Table 2 Final set of quality indicators
Number | Category | Subject | Nominator | Denominator | Comments |
|---|---|---|---|---|---|
1 | General aspects, efficiency | Number of emergency hospital admissions per 1000 insured persons | Number of emergency hospital admissions | Number of insured persons | Measure is sensitive to density of health care providers, culture, socioeconomics and other factors not influenceable by primary care |
2 | General aspects, efficiency | Medication costs per insured person | Sum of gross medication costs per insured person irrespective of the prescriber | Number of insured persons | Measure is sensitive to case mix |
3 | General aspects, efficiency | Costs per daily dose in specific ATC groups relevant in primary care | Sum of gross medication costs | Sum of daily doses | Practical implementation depends on quality of medication master data of claims insurance database. Might be more easily implementable for few most important ATC groupsa |
4 | General aspects, efficiency | Proportion of prescriptions of generics | Sum of prescriptions of generics | Sum of prescriptions of generics eligible medication | The original QISA indicator measures the share of generics in the overall market. As this depends on the market of generics and on approval policy and is not |
influenceable by primary care, the group decided to specify the indicator. | |||||
5 | General aspects, efficiency | Proportion of prescriptions of inefficient me-too medications | Sum of prescriptions of medications listed on corresponding listsb | Sum of all medication prescriptions | Lists need adaptation to Swiss medication market |
6 | General aspects, efficiency | Number of different primary care physicians consulted by an individual insured person | Number of different primary care physicians consulted per insured person | Number of insured persons with at least 1 primary care physician consultation | Interval of interest needs to be determined. Persons enrolled in managed care health plans are presumed to have a value of 1 or marginally higher than 1. |
7 | General aspects, efficiency | Number of different specialist physicians consulted by an individual insured person | Number of different specialist physicians consulted per insured person | Number of insured persons with at least 1 physician consultation | Interval of interest needs to be determined. Number of persons enrolled in managed care plans is presumed to be lower as compared to persons enrolled in plans without collaboration/ coordination of care. |
8 | Drug safety | Number of prescriptions of anxiolytics, sedatives or hypnotics | Number of prescriptions of anxiolytics, sedatives or hypnotics per quarter year | Number of insured persons with at least 1 medication prescription per quarter year | The original QISA indicator measures the proportion of persons receiving more than 30 DDD of persons receiving anxiolytics, sedatives, or hypnotics. Swiss health insurance claims provide currently insufficient detail/data quality to measure DDD of anxiolytics, sedatives, and hypnotics on a routine basis. The expert group recommended therefore to use number or prescriptions as crude but still informative measure. |
9 | Drug safety | Number of prescriptions of non-steroidal anti-inflammatory drugs (NSAIDs) | Number of NSAIDs prescriptions per quarter year | Number of insured persons with at least 1 NSAIDs prescription per quarter year | The original QISA indicator measures the proportion of persons receiving more than 75 DDD of persons receiving NSAIDs. Swiss health insurance claims provide currently insufficient detail/data quality to measure DDD of NSAIDs on a routine basis. The expert group recommended therefore to use number or prescriptions as crude but still informative measure. |
10 | Geriatric care | Proportion of insured persons aged 65 years or older with polymedication | Sum of insured persons aged 65 years or older with 5 or more different medication prescriptions per quarter year | Sum of insured persons aged 65 year or older with at least 1 medication prescription (related to quarter year) | Based on difference of ATC codes |
11 | Geriatric care | Proportion of insured persons aged 65 years or older with prescription of potential inappropriate medications (PIM) | Sum of insured persons aged 65 years or older with PIM prescriptions per quarter year | Sum of insured persons ages 65 years or older with at least 1 medication prescription (related to quarter year) | Based on ATC codes and PRISCUS list and Beers criteria |
12 | Geriatric care | Proportion of insured persons aged 65 year or older with reimbursed influenza vaccination | Sum of insured persons aged 65 year or older with reimbursed influenza vaccination per year | Sum of insured persons aged 65 year or older per year | Evidence is unclear, currently controverse discussions. Subject to patient preferences and shared decision making. |
13 | Geriatric care | Proportion of insured persons aged 65 year or older with at least one chronic condition who were hospitalised for fracture near the pelvic joint | Sum of insured persons aged 65 year or older with at least one chronic condition (presence of at least 1 PCG) who were hospitalised for fracture near the pelvic joint | Sum of insured persons aged 65 year or older per year | The original QISA indicator refers to persons older than 70 years. The expert committee preferred to specify a potentially frail older population based on comorbidity. For identification of hospitalization due to for fracture near the pelvic joint, SwissDRG codes or ICD codes can be used. DRG codes are less precise. |
