A new study has taken a closer look at how healthcare quality is measured in three major countries—Israel, the United States, and the United Kingdom—uncovering striking similarities and critical gaps. The research delved into Israel’s Quality Indicators in Community Healthcare (QICH), the US’s Healthcare Effectiveness Data and Information Set (HEDIS), and the UK’s Quality and Outcomes Framework (QOF). While all three systems prioritize family medicine and process-focused metrics, the study highlights a lack of attention to structural and outcome-based indicators. The findings underscore the need to rethink how we assess healthcare quality, urging a more balanced approach that includes all aspects of medical care, from infrastructure to patient outcomes. This analysis sheds light on how countries can learn from each other to provide better, more equitable care for their populations.
A new comparative study led by Prof. Adam J. Rose from the Hebrew University's Braun School of Public Health and Community Medicine, alongside Reut Israeli from the Hebrew University’s Braun School of Public Health and Community Medicine and Dr. Gil A. Geva from Tel Hashomer, sheds light on how healthcare quality is measured in Israel, the United States, and the United Kingdom. The study evaluated three major sets of quality indicators: Israel's Quality Indicators for Community Healthcare (QICH), the US's Healthcare Effectiveness Data and Information Set (HEDIS), and the UK's Quality and Outcomes Framework (QOF).
The findings, published in Journal of General Internal Medicine highlight key differences and similarities in how healthcare systems prioritize quality measures, providing critical insights for future policy development.
The key findings of the study highlight several important aspects. First, all three measure sets heavily focus on family medicine and primary care, which account for the majority of their indicators. This emphasis may inadvertently overlook the contributions of other medical disciplines such as mental health, surgery, and internal medicine.
Second, the study revealed an overwhelming reliance on process measures across the three systems, with limited emphasis on structural and definitive outcome measures. For instance, while QICH emphasized intermediate outcomes, it lacked indicators for structural measures and completely omitted definitive patient outcomes.
Third, the domains of "effective clinical care," "community/population health," and "communication and care coordination" received the most attention across all three systems. However, certain domains, such as "efficiency and cost reduction" and "patient safety," were underrepresented, particularly in QICH and QOF.
Finally, the study attributes differences in indicator selection to systemic and procedural disparities. While QICH operates through a voluntary, collaborative framework with Israel’s HMOs, both HEDIS and QOF are guided by external agencies that rely on financial incentives to drive compliance.
Implications for Policy and Practice:
Dr. Rose emphasized the need for greater balance in quality measurement systems, particularly in addressing underrepresented medical disciplines and quality domains. “Reassessing these indicators regularly could help ensure they better reflect the comprehensive needs of healthcare systems and the populations they serve,” said Dr. Rose.
The study serves as a foundation for future research to refine and expand quality measurement frameworks, enabling healthcare systems to promote more equitable and effective care.
The research paper titled “Evaluating and Comparing the Content Coverage of Quality Measure Sets from Israel, the United States, and the United Kingdom” is now available in Journal of General Internal Medicine and can be accessed at https://doi.org/10.1007/s11606-025-09363-3
Researchers:
Reut Israeli1, Gil A. Geva2, Adam J. Rose1,3
Institutions:
1) Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
2) Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
3) National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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