Patient Information in 10 Countries

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Patient information in 10 countries 14 July 2015

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Table of Contents

Acknowledgements ..............................................................................................................................................................................3

Introduction...........................................................................................................................................................................................4

Methods................................................................................................................................................................................................4

Findings................................................................................................................................................................................................4

Rating for overall quality and safety of care ......................................................................................................................................5

Rating of outcomes of individual professionals .................................................................................................................................6

Waiting times for hospital treatment: referral to treatment times.......................................................................................................8

Patient experience by individual provider..........................................................................................................................................9

Access to medical records and data linkage...................................................................................................................................10

Annex Questionnaire.....................................................................................................................................................................11

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Acknowledgements This report was prepared by Bernd Rechel, based on the valuable contributions from the following country experts: Marion Haas, Greg Marchildon, Frederic Bousquet, Miriam Bluemel and Alexander Geissler, Ewout van Ginneken, Toni Ashton, Ingrid Sperre Saunes, Anders Annell, Wilm Quentin, Richard Saltman, Steve Culler, Andrew Barnes. We are very grateful to these experts for sharing their expertise. Many thanks go to Willy Palm and Ellen Nolte who have developed the questionnaire.

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Introduction This report was prepared by the European Observatory on Health Systems and Policies in response to a request of the United Kingdom Department of Health. It provides a comparative overview of several domains of patient information in the following 10 countries: Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States.

The report explores:

• whether there is an overall rating for quality and safety for every major hospital, every GP practice, every residential care provider and every domiciliary care provider

• whether outcomes of individual doctors are published with regard to mortality and GP outcomes • whether data on referral to treatment times is published for every major hospital • whether data on patient experience of hospital and GP services are published for every provider (hospital, GP practice)

• whether patients can access their medical records online and (ii) there is a single patient record across whole system (including both primary and secondary/hospital care data)

Some caution is necessary when interpreting the findings presented here. The information was collected at very short notice and may not be fully complete or accurate.

Methods A common questionnaire was sent to correspondents in each of the 10 countries, exploring the five domains outlined above. The questionnaire is given in the appendix to this report.

Findings The findings of this rapid response are presented according to the five domains of patient information explored:

• ratings for overall quality and safety of care • ratings of outcomes of individual professionals

• waiting times for hospital treatment • patient experience by individual provider • access to medical records and data linkage

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Rating for overall quality and safety of care

Table 1 Overall rating for every major hospital

Is an OVERALL rating available

at individual provider level?

If such a rating is not available at

individual provider level, at which level is it

available?

Is the rating accessible by

patients (= published on a website) Please provide weblink

If an OVERALL rating is not yet publicly

available, are there plans to develop

these? Australia No none n.a. No Canada No none n.a. No France No none n.a. No Germany No none n.a. No Netherlands No none n.a. No New Zealand No none n.a. No Norway No none n.a. No Sweden No regional Yes No Switzerland No none n.a. No United States No none n.a. No

None of the 10 countries has an overall rating for every major hospital and none has plans to introduce one (Table 1). The Swedish association of local authorities and regions SALAR (SKL) has published a comparison of the 21 county councils using a composite of 100 indicators, but this is not done regularly. The comparison concerns county councils, but most indicators are from specialist services (hospitals).

Table 2 Overall rating for every GP practice

Is an OVERALL rating available



individual provider level, at which level is it

available?

Is the rating accessible by

patients (= published on a website) Please provide weblink



these? Australia No none n.a. No Canada No none n.a. No France Yes none No n.a. Germany No none n.a. No Netherlands No none n.a. No New Zealand No none n.a. No Norway No none n.a. No Sweden No none n.a. No Switzerland No none n.a. No United States No none n.a. No

France is the only one of the 10 countries that provides an overall rating for every GP practice (Table 2). However, it is only used for the purpose of the Pay for Performance (P4P) scheme and not available to the public. The other nine countries do not have such a rating at the level of individual providers, nor at regional or national level. They also do not have any plans to introduce one.

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Table 3 Overall rating for every residential care provider

Is an OVERALL rating

available at individual provider

level?

If such a rating is not available

at individual provider level,

at which level is it available?

Is the rating accessible by patients (= published on a website) Please

provide weblink



these? Australia No none n.a. No Canada No none n.a. No France No none n.a. No

Germany Yes n.a.

http://www.pflegenoten.de/service/ihr_weg_zu_den_pflegenoten/ihr_weg_zu_den_pflegenoten.jsp n.a.

Netherlands No none n.a. No New Zealand No none n.a. No Norway No none n.a. No Sweden No none n.a. No Switzerland No none n.a. No United States No none n.a. No

Only Germany has an overall rating for every residential care provider (Table 3). The rating is published on the Internet. None of the other countries has such a rating and none has plans to introduce one.

Table 4 Overall rating for every domiciliary care provider

Is an OVERALL rating available at

individual provider level?


individual provider level, at which level

is it available?

Is the rating accessible by patients

(= published on a website) Please provide weblink


available, are there plans to develop these?

Australia No none n.a. No Canada No none n.a. No France No none n.a. No

Germany Yes n.a.

http://www.pflegenoten.de/service/ihr_weg_zu_den_pflegenoten/ihr_weg_zu_den_pflegenoten.js

p n.a. Netherlands No none n.a. No New Zealand No none n.a. No Norway No none n.a. No Sweden No none n.a. No Switzerland No none n.a. No United States No none n.a. No

Again, only Germany has an overall rating for every provider of domiciliary care (Table 4). The rating is published on the Internet. None of the other countries has such a rating and none has plans to introduce one.

Rating of outcomes of individual professionals

Outcomes for individual professionals are not available in nine of the 10 countries. Countries noted concerns with regard to conceptual and methodological grounds (Norway) or ethical reasons (Netherlands). In New Zealand, concern has been raised about small numbers, especially in provincial hospitals, and the lacking possibility of adjusting appropriately for case mix and complexity.

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Table 5 Individual hospital specialist outcome: mortality

Are mortality rates by individual hospital specialists available?

Are mortality rates by individual hospital specialists accessible by patients (= published on a website) Please provide weblink

If mortality rates by individual hospital

specialists are not yet publicly available, are there plans to develop

these? Australia No n.a. No Canada No n.a. No France Yes No No Germany No n.a. No Netherlands No n.a. No New Zealand No n.a. No Norway No n.a. No Sweden No n.a. No Switzerland No n.a. No United States No n.a. No

France is the only one of the 10 countries that has information on mortality rates by individual hospital specialists (Table 5). These are collected through the DRG payment system, but only available for regulatory institutions. In none of the other countries is information available on mortality rates by individual hospital specialists and none of the 10 countries has plans to collect these data and make them publicly available.

Table 6 Individual GP outcomes

Are outcome measures by

individual GPs available?

Are individual GP outcomes accessible by

patients (= published on a

website) Please provide weblink

If individual GP outcomes are not yet publicly available, are there plans to develop

these? Australia No n.a. No Canada No n.a. No

France Yes, for 5 outcome

indicators No No Germany No n.a. No Netherlands No n.a. No New Zealand No n.a. No Norway No n.a. No Sweden No n.a. No Switzerland No n.a. No United States No n.a. No

Again, France is the only country that has information on outcome measures by individual GPs (Table 6). This information is available through the P4P scheme for the following 5 outcome indicators:

• percentage of diabetic T2 patients with HbA1c < 8,5%

• percentage of diabetic T2 patients with HbA1c < 7,5% • percentage of diabetic T2 patients with LDl cholesterol < 1,5g/l • percentage of diabetic T2 patients with LDl cholesterol < 1,3g/l • percentage of patients taking anti-hypertensive drugs with blood pressure ≤ 140/90 mmHg

GPs process the percentages themselves and provide the aggregated indicators to the health insurance funds. However, these data are not publicly available. None of the other countries has information on outcome measures by individual GPs and none of the 10 countries has plans to develop these. However, in Germany there are initiatives at individual provider level to develop sets of indicators (for GPs and specialists in ambulatory care). In the United States, physicians and group practices have the opportunity to assess the quality of care they provide to their patients through the Physician Quality Reporting System (PQRS). This is still an

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optional reporting system, but there are plans to make it obligatory beginning in 2015 for patients on Medicare (30 million elderly) and Medicaid (50+ million on state-run welfare programmes).

