ECHO European Collaboration for Healthcare Optimization
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1 ECHO European Collaboration for Healthcare Optimization An international project on variations in healthcare performance Enrique Bernal-Delgado Sandra García-Armesto on behalf of the ECHO Consortium
2 Disclosure: results in this presentation are preliminary, therefore subject of further validation. They have been used just for illustrative purposes. Acknowledgments: Indebted to Natalia Martínez-Lizaga, Manuel Ridao and Miriam Seral who helped building all the results.
3 The concept ECHO has set about the task of bringing together patient-level data from several European countries, 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. Geographic perspective studying population exposure to healthcare, and, hospital-provider perspective, analysing patients exposure to hospital care
4 OECD variations project within the ECHO conceptual framework Effective care Hip fracture repair Uncertain benefit-risk balance in non-average patients Hospital admissions PCI CABG Knee replacement Arthroscopy Lower-value care C-section in low-risk deliveries PSA testing
5 Hip fracture repair Rate RV EB
6 Hip fracture repair in Spain Age-sex standardized rate per 10,000 inhabitants Standardized utilization ratio
7 PCI Rate RV EB
8 PCI in Denmark Age-sex standardized rate per 10,000 inhabitants Standardized utilization ratio
9 CABG Rate RV EB
10 CABG in England Age-sex standardized rate per 10,000 inhabitants Standardized utilization ratio
11 Knee replacement (all primary and revision) Rate RV EB
12 Knee replacement Age-sex standardized rate per 10,000 inhabitants Standardized utilization ratio
13 C-section in low-risk deliveries Rate RV EB
14 Some keys in ECHO international comparisons Building crosswalks Treating size heterogeneity across units of analysis Pooling data using same standards
15 CROSSWALKS: comparable definition Percutaneous Coronary Intervention ICD-MC 9th (SPAIN AND PORTUGAL) NOMESCO (DENMARK) OPCS4 code (ENGLAND) ACHI (SLOVENIA) FNG05 FNG02 FNG22 FNG96 FNW98 K49% K501% K75% K76%
16 size heterogeneity across units of analysis Portugal Spain Denmark England Slovenia inhabitants n % n % n % n % n % < < < < < < < < < < > total
17 Treating size heterogeneity across units of analysis Stabilizing statistics: Aggregating years missing time-based phenomena Aggregating areas missing ability of attribution Building new areas are they meaningful? Using proper statistics Is RV or CV the best alternative? Not representing systematic variation affected by over-dispersion Is CSV or EB the best alternative? non-intuitive Needs reference (calibrators)
18 Denmark, England and Portugal building new areas based on the actual population flows and catchment areas New areas in Denmark
19 Proper statistics in measuring systematic variation 0,4 0,35 Coefficient of Variation vs. EB statistic Empírical Bayes 0,3 0,25 0,2 0,15 0,1 0, ,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 Coefficient of Variation
20 Pooling data allows for sounder international comparison 2 1,5 1 0,5 0-0,5-1 -1,5-2 CABG mortality England vs Spain -2,5 England Spain Rho: 14% (CI: 9.9%-20%)
21 ECHO European Collaboration for Healthcare Optimization An international project on variations in healthcare performance Enrique Bernal-Delgado Sandra García-Armesto on behalf of the ECHO Consortium
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