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Health at a Glance: Latin America and the Caribbean 2020

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

Measuring health system performance: A new approach to accountability and quality improvement in New Zealand

Measuring the performance of health care services: a review of international experiences and their application to urban contexts

Ranked Performance of Canada's Health System on the International Stage: A Scoping Review

AUTOR(ES): Najafizada SAM, Sivanandan T, Hogan K, Cohen D, Harvey J.

ANO: 2017

RESUMO: INTRODUCTION: Since the release of the World Health Report in 2000, health system performance ranking studies have garnered significant health policy attention. However, this literature has produced variable results. The objective of this study was to synthesize the research and analyze the ranked performance of Canada's health system on the international stage. METHOD: We conducted a scoping review exploring Canada's place in ranked health system performance among its peer Organisation for Economic Co-operation and Development countries. Arksey and O'Malley's five-stage scoping review framework was adopted, yielding 48 academic and grey literature articles. A literature extraction tool was developed to gather information on themes that emerged from the literature. SYNTHESIS: Although various methodologies were used to rank health system performance internationally, results generally suggested that Canada has been a middle-of-the-pack performer in overall health system performance for the last 15 years. Canada's overall rankings were 7/191, 11/24, 10/11, 10/17, "Promising" and "B" grade across different studies. According to past literature, Canada performed well in areas of efficiency, productivity, attaining health system goals, years of life lived with disability and stroke mortality. By contrast, Canada performed poorly in areas related to disability-adjusted life expectancy, potential years of life lost, obesity in adults and children, diabetes, female lung cancer and infant mortality. CONCLUSION: As countries introduce health system reforms aimed at improving the health of populations, international comparisons are useful to inform cross-country learning in health and social policy. While ranking systems do have shortcomings, they can serve to shine a spotlight on Canada's health system strengths and weaknesses to better inform the health policy agenda.

FONTE:

REFERENCIA: Najafizada SAM, Sivanandan T, Hogan K, Cohen D, Harvey J. Ranked Performance of Canada's Health System on the International Stage: A Scoping Review. Classement du rendement du système de santé canadien sur la scène internationale : un examen de la portée. Health Policy. 2017;13(1):59–73. doi:10.12927/hcpol.2017.25191

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Health system performance comparison: new directions in research and policy

Resolving the challenges in the international comparison of health systems: the must do's and the trade-offs

Methodological concerns and recommendations on policy consequences of the World Health Report 2000

Estudo exploratório dos modelos de avaliação de desempenho em saúde: uma apreciação da capacidade avaliativa

Indicators of quality of care in general practices in England

AUTOR(ES): Jennifer Dixon, Emma Spencelayh, Anna Howells, Abraham Mandel, Felix Gille

ANO: 2015

RESUMO: In the summer of 2015 the Health Foundation was asked by the Secretary of State for Health to review indicators of the quality of care provided by general practices in England. We looked at how indicators could be developed to generate meaningful information that supports improvements to care and helps the public choose which practice might best meet their needs. Within the short timeframe available for the review (June to September 2015), the Foundation consulted with a wide range of organisations and individuals with an interest in how information about general practice care quality is collated and published. We assessed the literature, analysed indicators currently used as well as the websites on which they are published, and worked with insight agency BritainThinks to understand the public’s views. Our review focused on publication of indicators for the purposes of supporting local improvement of care, patient choice and voice, and the accountability and performance management of general practices. The review also strongly advises against making a composite score out of selected indicators to indicate the quality of care overall in general practice, or for particular population groups.

FONTE:

REFERENCIA: The Health Foundation, an independent health care charity, was asked by the Secretary of State for Health to review indicators of the quality of general practice in England. We looked at how they could be made better to support improvements to care, including how they are selected and presented. Within the short timeframe available for the review (June to September 2015), the Foundation consulted with a wide range of organisations and individuals with an interest in general practice and information. We assessed the available literature and analysed current indicators as well as the websites on which they are published. Our review focused on publication of indicators for the purposes of supporting local improvement of care, patient choice and voice, and the accountability and performance management of general practices. While our review was commissioned by the Department of Health, the Health Foundation did not receive any funding for completing the work. The Health Foundation retained full editorial control of the report’s content.