Waiting times for hospital treatment: referral to treatment times

Table 7 Waiting times for hospital treatment - every major hospital

Are data on referral to treatment times available for each major hospital?

If such data are not available at individual

provider level, at which level is it

available?

Are the data accessible by patients (= published on a

website) Please provide weblink

If data on referral to treatment times are not yet publicly available, are there

plans to develop these? Australia Yes n.a. http://www.myhospitals.gov.au/ n.a.

Canada Yes n.a. www.yourhealthsystem.cihi.ca/hs

p/ n.a. France No none n.a. No Germany No none n.a. No

Netherlands Yes n.a.

http://www.zorgatlas.nl/thema-s/wachtlijsten/wachtlijsten-

ziekenhuiszorg/ n.a.

New Zealand No regional

http://www.health.govt.nz/system/files/documents/pages/health-target-q3-results-2014-15b.pdf No

Norway Yes n.a. http://frittsykehusvalg.no/start/# n.a. Sweden Yes n.a. www.vantetider.se n.a. Switzerland No none n.a. No United States Yes n.a. Yes n.a.

Information on waiting times is more widely available (Table 7). In six of the 10 countries, data on referral to treatment times are available for each major hospital and in each of these six countries this information is publicly available on the internet. In Germany and Switzerland waiting times are not considered to be a problem. In New Zealand, the only information available is the percentage of patients who receive cancer treatment within 62 days of being referred with a high suspicion of cancer, this being one of 6 national health targets. This information is published for each District Health Board, not for each hospital. However, most District Health Board s have only one major hospital providing cancer treatment. In the Netherlands, information on waiting times is available for the following types of treatment:

• Allergology, Anesthesiology, Pain and Palliative Medicine

• cardiology • Cardiothoracic Surgery • dermatology • endocrine Diseases • geriatrics

• gynecology General • surgery • hematology • internal Medicine

• Throat-Nose-Throat • pediatrics • clinical Genetics • Lung Diseases • Gastroenterology and Hepatology

• Mouth-Jaw-Face Surgery (Oral and maxillofacial surgery?) • neurosurgery • neurology

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• nuclear Medicine • Nephrology • ophthalmology

• orthopedics • plastic Surgery • psychiatry • radiology • radiotherapy

• rheumatic Diseases • rehabilitation • urology

Patient experience by individual provider

Table 8 Patient experience by individual provider - every major hospital

Are data on patient experience

of hospital care available at

individual provider level?

If such data are not available at

individual provider level, at which level are they

available?

Are the data accessible by patients (= published on a website) Please

provide weblink

If data on patient experience of hospital

care are not yet publicly available, are there plans to develop

these? Australia No regional Yes n.a. Canada Yes n.a. Yes n.a. France Yes n.a. No Yes

Germany Yes n.a.

https://www.weisse-liste.de/de/krankenhaus/krankenhaus

suche/, https://weisse-liste.krankenhaus.aok.de/,

https://www.krankenhausnavi.barmer-gek.de/ n.a.

Netherlands Yes n.a. www.kiesbeter.nl n.a. New Zealand No none n.a. No

Norway Yes n.a. http://www.kunnskapssenteret.no/pu

blikasjoner#index=0&types=175540 n.a. Sweden Yes n.a. www.npe.skl.se n.a.

Switzerland Yes n.a. http://www.anq.ch/akutsomatik/akut

somatik-anq-hplus/ n.a. United States Yes n.a. Yes n.a.

In eight of the 10 countries is data on patient experience of hospital care available at the level of individual providers and in seven of these countries is this information available to the public on the Internet (Table 8).

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Table 9 Patient experience by individual provider - every GP practice

Are data on patient experience of GP services available


If such data are not available at

individual provider level, at which level are they available?

Are the data accessible by patients (= published on a website) Please

provide weblink

If data on patient experience of GP

services are not yet publicly available, are there plans to

develop these?

Australia No none n.a. No

Canada No none n.a. No France No n.a. No No

Germany No none n.a. No

Netherlands Yes n.a.

Mostly private initiatives, not systematically collected, e.g.:

https://www.zorgkaartnederland.nl n.a. New Zealand No none n.a. No Norway No regional and national n.a. Yes Sweden Yes n.a. www.npe.skl.se n.a. Switzerland No none n.a. No United States No none n.a. No

In only 2 of the 10 countries (the Netherlands and Sweden) is information available on patient experience of GP services at the level of individual providers (Table 9). This information available to the public through the Internet. However, Norway is planning to make this information available in the future.

Access to medical records and data linkage

Table 10 Access to medical records and data linkage

Can patients access their medical records online?

Is there a single patient record across whole system (including

both primary and secondary/hospital care data)?

Australia

Yes, if they have a personally controlled e-health record

(PCEHR) Yes Canada No No France No No Germany No No Netherlands No No New Zealand No No Norway Yes In development Sweden Yes No Switzerland No No United States No No

In only 3 of the 10 countries (Australia, Norway and Sweden) do patients have online access to their medical records (Table 10). Only in Australia there is a single patient record across the whole health system, although such data linkage is under development in Norway.

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Annex Questionnaire

[COUNTRY]

1. Rating for OVERALL quality and safety of care We are interested in whether an overall rating for quality and safety is published (for example, this could be a composite of individual measures [see example on the next page]). For the purposes of this request, publication of individual quality and safety indicators and/or proxies are considered irrelevant if no overall measure is created on the basis of these. If this indicator is not available at the hospital level, please consider whether it is available at greater aggregation (i.e. regional level)?

COMMENT: If your answer is NO please explain why – where possible/relevant

Is an OVERALL rating available at individual provider level? Y/N

If such a rating is not available at individual provider level, at which level is it available?

regional level national level

Is the rating accessible by patients (= published on a website) Please provide weblink

Y/N

Every major hospital

If an OVERALL rating is not yet publicly available, are there plans to develop these?

Y/N


If such rating is not available at individual provider level, at which level is it available?



Y/N

Every GP practice


Y/N




Every residential care provider (see definition in the Annex)

Is the rating accessible by patients (= published on a website) Please provide

Y/N

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weblink


Y/N





Y/N

Every domiciliary care provider (see definition in the Annex)


Y/N

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Background/Further information

In England, the Care Quality Commission (CQC) rates performance of health and socials services on the basis of 5 core questions: whether they are safe, effective, caring, responsive to people's needs and well-led.

Each provider (such as acute hospitals, GP practices, care homes, etc.) is evaluated on the basis of the performance of ‘core services’ (whether these are safe, effective, caring, responsive and well-led). Composite rankings are then created for each core service, and for each area of performance. The ultimate rating is then based on an aggregate of both. The individual areas/providers are given 5 potential evaluations:

• Outstanding: the service is performing exceptionally well. • Good: the service is performing well and meeting our expectations. • Requires improvement: the service isn't performing as well as it should and the service is being told how it must improve. • Inadequate: the service is performing badly and the regulator (CQC) has taken enforcement action against the provider of the service. • No rating/under appeal/rating suspended: there are some services which cannot be rated, while some might be under appeal from the provider. Suspended ratings are being reviewed and will

be published in due course.

The below illustrates the process for acute hospitals and GP practices.

Source: http://www.cqc.org.uk/content/provider-handbooks

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Source: http://www.cqc.org.uk/content/provider-handbooks

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[COUNTRY]

2. Rating of outcomes of INDIVIDUAL professionals We are interested in whether outcomes by individual doctors are published. For hospital specialists, this core outcome of interest is mortality rates (e.g. https://www.nhs.uk/Service-Search/consultants/performanceindicators/1018). For GPs, a range of outcomes are being considered (see examples below); for the latter, if such data is available publicly, please list for which outcomes these are available. Please not that this question does not consider patient experience as an outcome (please see Question 4).


