Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators

Int J Qual Health Care. 2015 Apr;27(2):137-46. doi: 10.1093/intqhc/mzv004. Epub 2015 Mar 10.


Objective: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work.

Design: A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development.

Setting: International group of countries participating to OECD projects.

Participants: Members of the OECD HCQI expert group.

Results: A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions.

Conclusions: The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.

Keywords: OECD Health Care Quality Indicators project; conceptual framework; health policy; health systems research; performance measurement; quality indicators.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Consensus
  • Delphi Technique
  • Humans
  • International Cooperation
  • Organisation for Economic Co-Operation and Development / organization & administration
  • Organisation for Economic Co-Operation and Development / standards*
  • Quality Indicators, Health Care / standards*
  • Quality of Health Care / standards*