Avoidable mortality in New Zealand, 1981-97

We outline the implementation of a new method of measuring the quality of medical care that counts cases of unnecessary disease and disability and unnecessary untimely deaths. First of all, conditions are listed in which the occurrence of a single case of disease or disability or a single untimely death would justify asking, "Why did it happen?" Secondly, we have selected conditions in which critical increases in rates of disease, disability, or untimely death could serve as indexes of the quality of care. Finally, broad categories of illness are noted in which redefinition and intensive study might reveal characteristics that could serve as indexes of health. We describe how these inth of the general population and the effects of economic, political, and other environmental factors upon it, and to evaluate the quality of medical care provided both within and without the hospital to maintain health and to prevent and treat disease.

There is a need for indicators of the outcome of health-care services against which the use of resources can be evaluated. From a previously published series of outcome indicators, which included diseases for which mortality is largely avoidable given appropriate medical intervention, causes were selected which were regarded as most amenable to medical intervention (excluding conditions whose control depends mainly on prevention) and for which there were sufficient numbers of deaths to allow an analysis of the variation in mortality rates among the 98 area health authorities of England and Wales. Considerable variation between AHAs was found in mortality from most of these diseases, and this variation remained even after adjustment for social factors. This substantial variation should be examined further in relation to health-service inputs and other factors. A finding of large variations in the quality of health-care delivery in different parts of the country would have important implications for resource allocation.

To analyse trends of avoidable mortality in Europe, emphasising causes of death amenable to primary prevention through reduction of exposures, secondary prevention through early detection and treatment, and tertiary prevention through improved treatment and medical care. Descriptive study of mortality from avoidable causes for the years 1955 through 1994, for ages 5-64 at time of death. Using the World Health Organisation Mortality Database, five year death rates were standardised to the world population. 21 countries of Europe in four regions (northern, central, and southern Europe, Nordic countries). All causes of deaths for men and women, aged 5-64, at time of death. Between 1955-59 and 1990-94, the reduction in mortality was somewhat greater for avoidable causes than for all causes: 45.8% v 45.1% (women) and 39.3% v 32.6% among men. Reductions in mortality were greater for causes amenable to improved medical care: 77.9% among women and 76.3% among men. The smallest reduction in mortality was seen in women for causes amenable to secondary prevention (11.0%), and in men for causes amendable to primary prevention including tobacco related conditions (16.6%). From a geographical point of view, there were slight differences in trends between European regions, but overall the patterns were similar. The greatest reduction of avoidable mortality in Europe from 1955-94 came from causes amenable to improved treatment and medical care for both sexes. Further reductions of avoidable mortality can be achieved through implementation of primary and secondary prevention activities, such as tobacco control, reduction of occupational exposures, and universal access to breast and cervical cancer screening programmes.