Key Composite Performance Indicators Used to Monitor Health Care System
It is widely acknowledged that health care performance is multi-dimensional, with providers having a legitimate interest in a wide variety of performance indicators, including efficiency, quality, accessibility, clinical outcomes and responsiveness. A successful surgery is believed to be dependent on a number of factors, such as availability for surgery, patient education, and a supportive and safe home environment. However, there has been little scientific evaluation of the benefits and system impact from a well orchestrated orthopaedic replacement continuum. A major reason for this is the lack of evaluation tools coupled with routine evaluation processes that support monitoring and feedback to health care providers in a systematic fashion.
Performance measurement is playing an increasingly important role in health care systems globally. Many counties are designing and implementing measurement systems to achieve a wide range of objectives, including system monitoring and improvements. The identification and application of key composite performance indicators to monitor health care systems has advances. First, they show the big picture, making them easier to identify and interpret than many individual performance measures. Second, they provide an overall performance measurement that can be compared with other systems or event at the physician level. This can, in turn, enhance the accountability and the quality of patient services.
Although the data collected for all Alberta Bone & Joint Health Institute (ABJHI) clinical trials are used primarily to answer the end points defined within the design of the clinical trial, the ABJHI will continue to collect necessary data elements to ensure ongoing monitoring and quality improvements of orthopaedic care in Alberta.
To develop and pilot the monitoring and quality improvement system, ABJHI is reviewing the data elements used to evaluate the new hip and knee replacement continuum. This will identify the key composite performance indicators.
The specific questions addressed this this project include:
- What are the key composite performance indicators for hip and knee replacements?
- How are they key composite performance indicators appropriately risk adjusted for system monitoring and ongoing quality improvement?
- Are the key composite performance indicators defined for hip and knee replacements extendable to all orthopaedic continuums or to other medical disciplines?
It is critical that each key composite performance indicators has direct link (relationship) with a clinically important evaluative outcome. With data from more than 3,500 patients, key composite performance measures will be identified from the four major components of the hip and knee replacement continuum.
The interpretation of any performance measure in health care can be problematic unless one can be confident that the observed variations in measured performance reflect real differences in actual performance rather than the impact of random factors over which there may be little control. Therefore, hierarchical models for each key composite performance indicate will be developed to adjust for patient risk factors and other variables that may influence the result.
It is predicted that all of the key composite performance measures will be inter-related and a weighted summary of these indicators will provide an overall performance measure. For example, overall cost and post-surgery health-related quality of life will be important measures and sources of information for decision makers at the health system level.
Once the key composite performance measures are identified, a status report will be issued to the respective providers. The goals for each indicator will be established using the world's best evidence, and it is predicted that some gaps in this evidence may exist.