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Random variation and rankability of hospitals using outcome indicators

AUTOR(ES): Van Dishoeck A, Lingsma HF, Mackenbach JP, et al

ANO: 2011

RESUMO: OBJECTIVE: There is a growing focus on quality and safety in healthcare. Outcome indicators are increasingly used to compare hospital performance and to rank hospitals, but the reliability of ranking (rankability) is under debate. This study aims to quantify the rankability of several outcome indicators of hospital performance currently used by the Dutch government. METHODS: From 52 indicators used by the Netherlands Inspectorate, the authors selected nine outcome indicators presenting a fraction and absolute numbers. Of these indicators, four were combined into two, resulting in seven indicators for analysis. The official data of 97 Dutch hospitals for the year 2007 were used. Uncertainty in the observed outcomes within the hospitals (within hospital variance, σ(2)) was estimated using fixed effect logistic regression models. Heterogeneity (between hospital variance, τ(2)) was measured with random effect logistic regression models. Subsequently, the rankability was calculated by relating heterogeneity to uncertainty within and between hospitals (τ(2)/(τ(2) +median σ(2))). RESULTS: Sample sizes varied but were typically around 200 per hospital (range of median 90-277) with a median of 2-21 cases, causing a substantial uncertainty in outcomes per hospital. Although fourfold to eightfold differences between hospitals were noted, the uncertainty within hospitals caused a poor (<50%) rankability in three indicators and moderate rankability (50-75%) in the other four indicators. CONCLUSION: The currently used Dutch outcome indicators are not suitable for ranking hospitals. When judging hospital quality the influence of random variation must be accounted for to avoid overinterpretation of the numbers in the quest for more transparency in healthcare. Adequate sample size is a prerequisite in attempting reliable ranking.

FONTE:

REFERENCIA: Van Dishoeck A, Lingsma HF, Mackenbach JP, et al. Random variation and rankability of hospitals using outcome indicators. BMJ Quality & Safety 2011;20:869-874.

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Do all paths lead to Rome? Comparative analysis in the institutionalization of the evaluation

AUTOR(ES): Aquilino, N., Ballescá , M., Potenza, F., Rubio, J.

ANO: 2017

RESUMO: In recent years, evaluation has gained importance within public administrations of different countries. Even still, in many cases, it is implemented in a fragmented manner, in response to specific and isolated requests. On the other hand, to speak of a “system” with regards to monitoring and evaluation (M&E) implies that the practice derives from stable institutional arrangements that distribute the functions between those involved in the process, as well as other definitions with an orientation towards quality assessment information in a regular and sustained manner. This document analyzes different institutional arrangements of a set of countries with federal governments with respect to M&E. Those analyzed include Canada, Spain, Mexico, Brazil and Argentina. The case studies of the following sub-national governments are included as well: Catalonia, Jalisco, Pernambuco and the Autonomous City of Buenos Aires. Said studies demonstrate that if a single pattern of institutionalization of M&E functions does not exist, it is important to consider transversal aspects that affect its development. The formation of a system does not end with the creation of an agency or body responsible for M&E. For this organism to have the necessary capacities to carry out its functions, it requires an institutional insertion that guarantees a certain degree of political independence, while also enabling it to promote evaluations as a management tool. Likewise, it is necessary to establish rules defining responsibilities, rules that establish the obligation to evaluate and define quality standards in addition to defining a financing mechanism that guarantees the autonomy, perdurability of the system, and the commitments of evaluated programs or organisms. With respect to the evaluative practice, it is important to consider, not only the definition of an evaluative plan, but also quality control of information produced, and the promotion of evaluation, the use of which improves accountability, transparency of government actions, and decision making. This last facet requires the instauration of mechanisms promoting the use of information in management but also the generation of M&E information that could easily translate into decisions, improving programs and policies. The analyzed case studies demonstrate that M&E systems have started to expand to a level of sub-national states. These governments should act as an active partner in the design and implementation of the national M&E systems and promoters of their own systems. Because of this, the development of capacities and the institutionalization of areas in the government with these specific attributions from said matters are key.

FONTE:

REFERENCIA: Aquilino, N., Ballescá, M., Potenza, F., Rubio, J. (June de 2017). Do all paths lead to Rome? Comparative analysis in the institutionalization of the evaluation. Working Paper No. 159 Buenos Aires: CIPPEC.

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Ranking hospitals: do we gain reliability by using composite rather than individual indicators?

AUTOR(ES): Hofstede SN, Ceyisakar IE, Lingsma HF, et al.