14 | Respiratory disease | Proportion of insured persons receiving long term therapy of systemic corticosteroids | Sum of insured persons with the Pharmacy Cost Group “respiratory disease” receiving systemic corticosteroids in two sequential quarter years | Sum of insured persons with the Pharmacy Cost Group “respiratory disease” | ATC H02. When interpreting the data it should be considered that currently, asthma and COPD cannot clearly be distinguished based on Swiss health insurance data. |
15 | Respiratory disease | Disease-specific hospitalisation rate of insured persons with the Pharmacy Cost Group “respiratory disease”c | Sum of insured persons with the Pharmacy Cost Group “respiratory disease” hospitalised because of complications of respiratory disease | Sum of insured persons with the Pharmacy Cost Group “respiratory disease” | Low controllability by primary care physician. Might be influenceable by efficient therapy. For identification of hospitalization due to asthma or COPD, SwissDRG codes or ICD codes can be used. DRG codes are less precise. |
16 | Diabetes mellitus | Proportion of insured persons with antidiabetic medication receiving which HbA1c controls (number of controls per year) | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” for which HbA1c controls were reimbursed per year | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” | Current guidelines recommend HbA1c controls at least each or every second quarter year. The expert group recommends stratified measurement of 1, 2, 3 and 4 HbA1c controls per year. Diabetic patients without antidiabetic medication will be missed. |
17 | Diabetes mellitus | Proportion of insured persons with antidiabetic medication receiving which an ophthalmologic control within 15 months | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” receiving which an ophthalmologic control within 15 months | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” | Current guidelines slightly vary in recommended intervals (between 1 and 2 years). The expert group recommends 15 months. An interval of 2 years would be clinically reasonable and calculation would be easier. |
18 | Diabetes mellitus | Hospitalisation rate of insured persons with antidiabetic medication | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” with at least 1 hospitalisation per year | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” per year | Good quality primary care (information, patient self-management skills, medication and non-medical therapies, coordinated care etc.) prevents hospitalisation of diabetic patients. Therefore, focusing non-disease-specific hospitalisations is reasonable. |
19 | Diabetes mellitus | Proportion of insured persons with antidiabetic medication receiving control of lipid values per year | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” for which control of lipid values was reimbursed per year | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” per year | |
20 | Diabetes mellitus | Proportion of insured persons with antidiabetic medication receiving control of kidney values per year | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” for which control of kidney values was reimbursed per year | Sum of insured persons with the Pharmacy Cost Group “diabetes mellitus” per year | |
21 | Cardiovascular disease | Proportion of insured persons with hospitalization for myocardial infarction receiving acetylsalicylic acid (ASS) | Sum of insured persons with hospitalization for myocardial infarction receiving ASS per year | Sum of insured persons with hospitalization for myocardial infarction per year | Extrapolating the patient’s medical long term history based on Swiss health insurance data is limited for technical reasons, changes in legislation (no diagnostic information from hospitals before 2012) and the right to change the health insurance every year. Should be operationalized pragmatically, e.g. proportion of insured persons with hospitalization for myocardial infarction in preceding year receiving acetylsalicylic acid in the year following the event. |
22 | Cardiovascular disease | Proportion of insured persons with hospitalization for myocardial infarction receiving statins | Sum of insured persons with hospitalization for myocardial infarction receiving statins per year | Sum of insured persons with hospitalization for myocardial infarction per year | As mentioned above. |
23 | Cardiovascular disease | Proportion of insured persons with hospitalization for stroke receiving ASS | Sum of insured persons with hospitalization for stroke receiving ASS per year | Sum of insured persons with hospitalization for stroke per year | As mentioned above. |
24 | Cardiovascular disease | Proportion of insured persons with hospitalization for stroke receiving statins | Sum of insured persons with hospitalization for stroke receiving statins per year | Sum of insured persons with hospitalization for stroke per year | As mentioned above. |