With health systems under pressure, quality, access and efficiency of healthcare services are at the heart of many debates in health policy-making and management in Europe. Evidence suggests that there are unwarranted variations in medical practice within healthcare systems, both in terms of the place where a person lives and in terms of the service provider. Measuring the performance of European health systems in a comparable and quantifiable way would allow for addressing these variations. However, as data sets available differ, comparing performance remains a major challenge, especially when it comes to evaluate health outcomes and assess the drivers of variations.
ECHO has set about the demanding task of bringing together databases of several European countries and making them comparable, with a view to provide new insights into equitable access, quality and efficiency of health care in Europe. Through an online ECHO tool the project will bring data and analysis to the fingertips of policy and management decision makers, supporting them in their efforts to contribute to responsive, safe and sustainable health systems.
There is significant research showing unwarranted variations in medical practice within healthcare systems, both from the point of view of the place where a person lives, and from the point of view of the service provider. These phenomena entail differences in health outcomes, in access to effective care and in efficiency in the use of resources.
Such differences are often masked when performance is assessed using only average measures with no consideration for the range of variation across territory and/or providers. Once these variation dimensions are added, systems can be compared not only on the basis of the results they achieve but on how homogeneous is performance across their parts.
Addressing unwarranted variations consists of reducing bad variation while preserving good variation and learning from these practices. Good care practices are then fostered (increasing healthcare quality), efficiency enhanced (reducing over and under use) and best policy and management practices are identified in different contexts. This approach allows for identifying hot spots in the organisation or bottle-necks in the management process, pointing out priority targets for action.
International comparison brings to the front-stage benchmarking, putting in perspective relative performance and variation of performance across the system beyond national inertias.
ECHO seeks to address performance measurement by applying two different methodological approaches: one is population geographical-based, the other one provider-specific. When it comes to population-based measures, the ECHO Project analyses country reality at the level of the smallest geographical area relevant in healthcare planning and functioning (health care area); the provider-specific indicators are measured at both hospital-provider and healthcare area level.
To this end the project brings together hospital and regional data from six countries. These data include individual in-patients registries as well as geographically referred population structure, socioeconomic and supply data. Of course no individual patient can be identified with all anonimisation procedures in place before merging and building the ECHO dataset. State-of-the-art methodological developments allow for data standardisation and storing in a high-standard data-warehouse.
Indicators and their variation will be modelled using edge- cutting multilevel approaches. These techniques allow for building into models decision-making structures, supply and demand-side factors with a view of identifying the sources of variation.
The project is expected to deliver:
The project pilots the feasibility of building a standardised international dataset able to feed comparative performance analyses based on individual inpatient data; the metrics of such performance analysis incorporates for the first time geographical and provider unwarranted variations. The results will be made publicly available on line for policy makers, managers, the scientific community and the general public.
This interactive digital format of accessing all the analysis performed in the project is complemented with a logged dynamic analytic tool targeted to research partners and policy makers. The logged tool, also web-based, allows the user for tailored queries better matching their own questions of interest. It enables users to use the whole ECHO tool-kit even with little or no command of the underpinning statistical methods
The success of this pilot involving the 6 initial partners may encourage more extensive use and adoption of the combined within and cross-country approach; the usability of the results in decision making may eventually call for a sustained information system involving a broader set of countries at EU level.
The ECHO project consortium is made up of partners from 7 countries which are listed below: