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ECHO Project in Sydney in July 2013 for the 9th World Congress of the International Health Economics Association
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ECHO Project in Sydney in July 2013 for the 9th World Congress of the International Health Economics Association

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European Collaboration for Healthcare Optimization An international project on healthcare performance. …

European Collaboration for Healthcare Optimization An international project on healthcare performance.
ECHO has set about the task of bringing together patient-level data from Austria, Denmark, England, Portugal, Slovenia and Spain, making them comparable.
ECHO is expanding the usual approach in healthcare performance international comparison, by adding the variation framework.


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  • 1. www.echo-health.eu ECHO – European Collaboration for Healthcare Optimization An international project on healthcare performance Enrique Bernal-Delgado, Sandra García-Armesto Julián Librero, Natalia Martínez, Cristobal Baixauli, Manolo Ridao, and Miriam Seral on behalf of the ECHO consortium
  • 2. www.echo-health.eu The concept • ECHO has set about the task of bringing together patient-level data from Austria, Denmark, England, Portugal, Slovenia and Spain, making them comparable. • ECHO is expanding the usual approach in healthcare performance international comparison, by adding the variation framework • The value-attribute informs on whether exposure/quality reaches an acceptable level using a reference-value. The variation-attribute signals whether the differences observed across territories/providers are unwarranted and systematic. • Performance dimensions: utilization, equitable access to effective care, quality, and efficiency, in terms of opportunity costs, and provider-level efficiency. • Healthcare areas or hospital providers will be flagged as over- or under performers – not a diagnostic tool but a screening tool
  • 3. www.echo-health.eu Geographic-perspective Hospital-perspective 1. Effective care (hip fracture, colectomy in colorectal cancer, breast surgery in breast cancer, etc) 2. Uncertain benefit/harm balance in “non-average” patients (CABG, knee replacement, etc.) 3. Doubtful/ lower value care and opportunity costs (tonsillectomy, spinal fusion, prostatectomy, etc.) 1. In-hospital case fatality rates for a condition (admissions with principal diagnosis of acute myocardial infarction, ischemic stroke); 2. In-hospital case fatality rates after a procedure (in hospital mortality after CABG, PCI, non- ruptured abdominal aortic aneurysm, hip replacement) 3. Patient safety event rates (Trauma after vaginal delivery with and without instrumentation, Catheter-related infection, Pulmonary Thromboembolism or Deep venous thrombosis, Postoperative sepsis)
  • 4. www.echo-health.eu Some key issues in ECHO’s international comparisons • Building a homogeneous knowledge infrastructure – 250 million discharges (universe of hospitalizations since 2002 to 2009) plus ECHO indicators, plus contextual info • Developing crosswalks across different languages – ICD 9th ICD10th – ICD 9th NOMESCO ACHI OPCS LEISTUNG-KATALOGUE-BMG • Treating size (volume) heterogeneity across units of analysis – Comparable geographic units – Controlling extra-heterogeneity • Making patients and populations comparable by pooling all eligible cases and … – Age-sex standardization or Risk adjustment
  • 5. www.echo-health.eu Some messages from ECHO performance assessment Utilization of effective procedures Equity Quality Efficiency
  • 6. www.echo-health.eu Utilization of effective procedures Case-study: unwarranted variation in the use of PCI
  • 7. www.echo-health.eu PCI Rate 32.9 22.9 19.7 47.9 20.1 RV5-95 1.95 3.4 3.8 2.4 3.2 EB 0.03 0.26 0.1 0.26 0.24
  • 8. www.echo-health.eu PCI in Slovenia and Portugal
  • 9. www.echo-health.eu Equity Case-study: income “effect” in hip replacement
  • 10. www.echo-health.eu England vs Spain: hip replacement 0 5 10 15 2002 2003 2004 2005 2006 2007 2008 2009 0 5 10 15 20 25 30 35 2002 2003 2004 2005 2006 2007 2008 2009 Q1' Q2' Q3' Q4' Q5'
  • 11. www.echo-health.eu Quality Case study: mortality after CABG – pooled 26,000 patients from England and Spain
  • 12. www.echo-health.eu
  • 13. www.echo-health.eu Spain to England adjusted mortality OR = 1.5 [CI95% (1.1 to 2.03)] Logit Multilevel: Fixed: age, sex, comorbidity, emergency Random: hospital
  • 14. www.echo-health.eu Efficiency
  • 15. www.echo-health.eu • Measuring hospital efficiency using SFA: a comparative analysis of hospitals in Europe – Ceu Mateus • Variation in length of stay and in-patient mortality for AMI patients in Europe – Karen Bloor • How to make comparable healthcare areas across European countries – Terkel Christiansen • Using geo analysis to enhance allocative efficiency: opportunity costs of lower value care – Sandra García- Armesto
  • 16. www.echo-health.eu more at www.echo-health.eu