 77 8 types of instruments 65 8 uses 63 5 utility instruments 66 7 validity 69 70

15 720 Index patient safety categorization schemes clinical surveillance EHRs follow-up 567 PSIs 566 transitions 567 patient safety indicators (PSIs) 566 patients, information requirements 5 8 patients information, risk adjustment pay-for-performance programmes 582 see also incentives clinical process measures design issues quality improvement risk adjustment payers, information requirements 5 8 payment incentives, clinical process measures PCA see principal components analysis performance data IT mental health services performance measurement accountability 5 8, 18 applications 5 12 attribution case study causality choosing performance measures consequences, unintended defining and measuring performance 8 12 future challenges health policy importance 373 5, international comparisons 19 20, mental health services roles 5 12 performance standardization, international comparisons perinatal mortality congenital anomalies 39 international comparisons population health 38 40, 62 physical health problems mental health services outcome measures physician organization-based incentives physicians, information requirements 5 8 PIM see practice improvement module policy applications, RAI policy challenges RAI policy goals, incentives policy, health, performance measurement policy implications access equity PROMs 80 1 policy issues EHRs IT policy making lessons choosing performance measures conceptual framework future priorities incentives international comparisons politics recommendations stakeholders statistical issues stewardship perspective policy questions, performance measurement politics policy making lessons stakeholders population differences, international comparisons population, eligible, clinical process measures 96 8 population health age-standardized mortality rates by cause 61 ageing of populations avoidable mortality 43 8, 51 cancer survival 40 3 chronic disease/care disability weighting 60

16 Index 721 disease-specific survival 62 future 50 1 health care contribution health systems health systems goals 27 health systems measures summary 61 2 healthy life expectancy at birth (HALE) 62 indicators infant mortality rate (IMR) 61 ischaemic heart disease 33 8 life expectancy 61 McKeown, Thomas measures summary, health systems 61 2 overview of measures 61 2 perinatal mortality 38 40, 62 quantitative indicators 30 3 responsiveness summary measures tracer concept populations, quality of care 376 practice improvement module (PIM), quality improvement 624 prescribing, quality improvement 621 primary care benefits 373 case study challenging domains critical elements 372 defining developing performance measures EPA-PM future challenges importance of measuring performance 373 5, QOF 381, quality improvement strategies quality of care removing/refreshing measurement sets 397 VA principal components analysis (PCA) composite indicators 349 statistical methods 349 privacy, patient see patient privacy process indicators process measures guidelines Ireland 443 mental health services performance measurement service-user experiences targets 524 production frontier, organizational efficiency production function Cobb-Douglas health systems inputs/outputs macro-level meso-level simplified process 226 productivity defining disease-oriented approach cf efficiency health system level health systems macro-level analysis McKinsey health-care productivity study OECD Ageing-Related Disease (ARD) Project Technological Change in Healthcare (TECH) Global Research Network (AMI) productivity measurement, mental health services professional improvement indicators professional participation, quality measurement professionals, engaging, quality improvement profiling quality improvement United States 619 promoting performance, performance measurement PROMs see patient-reported outcome measures provider locus of control diabetes performance measurement 322 4

17 722 Index provider organizations, information requirements 5 8 PSAs see Public Service Agreements PSIs see patient safety indicators public reporting challenges 543 clinical outcomes clinical process measures countries Denmark England 545 evaluating 542 evidence 542 Germany health plans HealthGrades 544 HEDIS Hospital Compare 544 hospitals 539 individual providers Netherlands Norway 548 outcomes, clinical pathways quality improvement activities selection pathway 538 unintended consequences United States Public Service Agreements (PSAs) criticisms Department of Health English health system targets , publicly released performance data, quality improvement purchaser organizations, information requirements 5 8 Q-Sys approach Switzerland Quality and Outcomes Framework (QOF) case study clinical process measures 105 performance measure domains primary care 381, quality assessment, information infrastructure 554 quality assurance, performance measurement quality improvement accreditation activities, public reporting audit Australia 621 Canada 622 consortia Denmark 622 education feedback HEDIS 623 4, 626 HQA 625 incentives individuals vs institutions 632 Netherlands 621, operative procedures 621 pathology 621 pay-for-performance programmes performance measurement PIM 624 prescribing 621 professionals, engaging profiling publicly released performance data radiology 621 recertification report cards strategies, primary care targets United States 619, 621 quality indicators CMS creating 633 efficiency measurement RAI specialty care 633 quality measurement, professional participation quality monitoring see also long-term care, elderly people RAI 481 7

18 Index 723 quality of care assessing 376 individual patients populations 376 primary care quantitative indicators health care contribution 30 3 population health 30 3 questionnaires see also survey design psychometric properties responsiveness radiology, quality improvement 621 RAI see Resident Assessment Instrument RAND/UCLA Appropriateness Method, clinical process measures 92 4 random error, performance measurement random fluctuation, performance measurement 13 randomized controlled trials (RCTs) attribution bias causality RCTs see randomized controlled trials readmission rates mental health services outcome measures recertification, quality improvement recommendations attribution bias causality future priorities policy making lessons records see electronic health records (EHRs); medical records regression method, access equity regulators, information requirements 5 8 reliability PROMs 68 9 survey design removing/refreshing measurement sets, performance measurement 397 report cards providers response quality improvement research needs RAI Resident Assessment Instrument (RAI) benchmarking Canada casemix reimbursement 477 Finland international examples Nursing Home Compare origin policy applications policy challenges quality indicators quality monitoring research needs Switzerland United States Resource Utilization Group (RUG), 477 responsiveness access equity ambulatory care 161 4, change, implementing common concerns defining 138 gradients health events health system characteristics health systems 10 11, implementing change inpatient health services 164 6, 168, 169 international comparisons measuring , 175 operationalization population health questionnaires sample statistics 161 survey design users roles 141 WHS 2002 results WHS groupings retrospective completeness, time series, international comparisons 662

19 724 Index risk adjustment administrative data BHPMS 453, 454 chronic disease/care clinical data clinical process measures 101 composite measures conceptualizing risk factors conclusions consequences of failing coronary artery bypass graft (CABG) surgery deaths 257, criticisms 255 data options/implications defining different performance measures EHRs inadequate medical records mental health services methods outcome measures vs process measures patient outcomes 254 patient preferences measures patients information pay-for-performance programmes performance measurement 13, potential patient risk factors rationale reasons for risk stratification Society of Thoracic Surgeons (STS) quality measurement task force statistical considerations transparency risk factors attribution interrelationships risk stratification, risk adjustment risks attribution bias causality targets Royal Statistical Society, targets RUG see Resource Utilization Group safety, patient see patient safety SAH see self-assessed health scan statistics clinical surveillance statistical chart options schizophrenia, mental health services scoring methods, clinical process measures selection pathway, public reporting 538 self-assessed health (SAH), access equity 195 7, 211 service improvement, outcome measures service-user experiences mental health services process measures sets method clinical surveillance statistical chart options Shewhart charts clinical surveillance statistical chart options Shipman, Harold, clinical surveillance short-form 36 (SF-36), PROMs 65 6 SMART targets 510 Social Market Foundation, targets 519, 527 8, Society of Thoracic Surgeons (STS) quality measurement task force, risk adjustment specialty care, quality indicators 633 SQUID, composite indicators stakeholders information requirements 5 8 policy making lessons politics standardization, international comparisons definitions standardization of performance, international comparisons statistical chart options cardiac surgery clinical surveillance

20 Index 725 cumulative O E and CUSUM charts EWMA example data moving average (MA) scan statistics sets method Shewhart charts statistical considerations risk adjustment risk stratification statistical issues, policy making statistical methods composite indicators PCA 349 statistical tools, performance measurement stewardship perspective performance measurement policy making lessons strategies clinical process measures 89 92, 109 quality improvement, primary care strategy development, international comparisons suicide mental health services outcome measures survey design feasibility psychometric properties reliability responsiveness validity survey research data sources 95 6 PROMs 64 Sweden education 618 outreach 618 Switzerland Q-Sys approach RAI systematic error, performance measurement target entity, incentives 584 5, 600 targets 17 18, accountability attainment scrutiny criticisms cross-departmental English health system failings focus Health of the Nation Hungary 520 identifying incentives local organizations measuring National Audit Office 525 outcome measures principles process measures 524 PSAs , quality improvement risks Royal Statistical Society setting SMART 510 Social Market Foundation 519, 527 8, successful 691 Technological Change in Healthcare (TECH) Global Research Network (AMI), productivity tracer concept criteria 48 diabetes neonatal mortality 49 population health transparency, risk adjustment type I and II errors, performance measurement unintended consequences incentives performance measurement public reporting United Kingdom see also England; English health system information infrastructure 555 6

21 726 Index United States audit 621 education 618 feedback 619, 621 information infrastructure Nursing Home Compare outcome measures 436, 437 outreach 618 profiling 619 public reporting quality improvement 619, 621 RAI utility instruments EuroQol (EQ-5D) 66 HUI 66 7 PROMs 66 7 utilization inequalities, mental health services VA see Veterans Administration validity PROMs survey design Veterans Administration (VA) case study organizational efficiency reforms volume-outcome relationship attribution bias causality weighting, composite indicators World Health Organization (WHO) international comparisons, health system performance framework mental health services 460 The world health report 2000; composite indicators controversies international comparisons 642 3

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