AB037. Quality measurement of specialty care in Pacific Rim countries: an analysis of five models

Background: Due to its complexity, specialty care is more concentrated in urban areas, and less subject to being measured by standardized quality indicators. A quality measurement program can inform resource allocation and patient care-seeking. Particularly for specialty care, rural residents might need to travel to unfamiliar urban facilities. This analysis surveys existing initiatives to inform stakeholders of the diverse ways to develop such a program.

Methods: We purposefully sampled five initiatives for their diverse program setup: Society for Thoracic Surgery (STS) clinical registries; Chinese government non-payer branch’s National Report on Quality and Safety (CN-NRQS; all specialties), US government payer branch’s Care Compare (US-CC; all specialties), a partnership between the Japanese government, National Cancer Center and Hospital Association (JP-NCC-DCCH), and Singapore National Eye Centre’s clinical audit (SG-NEC).

Results: STS is a society-led international initiative (US, Canada, Australia, etc.) while others are on a country or facility level. STS developed its measures and sought external endorsement. CN-NRQS’s measures were developed by the government. Some of US-CC’s and all JP-NCC-DCCH’s measures were developed by government-sponsored academia, while US-CC also built upon other US quality programs. SG-NEC aligned internal measures with existing publications. Every year, CN-NRQS is published as a book, with aggregated results on a random sample of hospitals. JP-NCC-DCCH published several one-off papers for different cancers. Hospital participation was voluntary and anonymous. STS and US-CC were most transparent, as hospital-identifiable information was either voluntarily (STS) or mandatorily (US-CC) available on websites. SG-NEC used to update annually on their website. STS, CN-NRQS and SG-NEC heavily relied on outcome measures, while US-CC and JP-NCC-DCCH also had process measures. Each JP-NCC-DCCH paper only selected a subset of measures from its library.

Conclusions: Healthcare executives on all levels could learn from these initiatives to develop specialty care quality programs that meet their needs.

Keywords: Clinical quality measures; specialty care; oncology; cardiology; ophthalmology