Are mortality rates by individual hospital specialists available? Y/N

Are mortality rates by individual hospital specialists accessible by patients (= published on a website) Please provide weblink

Y/N

Individual hospital specialist outcome: Mortality

If mortality rates by individual hospital specialists are not yet publicly available, are there plans to develop these?

Y/N

Are outcome measures by individual GPs available? Y/N

If YES, please list which outcomes are available *

Are individual GP outcomes accessible by patients (= published on a website) Please provide weblink

Y/N Individual GP outcomes *

If individual GP outcomes are not yet publicly available, are there plans to develop these?

Y/N

* Individual GP outcomes may include: emergency admissions for ambulatory care sensitive conditions; emergency admissions of people on the cancer register; percentage of patients with diagnosed hypertension whose blood pressure is lower than a specific threshold (e.g. 150/90); percentage of patients with diabetes whose HbA1c was less than a specific threshold (e.g. 64 mmol/mol), etc.

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3. Waiting times for hospital treatment: Referral to treatment times

We are interested in whether data on referral to treatment times is published for every major hospital (i.e median, average, 95th percentile) by type of treatment. If this indicator is not available at the hospital level, please consider whether it is available at greater aggregation (i.e. regional level)?


Are data on referral to treatment times available for each major hospital? Y/N If YES, please list the treatment types for which these data are available

If such data are not available at individual provider level, at which level is it available?


Are the data accessible by patients (= published on a website) Please provide weblink

Y/N


If data on referral to treatment times are not yet publicly available, are there plans to develop these?

Y/N

4. Patient experience by individual provider We are interested in whether data on patient experience of hospital and GP services are published for every provider (hospital, GP practice). If this indicator is not available at individual provider level, please consider whether it is available at greater aggregation (i.e. regional level)?


Are data on patient experience of hospital care available at individual provider level? Y/N

If such data are not available at individual provider level, at which level are they available?



Y/N


If data on patient experience of hospital care are not yet publicly available, are there plans to develop these?

Y/N

Every GP practice

Are data on patient experience of GP services available at individual provider level?

Y/N

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If such data are not available at individual provider level, at which level are they available?



Y/N

If data on patient experience of GP services are not yet publicly available, are there plans to develop these?

Y/N

5. Access to medical records and data linkage

We are interested in whether (i) patients can access their medical records online and (ii) there is a single patient record across whole system (including both primary and secondary/hospital care data)?

PLEASE COMMENT

Can patients access their medical records online?

Y/N

Is there a single patient record across whole system (including both primary and secondary/hospital care data)

Y/N

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Definitions

Residential care home

Residential care homes are now generally referred to simply as care homes. And what used to be called nursing homes are now called care homes with nursing.

A care home is a place where personal care and accommodation are provided together. People may live in the service for short or long periods. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. Both the care that people receive and the premises are regulated.

A home registered simply as a care home will provide personal care only. Category includes: residential home, rest home, convalescent home, respite care, mental health crisis houses, therapeutic communities.

In addition, there are care homes that provide qualified nursing, to ensure that the full needs of the person using the service are met. This category includes: nursing home, convalescent home with nursing, respite care with nursing, mental health crisis house with nursing

Sources: http://www.housingcare.org/jargon-residential-care-homes.aspx; http://www.cqcguidanceaboutcompliance.org.uk/step1.php

Example NHS Choices: http://www.nhs.uk/conditions/social-care-and-support-guide/pages/care-homes.aspx

Domiciliary care service:

These services provide personal care for people living in their own homes. The needs of people using the services may vary greatly, but packages of care are designed to meet individual circumstances.

The person is visited at various times of the day or, in some cases, care is provided over a full 24-hour period. Where care is provided intermittently throughout the day, the person may live independently of any continuous support or care between the visits.

Source: CQC. http://www.cqcguidanceaboutcompliance.org.uk/step1.php

Example NHS Choices: http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/home-care.aspx

Patient Information in 10 Countries

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