Performance Measurement in Health Care: History, Challenges and Prospects

Smith, Peter

doi:10.1080/09540962.2005.10600096

Cited by 139 publications

(162 citation statements)

References 17 publications

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“…Such cross-national comparisons of health system performance offer greater accountability and transparency, support strategy review and development, and give potential for mutual learning. 40 Contributors KES planned the paper together with AMG, BE, TL, JS and OAB, carried out the statistical analysis and drafted the paper. AMG, BE, TL, JS and OAB revised the draft critically and approved the final version.…”

Section: Discussionmentioning

confidence: 99%

The Nordic Patient Experiences Questionnaire (NORPEQ): cross-national comparison of data quality, internal consistency and validity in four Nordic countries

et al. 2012

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ObjectivesTo evaluate the Nordic Patient Experiences Questionnaire (NORPEQ) for data quality, reliability and validity following surveys of patients in Finland, Norway, Sweden and the Faroe Islands.Design, methods and participantsThe NORPEQ was mailed to 500 patients randomly selected after receiving inpatient treatment in Finland, Norway and Sweden. The NORPEQ was also included in a national survey in Norway and in the Faroe Islands. Dimensionality was assessed using principal component analysis and internal consistency by item-total correlation and Cronbach's α. Construct validity was assessed by correlating NORPEQ scores with variables known to be related to patient experiences.SettingSomatic hospitals in Finland, Faroe Islands, Norway and Sweden.Primary and secondary outcome measuresItem missing, internal consistency reliability and construct validity.ResultsResponse rates ranged from 45.8% in Norway to 84% for Sweden. Levels of missing data were low for all items across the surveys. Principal component analysis identified one component with six experiences items. Mean NORPEQ scores ranged from 74 to 79 on the 0–100 scale, where 100 represents the best possible experiences. Cronbach's α ranged from 0.84 in Finland to 0.88 in Sweden.ConclusionsThe NORPEQ is a brief measure of patient experiences that covers important aspects of the healthcare encounter. It shows good evidence of reliability and validity.Practice implicationsThe NORPEQ instrument is recommended for cross-national comparisons of healthcare experiences for the four Nordic countries.

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Section: Discussionmentioning

confidence: 99%

The Nordic Patient Experiences Questionnaire (NORPEQ): cross-national comparison of data quality, internal consistency and validity in four Nordic countries

et al. 2012

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“…The indicators were not made publicly available, and their purpose was to assess performance across different trusts and locations in order to stimulate improvements. However, Smith 100 notes that the Performance Assessment Framework was used largely as a device for central government to monitor the performance of the NHS as a whole, rather than as a tool to highlight variations in performance.…”

Section: Policy and Programme Historymentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

173

263

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…It provides care suppliers with benchmark information, helping them to increase their market share. The goals of performance measurement in this context are twofold: to promote accountability to the public and to improve the performance of the health system [5]. In this article we compare performance measurement in the health care systems of Massachusetts and the Netherlands.…”

Section: Introductionmentioning

confidence: 99%

Governing healthcare through performance measurement in Massachusetts and the Netherlands

et al. 2014

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Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of institutes to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care. In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives.

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Performance Measurement in Health Care: History, Challenges and Prospects

Cited by 139 publications

References 17 publications

The Nordic Patient Experiences Questionnaire (NORPEQ): cross-national comparison of data quality, internal consistency and validity in four Nordic countries

The Nordic Patient Experiences Questionnaire (NORPEQ): cross-national comparison of data quality, internal consistency and validity in four Nordic countries

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Governing healthcare through performance measurement in Massachusetts and the Netherlands

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