ANO: 2019

RESUMO: Background Despite widespread use of quality indicators, it remains unclear to what extent they can reliably distinguish hospitals on true differences in performance. Rankability measures what part of variation in performance reflects ‘true’ hospital differences in outcomes versus random noise. Objective This study sought to assess whether combining data into composites or including data from multiple years improves the reliability of ranking quality indicators for hospital care. Methods Using the Dutch National Medical Registration (2007–2012) for stroke, colorectal carcinoma, heart failure, acute myocardial infarction and total hiparthroplasty (THA)/ total knee arthroplasty (TKA) in osteoarthritis (OA), we calculated the rankability for in-hospital mortality, 30-day acute readmission and prolonged length of stay (LOS) for single years and 3-year periods and for a dichotomous and ordinal composite measure in which mortality, readmission and prolonged LOS were combined. Rankability, defined as (between-hospital variation/between-hospital+within hospital variation)×100% is classified as low (<50%), moderate (50%–75%) and high (>75%). Results Admissions from 555 053 patients treated in 95 hospitals were included. The rankability for mortality was generally low or moderate, varying from less than 1% for patients with OA undergoing THA/TKA in 2011 to 71% for stroke in 2010. Rankability for acute readmission was low, except for acute myocardial infarction in 2009 (51%) and 2012 (62%). Rankability for prolonged LOS was at least moderate. Combining multiple years improved rankability but still remained low in eight cases for both mortality and acute readmission. Combining the individual indicators into the dichotomous composite, all diagnoses had at least moderate rankability (range: 51%–96%). For the ordinal composite, only heart failure had low rankability (46% in 2008) (range: 46%–95%). Conclusion Combining multiple years or into multiple indicators results in more reliable ranking of hospitals, particularly compared with mortality and acute readmission in single years, thereby improving the ability to detect true hospital differences. The composite measures provide more information and more reliable rankings than combining multiple years of individual indicators.

FONTE:

REFERENCIA: Hofstede SN, Ceyisakar IE, Lingsma HF, et al. Ranking hospitals: do we gain reliability by using composite rather than individual indicators? BMJ Quality & Safety 2019;28:94-102.

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The multiple aims of pay-forperformance and the risk of unintended consequences

Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017

AUTOR(ES): Zimmerman FJ, Anderson NW.

ANO: 2019

RESUMO: Importance Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services’ Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal. Objectives To identify variation in several measures of health equity from 1993 to 2017 in the United States and to test whether there are significant time trends. Design, Setting, and Participants Survey study using 25 years of data, from January 1, 1993, to December 31, 2017, from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System to assess trends in health equity and health justice by race/ethnicity, sex, and income in 3 categories by year. Main Outcomes and Measures Health equity was assessed separately for each of 2 health constructs: healthy days—the average of physical and mental healthy days over the previous 30 days—and general health in 5 categories, rescaled to approximate a continuous variable. For each health construct, average health was calculated along with 4 measures of health equity: disparities across 3 income groups; black-white disparities; health justice—a measure of the correlation of health outcomes with income, race/ethnicity and sex; and a summary health equity metric. Results Among the 5 456 006 respondents, the mean (SD) age was 44.5 (12.7) years; 3 178 688 (58.3%) were female; 4 163 945 (76.3%) were non-Latinx white; 474 855 (8.7%) were non-Latinx black; 419 542 (7.7%) were Latinx; and 397 664 (7.3%) were of other race/ethnicity. The final sample included 5 456 006 respondents for self-reported health and 5 349 527 respondents for healthy days. During the 25-year period, the black-white gap showed significant improvement (year coefficient: healthy days, 0.021; 97.5% CI, 0.012 to 0.029; P < .001; self-reported health, 0.030; 97.5% CI, 0.025 to 0.035; P < .001). The health equity metric for self-reported health showed no significant trend. For healthy days, the Health Equity Metric declined over time (year coefficient: healthy days, −0.025; 97.5% CI, −0.033 to −0.017; P < .001). Health justice declined over time (year coefficient: healthy days, −0.045; 97.5% CI, −0.053 to −0.038; P < .001; self-reported health, −0.035; 97.5% CI, −0.046 to−0.023; P < .001), and income disparities worsened (year coefficient: healthy days, −0.060; 97.5% CI, −0.076 to −0.044; P < .001; self-reported health, −0.029; 97.5% CI, −0.046 to −0.012; P < .001). Conclusions and Relevance Results of this analysis suggest that there has been a clear lack of progress on health equity during the past 25 years in the United States. Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health.

FONTE:

REFERENCIA: Zimmerman FJ, Anderson NW. Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017. JAMA Netw Open. 2019;2(6):e196386. doi:10.1001/jamanetworkopen.2019.6386

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