Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 154 No. 10 (2024)

Monitoring equity in the delivery of health services: a Delphi process to select healthcare equity indicators

DOI
https://doi.org/10.57187/s.3714
Cite this as:
Swiss Med Wkly. 2024;154:3714
Published
03.10.2024

Summary

AIMS OF THE STUDY: Health equity is a key component of quality of care and an objective for a growing number of quality improvement projects for deontological, ethical, public health and economic reasons. To monitor equity in the delivery of health services in Switzerland, there is a need to implement valid, measurable and actionable equity indicators, along with vulnerability stratifiers such as migrant status, which could lead to differences in quality of care. The aim of this study was to develop a set of healthcare equity indicators and stratifiers targeting inpatient and outpatient populations and to test their feasibility.

METHODS: A scoping literature review and inputs from a national interprofessional expert taskforce provided a set of indicators and vulnerability stratifiers. The most valid and measurable indicators and stratifiers were retained using a Delphi process. They were then operationalised, and their implementation tested in three Swiss hospitals from the three language regions.

RESULTS: A taskforce of 18 experts, including a patient representative, selected 11 indicators that evaluate structures, processes and outcomes, and five vulnerability stratifiers. Although most indicators and stratifiers could be implemented in all three hospitals, data availability was limited for some variables, including patient satisfaction and access to interpreters for foreign-language patients.

CONCLUSIONS: The equity indicators and stratifiers identified by this two-stage process have content validity, wide patient coverage and are focused on inequities in the healthcare system that are actionable through improvement projects. Both the indicators and the project methodology could be replicated in institutions aiming for more equitable care.

