Health system monitoring: Building an information infrastructure for measuring quality
Strengthening the data- infrastructure to monitor quality of care
An adequate information infrastructure is key for being able to monitor quality of care with reliable and valid quality measures. This infrastructure has different components such as the mortality statistics, specific clinical registries such as the cancer registry, administrative data bases, both from the financier and the health-care provider, electronic health records and surveys both on the level of households and specific patient groups. These various data sources and their inter-linkages differ very much between OECD countries (OECD, 2013), an assessment of the suitability of the existing data sources for generating quality of care information and of the potential of their inter linkage constitutes an important element of a country review on quality of care.
In Turkey a broad variety of data sources has been developed and improved over the past ten years. Nevertheless, the focus of most of these has been on monitoring trends in health needs and in health-care activities. Less focus has been on the suitability and use of the existing data bases for measuring quality of care. For example, limitations of the present mortality statistics have been reported (Sankaranarayanan, 2010). Both the SSI and the Ministry of Health have access to a huge amount of data, however, exploration of these data bases for quality of care purposes has only recently started. SSI for example is exploring in its data base on practice variations (transplantation, dialyses and caesarean sections). The Ministry of Health has many initiatives to study the data and the affiliated institutions for public hospitals, public health and drugs and devices have their own data sources. The public hospital institute is looking at the appropriateness of procedures (caesarean sections, knee, bypass, neurosurgical operations and coronary angiography). The Public Health Institute has, for example, specific projects on diabetes and knee replacement) and the agency on devices and drugs has different types of vigilance data and data on drug prescription. Also, various departments and institutes report to be involved in the collection of information on patient experiences via surveys.
It seems advisable to keep overview of the various data systems and ongoing projects. A policy to optimise the existing data bases for generating data for quality measures (standardised coding, present at admission codes, use of unique patient identifiers) seems warranted.
A special point of attention is the sharing of data between SSI and the Ministry of Health; this seems at present less optimal than desirable.