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ISO Health Indicators Conceptual Framework

A common health indicators conceptual framework can inform the selection and interpretation of meaningful health indicators. Such a framework identifies what information is required to address questions about health and health care, how these pieces fit together and the interrelationships between them. This framework is based on Canada's health indicator framework.

The health indicators conceptual model is based on a population health, or determinants of health model. This framework reflects the principle, based on the supporting scientific evidence, that health is determined by a complex interaction of factors, including the social and physical environments, wellbeing, prosperity, health care, as well as genetic endowment and individual behavioural and biological response. In other words, according to the population health perspective, health is not determined solely by medical care, but by a range of individual-and population-level cultural, social and economic factors.

Ref: Health informatics-Health indicators conceptual framework technical specification ISO/TS 21667 First edition 2004-04-01.

Dimensions of this framework

  • Community and health system characteristics

    The dimension of community and health system characteristics contains contextual information which may be useful in interpretation of indicators.

    Sub-dimensions of this framework

    • Health system

      Contextual information about the configuration, organisation, sustainability of utilization of the health care system.

      Examples include number of coronary artery bypass graft (CABG) per capita, number of home care services provided per capita.

    • Population

      Contextual information about the characteristics of the population.

      Examples include health insurance enrolment, % population over 65 years of age, % residing in urban centres.

    • Resources

      The dimension of community and health system characteristics contains contextual information which may be useful in interpretation of indicators.
  • Health status

    Deaths, or measures of length of life, are perhaps the most widely used and available health status indicators. These include a range of age-specific mortality rates, as well as derived indicators such as life expectancy and potential years of life lost.

    Sub-dimensions of this framework

  • Health system performance

    Factors that are able to capture outcomes, or processes that may be related to outcomes that result from contact with the health care system. Nine categories of indicators are considered within this health system performance dimension.

    Sub-dimensions of this framework

    • Acceptability

      All care/services provided meet the expectation s of the client, community, providers and payment organisations, recognizing that there may be conflicting, competing interests between stakeholders and that the needs of the clients/patients are paramount.
    • Accessibility

      The ability of clients/patients to obtain care/service at the right place and the right time, based on respective needs.

      Examples include waiting times, practice availability and availability of dentists.

    • Appropriateness

      Care/service is relevant to the clients/patients' needs and based on established standards.

      Examples include inappropriately used surgery, appropriate use of ACEI at discharge for heart failure.

    • Competence

      An individual's knowledge and skills are appropriate to the care/service being provided.
    • Continuity

      The ability to provide uninterrupted coordinated care/service across programs, practitioners, organisations, and levels of care/service, overtime.
    • Effectiveness

      The care/service, intervention or action achieves the desired result.

      Examples include cancer survival, recurrence of hernia after repair, smoking cessation during pregnancy (effectiveness of maternal health care), chronic care management: admission rates for asthma, diabetes, epilepsy.

    • Efficiency

      Achieving the desired results with the most cost-effective use of resources.

      Examples include avoidable hospitalizations, cost per casemix-adjusted separation, cost-effective prescribing.

    • Safety

      Potential risks of an intervention of the environment are avoided or minimized.

      Examples include hospital-acquired infection rate.

  • Non-medical determinants of health

    Non-medical determinants of health are those that fall outside the sphere of medical/health care, generally speaking, but that have been shown to affect health status and, in some cases, access to health services.

    Sub-dimensions of this framework