There is growing interest in the systematic assessment and international benchmarking of quality of care provided in different healthcare systems, and major work is under way to support this process through the development and validation of quality indicators that can be used internationally.
Efforts under way involve systematic analysis of the suitability of routine datasets for comparing quality of care in different countries, including the development of standard definitions to improve the comparability of national data systems. There is scope to develop indicators which are specifically designed to compare care quality in different systems. The initiatives of greatest relevance to England are probably those seeking to benchmark quality of care and outcomes in European countries.
Recognising that cross-national data comparison remains a challenge, there is now a considerable body of data that allow for comparisons of healthcare quality in selected areas of care. The study includes a description of existing indicators that could be used to compare healthcare quality in different countries, along with a discussion of specific problems in making comparisons at this level of detail. This is illustrated with case studies of two measures widely used for international comparisons: avoidable mortality and cancer survival. These show both the potential power of cross-national comparisons and some of the difficulties in drawing valid interpretations from the data.
The study focuses on the three quality domains identified as important by the NHS Next Stage Review High Quality Care for All, namely effectiveness of care, patient safety and patient experience. It is however important to recognise that access is an important additional component of quality which may be a key determinant of differences in outcome between different countries. Thus comparing quality across countries is only a first step to then assess the causes underlying those differences and determining what actions may be appropriate to take to improve health outcomes.
International benchmarking of quality of care with the NHS has considerable potential to improve patient outcomes in England, but only if research is undertaken to understand the reasons for differences between countries and their possible relevance to England.