References

  1. Doherty R, Cooney TG, Mire RD, Engel LS, Goldman JM; Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians. Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians. Ann Intern Med. 2020 Jan;172(2 Suppl):S3–6. doi: https://doi.org/10.7326/M19-2411 DOI: https://doi.org/10.7326/M19-2411
  2. Health D of. The NHS Plan: a plan for investment, a plan for reform. The Stationery Office Parliamentary Press, Mandela Way, London, SE1 5SS, customer.services@tso.co.uk; 2000. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/+mp_/http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4002960
  3. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC). US: National Academies Press; 2001.
  4. Health Care Quality and Outcomes Indicators - OECD. Available from: https://www.oecd.org/health/health-care-quality-outcomes-indicators.htm
  5. Vincent C, Staines A. Enhancing the quality and safety of swiss healthcare. Federal Office of Public Health on quality and safety of healthcare in Switzerland; 2019.
  6. Achieving Health Equity. A Guide for Health Care Organizations | IHI - Institute for Healthcare Improvement. Available from: http://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Health-Equity.aspx. https://www.ihi.org/resources/white-papers/achieving-health-equity-guide-health-care-organizations
  7. Bosworth B. Increasing Disparities in Mortality by Socioeconomic Status. Annu Rev Public Health. 2018 Apr;39(1):237–51. doi: https://doi.org/10.1146/annurev-publhealth-040617-014615 DOI: https://doi.org/10.1146/annurev-publhealth-040617-014615
  8. Akinade T, Kheyfets A, Piverger N, Layne TM, Howell EA, Janevic T. The influence of racial-ethnic discrimination on women’s health care outcomes: A mixed methods systematic review. Soc Sci Med. 2023 Jan;316:114983. doi: https://doi.org/10.1016/j.socscimed.2022.114983 DOI: https://doi.org/10.1016/j.socscimed.2022.114983
  9. Burton-Jeangros C, Cullati S, Manor O, Courvoisier DS, Bouchardy C, Guessous I. Cervical cancer screening in Switzerland: cross-sectional trends (1992-2012) in social inequalities. Eur J Public Health. 2017 Feb;27(1):167–73. DOI: https://doi.org/10.1093/eurpub/ckw113
  10. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–45. doi: https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN DOI: https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN
  11. LaVeist TA, Gaskin D, Richard P. Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 2011;41(2):231–8. doi: https://doi.org/10.2190/HS.41.2.c DOI: https://doi.org/10.2190/HS.41.2.c
  12. Yi H, Ng ST, Farwin A, Pei Ting Low A, Chang CM, Lim J. Health equity considerations in COVID-19: geospatial network analysis of the COVID-19 outbreak in the migrant population in Singapore. J Travel Med. 2021 Feb;28(2):28. doi: https://doi.org/10.1093/jtm/taaa159 DOI: https://doi.org/10.1093/jtm/taaa159
  13. Riou J, Panczak R, Althaus CL, Junker C, Perisa D, Schneider K, et al. Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis. Lancet Public Health. 2021 Sep;6(9):e683–91. doi: https://doi.org/10.1016/S2468-2667(21)00160-2 DOI: https://doi.org/10.1016/S2468-2667(21)00160-2
  14. World Health Organization website. Health topic: Equity. World Health Organization website. Available from: https://www.who.int/health-topics/health-equity
  15. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988 Sep;260(12):1743–8. doi: https://doi.org/10.1001/jama.1988.03410120089033 DOI: https://doi.org/10.1001/jama.260.12.1743
  16. Lorini C, Porchia BR, Pieralli F, Bonaccorsi G. Process, structural, and outcome quality indicators of nutritional care in nursing homes: a systematic review. BMC Health Serv Res. 2018 Jan;18(1):43. doi: https://doi.org/10.1186/s12913-018-2828-0 DOI: https://doi.org/10.1186/s12913-018-2828-0
  17. Calvillo-King L, Arnold D, Eubank KJ, Lo M, Yunyongying P, Stieglitz H, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med. 2013 Feb;28(2):269–82. doi: https://doi.org/10.1007/s11606-012-2235-x DOI: https://doi.org/10.1007/s11606-012-2235-x
  18. Anderson AC, O’Rourke E, Chin MH, Ponce NA, Bernheim SM, Burstin H. Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment. Health Aff (Millwood). 2018 Mar;37(3):371–7. doi: https://doi.org/10.1377/hlthaff.2017.1301 DOI: https://doi.org/10.1377/hlthaff.2017.1301
  19. Dover DC, Belon AP. The health equity measurement framework: a comprehensive model to measure social inequities in health. Int J Equity Health. 2019 Feb;18(1):36. doi: https://doi.org/10.1186/s12939-019-0935-0 DOI: https://doi.org/10.1186/s12939-019-0935-0
  20. Wolkin A, Collier S, House JS, Reif D, Motsinger-Reif A, Duca L, et al. Comparison of National Vulnerability Indices Used by the Centers for Disease Control and Prevention for the COVID-19 Response. Public Health Rep. 2022;137(4):803–12. doi: https://doi.org/10.1177/00333549221090262 DOI: https://doi.org/10.1177/00333549221090262
  21. Panczak R, Galobardes B, Voorpostel M, Spoerri A, Zwahlen M, Egger M; Swiss National Cohort and Swiss Household Panel. A Swiss neighbourhood index of socioeconomic position: development and association with mortality. J Epidemiol Community Health. 2012 Dec;66(12):1129–36. doi: https://doi.org/10.1136/jech-2011-200699 DOI: https://doi.org/10.1136/jech-2011-200699
  22. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, et al. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002 May;324(7347):1183. doi: https://doi.org/10.1136/bmj.324.7347.1183 DOI: https://doi.org/10.1136/bmj.324.7347.1183
  23. Bischoff A, Tonnerre C, Eytan A, Bernstein M, Loutan L. Addressing language barriers to health care, a survey of medical services in Switzerland. Soz Praventivmed. 1999;44(6):248–56. doi: https://doi.org/10.1007/BF01358973 DOI: https://doi.org/10.1007/BF01358973
