Can health care quality indicators be transferred between countries?

Abstract

Objective: To evaluate the transferability of primary care quality indicators by comparing indicators for common clinical problems developed using the same method in the UK and the USA. Method: Quality indicators developed in the USA for a range of common conditions using the RAND-UCLA appropriateness method were applied to 19 common primary care conditions in the UK. The US indicators for the selected conditions were used as a starting point, but the literature reviews were updated and panels of UK primary care practitioners were convened to develop quality indicators applicable to British general practice. Results: Of 174 indicators covering 18 conditions in the US set for which a direct comparison could be made, 98 (56.3%) had indicators in the UK set which were exactly or nearly equivalent. Some of the differences may have related to differences in the process of developing the indicators, but many appeared to relate to differences in clinical practice or norms of professional behaviour in the two countries. There was a small but non-significant relationship between the strength of evidence for an indicator and the probability of it appearing in both sets of indicators. Conclusion: There are considerable benefits in using work from other settings in developing measures of quality of care. However, indicators cannot simply be transferred directly between countries without an intermediate process to allow for variation in professional culture or clinical practice. Q uality indicators are increasingly used to facilitate regulation, ensure accountability, and improve quality.1-3 In recent years there has been considerable interest in using high level indicators to compare the performance of different health systems.4 5 However, developing lower level clinical quality indicators is an expensive and time consuming process, and there is currently little evidence to suggest that the process can be facilitated by transferring indicators developed for the health system in one country to another country. Researchers in the United States have led the way in the development and use of quality indicators for health care. In principle it might make sense for other countries to use this expertise rather than to develop their own indicators de novo, and there is some experience of doing this from the Maryland Hospital Indicator project. 6 However, it is unclear whether such a direct technology transfer is always appropriate or desirable. The aim of this study was to develop a set of quality indicators for UK general practice, aimed primarily at clinicians for quality assessment and improvement purposes. The indicators were based on work carried out at RAND in the US, one of the leading organisations in the field. We outline the methods used to develop a set of indicators in the US and describe a demonstration project that used the same methods to develop indicators for use in the UK. By comparing the outcomes of the two parallel processes, we draw conclusions on the extent to which quality indicators and their associated tec...

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