International benchmarking of healthcare quality

A review of the literature

by Ellen Nolte

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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.

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 report 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 report 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.

Research conducted by

The research in this report was prepared for the Department of Health within the PRP project "An 'On-call' Facility for International Healthcare Comparisons" and conducted by RAND Europe.

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