  24. Kounev S, Lange KD, von Kistowski J. Standardization. In: Kounev S, Lange KD, von Kistowski J, editors. Systems Benchmarking: For Scientists and Engineers. Cham: Springer International Publishing; 2020. pp. 203–27. 10.1007/978-3-030-41705-5_9 DOI: https://doi.org/10.1007/978-3-030-41705-5_9
  25. Oesch D. La structure économique et sociale de la Suisse. LIVES Working papers. 2022;94. Available from: http://dx.doi.org/10.12682/lives.2296-1658.2022.94
  26. Spycher J, Morisod K, Eggli Y, et al. Indicators on Healthcare Equity in Switzerland. New Evidence and Challenges. Rapport sur mandat de l’Office fédéral de la santé publique OFSP. 2021.
  27. Ebert ST, Pittet V, Cornuz J, Senn N. Development of a monitoring instrument to assess the performance of the Swiss primary care system. BMC Health Serv Res. 2017 Nov;17(1):789. doi: https://doi.org/10.1186/s12913-017-2696-z DOI: https://doi.org/10.1186/s12913-017-2696-z
  28. Hudelson P, Dominice Dao M, Perneger T, Durieux-Paillard S. A “migrant friendly hospital” initiative in Geneva, Switzerland: evaluation of the effects on staff knowledge and practices. PLoS One. 2014 Sep;9(9):e106758. doi: https://doi.org/10.1371/journal.pone.0106758 DOI: https://doi.org/10.1371/journal.pone.0106758
  29. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000 Oct;32(4):1008–15. doi: https://doi.org/10.1046/j.1365-2648.2000.t01-1-01567.x DOI: https://doi.org/10.1046/j.1365-2648.2000.t01-1-01567.x
  30. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al.; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. doi: https://doi.org/10.1016/j.jbi.2019.103208 DOI: https://doi.org/10.1016/j.jbi.2019.103208
  31. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. doi: https://doi.org/10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010
  32. Kallen MC, Roos-Blom MJ, Dongelmans DA, Schouten JA, Gude WT, de Jonge E, et al. Development of actionable quality indicators and an action implementation toolbox for appropriate antibiotic use at intensive care units: A modified-RAND Delphi study. PLoS One. 2018 Nov;13(11):e0207991. doi: https://doi.org/10.1371/journal.pone.0207991 DOI: https://doi.org/10.1371/journal.pone.0207991
  33. Hekkert KD, Cihangir S, Kleefstra SM, van den Berg B, Kool RB. Patient satisfaction revisited: a multilevel approach. Soc Sci Med. 2009 Jul;69(1):68–75. doi: https://doi.org/10.1016/j.socscimed.2009.04.016 DOI: https://doi.org/10.1016/j.socscimed.2009.04.016
  34. Mpinga EK, Chastonay P. Satisfaction of patients: a right to health indicator? Health Policy. 2011 May;100(2-3):144–50. doi: https://doi.org/10.1016/j.healthpol.2010.11.001 DOI: https://doi.org/10.1016/j.healthpol.2010.11.001
  35. Jenkinson C, Coulter A, Bruster S. The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care. 2002 Oct;14(5):353–8. doi: https://doi.org/10.1093/intqhc/14.5.353 DOI: https://doi.org/10.1093/intqhc/14.5.353
  36. Thayaparan AJ, Mahdi E. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings. Med Educ Online. 2013 Jul;18(1):21747. doi: https://doi.org/10.3402/meo.v18i0.21747 DOI: https://doi.org/10.3402/meo.v18i0.21747
  37. Bischoff A, Hudelson P. Access to healthcare interpreter services: where are we and where do we need to go? Int J Environ Res Public Health. 2010 Jul;7(7):2838–44. doi: https://doi.org/10.3390/ijerph7072838 DOI: https://doi.org/10.3390/ijerph7072838
  38. Touré V, Krauss P, Gnodtke K, Buchhorn J, Unni D, Horki P, et al. FAIRification of health-related data using semantic web technologies in the Swiss Personalized Health Network. Sci Data. 2023 Mar;10(1):127. doi: https://doi.org/10.1038/s41597-023-02028-y DOI: https://doi.org/10.1038/s41597-023-02028-y
  39. Tyser AR, Abtahi AM, McFadden M, Presson AP. Evidence of non-response bias in the Press-Ganey patient satisfaction survey. BMC Health Serv Res. 2016 Aug;16(1 a):350. doi: https://doi.org/10.1186/s12913-016-1595-z DOI: https://doi.org/10.1186/s12913-016-1595-z
  40. Perneger TV, Peytremann-Bridevaux I, Combescure C. Patient satisfaction and survey response in 717 hospital surveys in Switzerland: a cross-sectional study. BMC Health Serv Res. 2020 Mar;20(1):158. doi: https://doi.org/10.1186/s12913-020-5012-2 DOI: https://doi.org/10.1186/s12913-020-5012-2
  41. Deutsch MB, Plasencia N. Patient Attitudes on Collection of Sexual Orientation and Gender Identity Data in a Women’s Health Clinic with an Embedded Transgender Medicine Program. LGBT Health. 2023 Oct;10(7):552–9. doi: https://doi.org/10.1089/lgbt.2021.0381 DOI: https://doi.org/10.1089/lgbt.2021.0381
  42. Haider A, Adler RR, Schneider E, Uribe Leitz T, Ranjit A, Ta C, et al. Assessment of Patient-Centered Approaches to Collect Sexual Orientation and Gender Identity Information in the Emergency Department: the EQUALITY Study. JAMA Netw Open. 2018 Dec;1(8):e186506. doi: https://doi.org/10.1001/jamanetworkopen.2018.6506 DOI: https://doi.org/10.1001/jamanetworkopen.2018.6506
  43. Cahill S, Singal R, Grasso C, King D, Mayer K, Baker K, et al. Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One. 2014 Sep;9(9):e107104. doi: https://doi.org/10.1371/journal.pone.0107104 DOI: https://doi.org/10.1371/journal.pone.0107104
  44. Garg A, LeBlanc A, Raphael JL. Inadequacy of Current Screening Measures for Health-Related Social Needs. JAMA. 2023 Sep;330(10):915–6. doi: https://doi.org/10.1001/jama.2023.13948 DOI: https://doi.org/10.1001/jama.2023.13948
  45. Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008 Feb;98(2):216–21. doi: https://doi.org/10.2105/AJPH.2007.114777 DOI: https://doi.org/10.2105/AJPH.2007.114777

Most read articles by the same author(s)

1 2 3 > >>