health quality indicators, value of health: accounting for quality change aileen simkins, department...
TRANSCRIPT
![Page 1: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/1.jpg)
Health Quality Indicators, Value of Health: Accounting for Quality Change
Aileen Simkins, Department of HealthCo-Director of the Atkinson Review
![Page 2: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/2.jpg)
Context
• UK measurement of public service healthcare output and productivity – Part 2
• Quality adjustments to series for healthcare output described earlier by Chris Little
• Quality adjustments developed by DH; used by ONS in Health Productivity article but not in National Accounts
• Development programme
![Page 3: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/3.jpg)
ONS Health Productivity Oct 2004
80
85
90
95
100
105
110
1995 1996 1997 1998 1999 2000 2001 2002 2003
Output w ithout quality; inputs: drugs deflated by cost of all items; capitalservices; missing years estimated as average of last 3 years
Output w ithout quality; inputs: drugs deflated by Paasche Price Index;capital consumption; missing years estimated as previous year
![Page 4: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/4.jpg)
DH Press Release Oct 04
John Reid (Secretary of State for Health) says
“ it is absurd to measure NHS output without taking account of quality”
![Page 5: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/5.jpg)
Quality as part of NHS Output• How many domains of quality?
– Health gain– Patient experience
• What can we measure?• How can we link quality measures to the NHS
output index?• How should we weight different aspects of
quality?• How valid is a partial story?
![Page 6: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/6.jpg)
DH Work on Quality Adjusted Output
• York/NIESR research commissioned 2004
• Parallel DH work during 2005
• DH paper Accounting for Quality Change published Dec 2005, with research report
• Used in 2nd ONS Health Productivity article Feb 2006
![Page 7: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/7.jpg)
Accounting for Quality Change
Average over last 5 years:• Value of health 1.5%• Value weight for statins 0.81%• York/NIESR adjustment 0.17%• Patient experience* 0.07%• Blood pressure control * 0.05%• Heart attack survival 0.01%Total ** 2.68% Quality adjusted output growth 6.29%
![Page 8: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/8.jpg)
ONS Health Productivity 2006
80
85
90
95
100
105
110
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Output w ith quality and value of health; inputs: drugs deflated by cost of allitems; capital consumption, direct labour method
Output w ith quality and value of health; inputs: drugs deflated by PaaschePrice Index; capital services, indirect labour method
![Page 9: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/9.jpg)
York/NIESR Research 0.17%
• Ideal method is value weighted output index, not cost weighted activity index
• Algebra takes account of multiple aspects of quality and their value to patients – e.g. health gain (QALYs)
• Interim formula uses cost weights with mortality after hospital treatment + estimate for health gain if not dead
• Waiting time – interim formula measures as deferred benefit (discounted)
![Page 10: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/10.jpg)
Quality Adjusted Life Years
t0 t1 t2 t3
Health Status
h=1
()oht
*()ht*h
oh
Ideally we want to measure the area under the curveBefore and after measures are a reasonable approximation (?)
