Selecting Indicators for the Quality of Health Promotion, Prevention and Primary Care

This 50-page report presents the consensus recommendations of OECD's Health Promotion, Prevention and Primary Care Panel. The report describes the review process and provides a detailed discussion of the scientific soundness and policy importance of the indicators that were selected.

Some context may be helpful in understanding the motivation for the Panel's work: "To improve care for their citizens and to realise...potential efficiency gains, policymakers are looking for methods to measure and benchmark the performance of their health care systems as a precondition for evidence-based health policy reforms. As published international health data sets such as OECD Health Data currently lack comparable measures for the technical quality of national health systems, there is, so far, little possibility of such international benchmarking. To fill this gap, the OECD Health Care Quality Indicators Project (HCQI) has brought together 21 countries, the World Health Organization (WHO), the European Commission (EC), the World Bank, and leading research organisations, such as the International Society for Quality in Health Care (ISQua) and the European Society for Quality in Healthcare (ESQH)."

The expert group representing these countries and organisations undertook a process of selection for quality indicators. This Panel sought to identify indicators to capture the core components of care in each of the sectors (e.g., preventive services like vaccination), regardless of the institutional setting in which those components are provided (e.g., by dedicated government agencies in one country, by general practitioners in private practice in a second, and by health plans in a third). Having made this conceptual choice, and following the recommendations for indicator evaluation developed by the US Institutes of Medicine, the Panel decided that an indicator had to:

I. capture an important performance aspect:

1. Health impact (does the measure address areas in which there is a clear gap between the actual and potential levels of health?)
2. Policy importance
3. Susceptibility to being influenced by the health care system

II. be scientifically sound:

1. Face validity (does the measure make sense, logically and clinically?)
2. Content validity (does the measure capture meaningful aspects of the quality of care?)

III. be feasible:

1. Data availability
2. Reporting burden (does the value of the information contained in an indicator outweigh the cost of data collection and reporting?)

The 27 indicators selected are:


Health Promotion - i.e., population-based strategies carried out through efforts to change health-related behaviour

• Obesity prevalence
• Physical activity
• Smoking rate
• Diabetes prevalence

Gonorrhoea/Chlamydia rates

Abortion rates

Preventive Care - i.e., organised, population-directed services

• Blood typing and antibody screening for prenatal patients
• HIV screen for prenatal patients
• Bacteriuria screen for prenatal patients
• Immunisable conditions
• Low birth weight rate
• Adolescent immunisation
• Anaemia screening for pregnant women
• Cervical gonorrhoea screening for pregnant women
• Hepatitis B screen for pregnant women
• Hepatitis B documentation in record at time of delivery
• Hepatitis B immunisation for high-risk groups
• Influenza vaccination for high-risk groups
• Pneumococcal vaccination for high-risk groups

Diagnosis and Treatment: Primary Care - i.e., diagnostic and therapeutic activities that constitute the first line of organised personal medical care

• Congestive Heart Failure readmission rate
• First visit in first trimester
• Smoking cessation counselling for asthmatics
• Blood pressure measurement
• Re-measurement of blood pressure for those with high blood pressure
• Initial laboratory investigations for hypertension
• Hospitalisation for ambulatory care sensitive conditions

The report stresses that "the operational feasibility of the proposed indicators will now have to be assessed by a survey of data availability in OECD countries....In addition, further development of indicators, beyond the gaps indicated above, should be considered....the Panel is aware that other functions of health care systems, such as hospice care and social care, overlap and interact with primary care, yet are not covered by the present set. Finally, the focus has been on the potential contributions of physicians to quality and other professionals such as dentists and allied health professionals have not been specifically addressed."