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International Journal for Quality in Health Care 2006 18(Supplement 1):5-13; doi:10.1093/intqhc/mzl024
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International Journal for Quality in Health Care September 2006 © The Author 2006. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

A conceptual framework for the OECD Health Care Quality Indicators Project

Onyebuchi A. Arah1,2, Gert P. Westert2,3, Jeremy Hurst4 and Niek S. Klazinga1

1 Department of Social Medicine, University of Amsterdam, Amsterdam, 2 National Institute of Public Health and the Environment, Center for Health Services Research and Prevention, Bilthoven, 3 Faculty of Social and Behavioural Sciences, Tilburg University, Tranzo, Tilburg, The Netherlands, 4 Organization for Economic Cooperation and Development, The Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France

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.

Keywords: conceptual framework, health determinants, health policy, health systems research, OECD Health Care Quality Indicators Project, performance indicators, performance measurement, quality in health care

Address reprint requests to Onyebuchi A. Arah, Department of Social Medicine, University of Amsterdam, Amsterdam, The Netherlands. E-mail: o.a.arah{at}amc.uva.nl; oacarah{at}yahoo.com

Accepted for publication June 15, 2006.


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