Health system frameworks and performance indicators in eight countries: A comparative international analysis

Braithwaite, Jeffrey; Hibbert, Peter; Blakely, Brette; Plumb, Jennifer; Hannaford, Natalie; Long, Janet C.; Marks, David H.

doi:10.1177/2050312116686516

Cited by 118 publications

(112 citation statements)

References 22 publications

(31 reference statements)

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…The proposed framework leverages constructs used widely in other frameworks (e.g. accessibility, appropriateness, effectiveness) [18] but where previous efforts have often considered elements of performance in isolation, the framework proposed here uses measures that are dynamic, sensitive to context, and to interlinked processes in healthcare delivery. Moving forward, this approach can help highlight current gaps in indicators and drive the development of measures that truly reflect performancemoving beyond simplicity to insightcombining different pieces of data to develop a more meaningful measure of performance, and one that does not focus solely on outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…This paradox may in part be a reflection of the absence of a clear definition of high performance [8] and a lack of conceptual clarity about how to assess performance domains within complex adaptive systems. Frameworks feature in many settings and have been used to guide public reporting efforts [9][10][11][12][13][14][15][16][17][18][19]. These existing frameworks have been successful in sorting and classifying different metrics into related thematic areas such as access, patient-centeredness, safety or efficiency.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework

Lévesque

Sutherland²

2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: The science of measuring and reporting on the performance of healthcare systems is rapidly evolving. In the past decade, across many jurisdictions, organisations tasked with monitoring progress towards reform targets have broadened their purview to take a more system-functioning approach. Their aim is to bring clarity to performance assessment, using relevant and robust conceptsand avoiding reductionist measuresto build a whole-of-system view of performance. Existing performance frameworks are not fully aligned with these developments. Methods: An eight stage process to develop a conceptual framework incorporated literature review, mapping, categorisation, integration, synthesis and validation of performance constructs that have been used by organisations and researchers in order to assess, reflect and report on healthcare performance. Results: A total of 19 performance frameworks were identified and included in the review. Existing frameworks mostly adopted either a logic model (inputs, outputs and outcomes), a functional, or a goal-achievement approach. The mapping process identified 110 performance terms and concepts. These were integrated, synthesised and resynthesised to produce a framework that features 12 derived constructs reflecting combinations of patients' needs and expectations; healthcare resources and structures; receipt and experience of healthcare services; healthcare processes, functions and context; and healthcare outcomes. The 12 constructs gauge performance in terms of coverage, accessibility, appropriateness, effectiveness, safety, productivity, efficiency, impact, sustainability, resilience, adaptability and equity. They reflect four performance perspectives (patient, population, delivery organisation and system). Conclusions: Internationally, healthcare systems and researchers have used a variety of terms to categorise indicators of healthcare performance, however few frameworks are based on a theoretically-based conceptual underpinning. The proposed framework incorporates a manageable number of performance domains that together provide a comprehensive assessment, as well as conceptual and operational clarity and coherence that support multifaceted measurement systems for healthcare.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework

Lévesque

Sutherland²

2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Influenza immunization is a critical preventive health service that substantially reduces hospitalization and death among older adults . Additionally, influenza immunization rates reflect health system functioning, since high immunization rates require adequate vaccine supplies, timely distribution, patient education, access to facilities providing the vaccine, and communication strategies addressing the knowledge and beliefs of low‐immunization communities . Efforts to increase vaccination may, therefore, benefit both individual patients and overall health system performance.…”

mentioning

confidence: 99%

Exploring Disparities in Influenza Immunization for Older Women

MacCarthy

Burkhart

Haviland

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES While women obtain most recommended preventive health interventions more often than men, evidence is mixed regarding influenza vaccination for older adults. Therefore, we evaluated sex differences in influenza vaccination among older adults. DESIGN Nationally representative cross‐sectional survey. SETTING United States. PARTICIPANTS A total of 1 252 705 adults, aged 65 years and older, responding to 2013 to 2017 Medicare Consumer Assessment of Healthcare Providers and Systems surveys. MEASUREMENTS The dependent variable was Healthcare Effectiveness Data and Information Set self‐reported influenza immunization. The primary predictor was sex. Covariates included general health status, education, race/ethnicity, and Medicare Advantage (MA; managed care) vs Fee‐for‐Service (FFS) coverage. RESULTS After adjusting for health status and other sociodemographic factors, women's immunization was 2% lower than men's immunization in MA, with no significant overall sex difference in FFS. Women were immunized less often than men in 95% of MA health plans, with the largest gaps in low‐immunizing plans. Further analyses revealed variation in sex differences by health status, education, and race/ethnicity in both MA and FFS. Notably in MA, women in poor health were immunized less often than men in similar health (−4%; P < .001). Black women were immunized much less often than black men in both MA and FFS (−5%; P < .001 for each). Hispanic women were immunized less often than Hispanic men in MA (−4%; P < .001) but not within FFS. CONCLUSION Women in MA experience small disparities overall in influenza immunization, with larger disparities for black and Hispanic women. Providers and MA plans should increase efforts to recommend and monitor immunization for older women, especially black and Hispanic women and those in poor health. Given the potential to reduce morbidity and mortality, equitable access to a critical preventive health service, such as influenza immunization, is crucial for all older adults.

show abstract

“…One possible explanation for the significant reduction in Estonia's rates is provided by the literature, which highlights the importance of having a quality measurement tool in which indicators are used by a provider to facilitate both organizational performance improvement and systems management and, at the same time, are used by policy makers to select the best care providers [15]. Since 2001, Estonia has taken measures in these directions but with limited success.…”

Section: Discussionmentioning

confidence: 99%

OUP accepted manuscript

2018

Int Journal for Quality in Health Care

View full text Add to dashboard Cite

Objective To analyse the trajectories of hip-fracture surgery rates within 2 days of admission to the hospital and the ratios of procedures initiated within the same day (day 0) and the following day (days 0-1) to procedures performed on the 2nd day. To study the association between socioeconomic , health input variables and early surgery. Design A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 15 European countries, during 2000/2013. Results The rate of patients aged ≥65 years that were operated on within 2 days of hip-fracture has changed over time with an EU average annual increase of 0.42% (95% IC = 0.25, 0.59; P < 0.001) and with a significant linear trend. Multiple slopes from all the countries compete with this result. In contrast, the ratios of procedures initiated within the same day (day 0) and the following day (days 0-1) compared to procedures performed on the 2nd day are constant. No association was found between the rate of patients treated within 2 days of admission and demographic structure, health expenditure, health resources. However, the rate of patients treated within 2 days of admission is significantly associated with surgical volumes. Conclusions As the early surgery rate is growing, policy makers should be encouraged to undertake further policies to support the quality of care, and the providers should be driven to improve their organizational effectiveness by taking actions aimed at acting on specific organizational and logistical causes that represent a barrier to early surgery.

show abstract

Health system frameworks and performance indicators in eight countries: A comparative international analysis

Cited by 118 publications

References 22 publications

Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework

Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework

Exploring Disparities in Influenza Immunization for Older Women

OUP accepted manuscript

Contact Info

Product

Resources

About