A conceptual framework for the OECD Health Care Quality Indicators Project

Int J Qual Health Care. 2006 Sep;18 Suppl 1:5-13. doi: 10.1093/intqhc/mzl024.


Issues: The Health Care Quality Indicator (HCQI) Project of the Organization for Economic Cooperation and Development (OECD), which is aimed at developing a set of indicators for comparing the quality of health care across OECD member countries, requires a balanced conceptual framework that outlines the main concepts and domains of performance that should be captured for the current and subsequent phases of the project.

Addressing the issues: This article develops a conceptual framework for the OECD's HCQI Project. It first argues that developing such a framework should start by addressing the question, 'performance of what-and to what ends?' We identify at least two different major classes of frameworks: (i) health and (ii) health care performance frameworks, both of which are in common use. For the HCQI, we suggest a conceptual framework that is largely a purposeful modification of the existing performance frameworks and which is driven by the health determinants model.

Conclusions: The conceptual basis for performance frameworks can be traced back to the health determinants model. A health performance framework takes a broader, societal or public health view of health determination, whereas a health care performance takes a narrower, mostly clinical or technical view of health care in relation to health (needs). This article proposes an HCQI framework that focuses on the quality of health care, maintains a broader perspective on health and its other determinants, and recognizes the key aims of health policy.

MeSH terms

  • Benchmarking*
  • Concept Formation
  • Consensus
  • Delivery of Health Care*
  • Developed Countries
  • Efficiency, Organizational
  • Health Policy*
  • Health Priorities / classification
  • Health Priorities / standards*
  • Health Status*
  • Humans
  • International Agencies
  • International Cooperation
  • Organizational Objectives
  • Outcome Assessment, Health Care
  • Pilot Projects
  • Quality Assurance, Health Care
  • Quality Indicators, Health Care* / classification
  • Sociology, Medical*