www.echo-health.eu

ECHO – European Collaboration for Healthcare Optimization An international project on healthcare performance assessment

www.echo-health.eu

http://echo-health.eu/supplement/

www.echo-health.eu

Basics

• ECHO employs routinely collected administrative data – hospital discharges, demographic and socioeconomic data, supply features.

• ECHO has set about the task of bringing together patient-level data from Austria, Denmark, England, Portugal, Slovenia and Spain, making them comparable – 200 million episodes

• ECHO is expanding the usual approach in healthcare performance

international comparison (built upon average values and average benchmark), adding variation within and across countries.

• Unwarranted variation is shown for a variety of comparable

performance indicators …

www.echo-health.eu

• Utilization• Effectiveness• Quality & Safety• Efficiency (societal)• Efficiency (productivity)• Equity in access

OECD, ARAH et al 2006

• Age, Sex and Socioeconomic group

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Some methodological keys

• Building a homogeneous knowledge infrastructurehttp://www.echo-health.eu/handbook/infrastructure.html

• Developing comparable indicators across different languages

http://www.echo-health.eu/handbook/getting-indicators.html

• Dealing with population size heterogeneityhttp://www.echo-health.eu/handbook/unit_analysis.html

• Measuring differences in hospitals rather than differences in patients (risk adjustment measures)

http://eurpub.oxfordjournals.org/content/25/suppl_1/15

• Using proper analyses meant to elicit systematic and unwarranted differences in performance

http://www.echo-health.eu/handbook/metrics.html

www.echo-health.eu

Messages from echowith potential impact in policy MAKING

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Uneven utilization of effective procedures

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PCI and burden of ischemic diseaseP

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Burden of ischemic disease

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Uneven utilization of effective proceduresby welfare level

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PCI utilization across welfare levels

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England Denmark

Portugal Spain

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NOTABLE variation in Undesirable events after surgery

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PTE & DVT after surgery

  Denmark England Portugal Slovenia Spain

aIR 1,43 7,55 0,87 4,36 1,87

EQ 25-75 2,11 1,48 3,84 2,04 3,16

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Substantial variation in Potentially avoidable hospitalizations in chronic conditions

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DENMARK

ENGLAND PORTUGAL

SLOVENIA

SPAIN

SR 93.36 56.15 33.96 61.86 47.02

EQ5-95 1.46 1.38 2.01 2.25 2.44

SCV 1.09 0.14 0.17 0.14 0.11

PAH IN CHRONIC CONDITIONS

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Uneven utilization of low-value PROCEDURES

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  DENMARK ENGLAND PORTUGAL SLOVENIA SPAIN

SR 40.13 19.55 7.02 21.45 8.58

EQ5-95 1.66 4.69 46.80 3.54 35.36

SCV 0.16 0.28 2.19 0.20 1.26.

C-section in low risk deliveries (excess risk)

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UNEVEN outcomes vs. uneven resources use

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SH

OR

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R L

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LESS MORTALITY

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www.echo-health.eu

ECHO AS A HSPA TOOL

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• For each performance indicator or set of performance indicators, and with respect to a particular benchmark, health care providers are identified as better- or poorer performers.

• Providers’ can be tracked down, and any change in performance monitored.

• Identification and monitoring have to be considered as a screening rather than a firm diagnosis.

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Areas with excess-cases of … are flagged

Minimisation to p10

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Hospitals are followed up for …

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Patient undergoing surgery

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Providers are identified using aspirational benchmarking

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