hspa 20150505 bernal-delgado echo project
TRANSCRIPT
www.echo-health.eu
ECHO – European Collaboration for Healthcare Optimization An international project on healthcare performance assessment
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
www.echo-health.eu
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
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PCI and burden of ischemic diseaseP
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Burden of ischemic disease
www.echo-health.eu
PCI utilization across welfare levels
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England Denmark
Portugal Spain
www.echo-health.eu
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
www.echo-health.eu
Substantial variation in Potentially avoidable hospitalizations in chronic conditions
www.echo-health.eu
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
www.echo-health.eu
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)
www.echo-health.eu
• 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.
www.echo-health.eu
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Patient undergoing surgery
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Providers are identified using aspirational benchmarking