![Page 11: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/11.jpg)
Value Weight for Statins 0.81%
• Statin prescriptions rising fast (so positive output growth in CWAI)
• Value per prescription, in QALYs, can be shown to be greater than cost
• Work based on epidemiological research – lives saved, less morbidity
• Value weight is £115 v cost £30 (assuming £30,000 per QALY)
• So using value weight raises output growth even further
![Page 12: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/12.jpg)
Improving blood pressure control 0.05%
• GP Contract Quality and Outcomes Framework• First data set Sept 2005 – no time series yet• QRESEARCH data on 400+ practices (3m patients)
– quarterly measures of many QOF indicators, pre-contract
• Prevalence rates and comorbidity rates• Examined data for blood pressure and cholesterol
control
![Page 13: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/13.jpg)
Hypertension: blood pressure control
![Page 14: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/14.jpg)
Key results Jan 2002 – Oct 2004
CHD
Blood pressure control Jan 02 60.4%
Blood pressure control Oct 04 78.3%
Annual rate of increase 10.4%
Hypertension
Blood pressure control Oct 01 44.6%
Blood pressure control July 04 63.0%
Annual rate of increase 22.4%
![Page 15: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/15.jpg)
Overall GP Quality Adjustment• Most patients (86%) don’t have CHD or
hypertension – assume no change in quality• Patients with hypertension and/or CHD also
see GP for other illnesses – weight as equally important as CHD/hypertension, no change
• Patients with CHD need wider treatment than blood pressure control – weight BP as 1/3
• Result: 1.1% a year for GMS as a whole• Raises NHS output by 0.14% a year
![Page 16: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/16.jpg)
Patient Experience 0.07%
• Survey programme set up NHS Plan 2000• Operated by Healthcare Commission• PSA target for national improvement in
measured patient experience • Separate surveys for inpatients, outpatients,
primary care, A&E – with 2 data sets each• Many questions; 5 domains
![Page 17: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/17.jpg)
Patient Experience Data
Domains Year 2001/2 2002/3 2003/4 2004/5 2005/6
Inpatient survey access and waiting 82 83 83 b a safe, high quality co-ordinated care 64 65 66 b a better information, more choice 67 68 68 b a building closer relationships 83 83 83 b a clean, friendly, comfortable place to be 78 78 77 b a Aggregate 74.8 75.1 75.4 b b
Outpatient survey access and waiting -- 70 70 69 -- safe, high quality co-ordinated care -- 83 83 82 -- better information, more choice -- 77 77 77 -- building closer relationships -- 86 86 86 -- clean, friendly, comfortable place to be -- 70 69 68 -- Aggregate -- 77.2 76.8 76.4 -- Figures in bold are actual data points. Figures not in bold are estimates. *: aggregate score calculated by taking average of first four domain scores. a : domain score based on actual data pointss to be published b : to be estimated / calculated when relevant data become available ‘--‘ : no survey carried out ‘n/a’ : domain not relevant for this survey
![Page 18: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/18.jpg)
Value of Health 1.5%
• Biggest single element; used first for education• Does not depend on NHS data – same every year• Atkinson Report Principle C
‘account should be taken of the complementarity between public and private output, allowing for the increased real value of public services in an economy with rising real GDP’
• E.g ‘rising real wage rates mean we attach a higher valuation to days lost through sickness absence’
![Page 19: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/19.jpg)
Establishing the Principles
• UKCeMGA consultation paper Sept 2006• Framework for quality adjustment – based on
Atkinson Report• Arguments on public/private
complementarity – two way• Effect depends on specific channels of
influence in each area of public spending• DH will await outcome of consultation and
further clarity
![Page 20: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/20.jpg)
DH Development Work
• Aiming for AfQC 2 in winter 2006/7• Improvements on volume series (hospital, GP)• ? Use ‘avoidable deaths’ instead of ’30 day mortality• Discussion of functional form – additive not
multiplicative, how to weight different domains• Wider, longer analysis of primary care clinical
outcomes• Re-analysis of patient experience• New quality indicators (e.g. discharge to normal
residence after stroke)• New value weight for smoking cessation• Progress on routine measurement of patient
reported outcomes
![Page 21: Health Quality Indicators, Value of Health: Accounting for Quality Change Aileen Simkins, Department of Health Co-Director of the Atkinson Review](https://reader035.vdocument.in/reader035/viewer/2022062409/56649ccc5503460f9499674a/html5/thumbnails/21.jpg)
Value and Validity of Quality Adjusted Output Measures
• Focus on attributable impact on outcomes and quality change
• Data incomplete; biased towards areas of attention / improvement
• Development work by DH – partial?• Techniques new, untried, difficult • UKCeMGA in position to set standards, lead
development work, assure independent view• External consultation important – health Nov 06 based on Dec 05 paper