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The ECHO project: potential insights into equitable access, quality and efficiency of health care in Europe

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Comparing health care systems: the usual way

• What are the health outcomes? • How much does it cost to get those outcomes? • Who pays for it? • Who benefits? • Which benefits? • How do they do it?

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What are we missing by using this approach?

• Variation is a local phenomenon, and…

• No variation might mislead conclusions • Proper attribution drives to action • Variation varies over time differently across areas • The relative impact on population´s health • Proper conclusions require proper comparisons

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Sweden: 43 per 1,000 inh. Spain: 45 per 1,000 inh.

No variation might mislead conclusions: knee replacement

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Proper attribution drives to action: PTA vs burden of disease

Region ICC: 0.4

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Variation varies over time differently across areas

PTA 2002-2009

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Prostatectomy in prostate cancer

The relative impact on population´s health

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Proper comparisons require proper adjustment

-2

-1,5

-1

-0,5

0

0,5

1

1,5

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… After pooling patients and risk adjustment

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ECHO: the project

• The consortium • Goals • Answering two questions • Performance model • Methods

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Goals

• Using established indicators adopted by international organisations, particularly those by AHRQ-OECD-EU, we will provide a set of accurate performance indicators

• Sound analysis of the actual performance of different providers at geographical and hospital levels

• Methodological insight into overcoming some of the classic hindrances for adequate performance measurement (ie, case-mix adjusted measures, Bayesian statistics, multilevel analyses, funnel plots, etc).

• Building tools to help decision-makers in taking informed decisions to tackle unwarranted variation.

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Does the place of residency influence

the population exposure to effective

and safe care?

Geographical-based approach

Is the likelihood of getting high-quality

and safe care dependant on the provider where a

person is assisted?

Hospital-specific approach

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3D ECHO performance model

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2 examples…

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ECHO: methods

• DWH building • Information analysis • Set of indicators (performance model)

• Methodological developments • Indicators validation • Risk adjustment measures • Flows analyses • Accounting for costs

• Health policy analyses on ECHO results

• Dissemination: Local feedback groups

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more at www.echo-health.eu