A novel method for measuring health care system performance: experience from QIDS in the Philippines.
OBJECTIVE
Measuring and monitoring health system performance is important albeit controversial. Technical, logistic and financial challenges are formidable. We introduced a system of measurement, which we call Q, to measure the quality of hospital clinical performance across a range of facilities. This paper describes how Q was developed, implemented in hospitals in the Philippines and how it compares with typical measures.


METHODS
Q consists of measures of clinical performance, patient satisfaction and volume of physician services. We evaluate Q using experimental data from the Quality Improvement Demonstration Study (QIDS), a randomized policy experiment. We determined its responsiveness over time and to changes in structural measures such as staffing and supplies. We also examined the operational costs of implementing Q.


RESULTS
Q was sustainable, minimally disruptive and readily grafted into existing routines in 30 hospitals in 10 provinces semi-annually for a period of 2(1/2) years. We found Q to be more responsive to immediate impacts of policy change than standard structural measures. The operational costs totalled USD2133 or USD305 per assessment per site.


CONCLUSIONS
Q appears to be an achievable assessment tool that is a comprehensive and responsive measure of system level quality at a limited cost in resource-poor settings.
Solon
Orville
O
University of the Philippines, School of Economics, Diliman, Philippines.
Woo
Kimberly
K
Quimbo
Stella A
SA
Shimkhada
Riti
R
Florentino
Jhiedon
J
Peabody
John W
JW
D002675:Child, Preschool; D002983:Clinical Competence; D006268:Health Facilities / Q000592:standards*; D006284:Health Plan Implementation / Q000191:economics; D006291:Health Policy; D006761:Hospitals / Q000592:standards; D006801:Humans; D007223:Infant; D017060:Patient Satisfaction; D010679:Philippines; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires