In the beginning of 2010, a new European four-year research project was launched to evaluate the performance of European health care systems in terms of outcomes, quality, use of resources and costs. The results from focused work are now emerging.
EuroHOPE will be directed and coordinated by the Centre for Health and Social Economics (CHESS) at the National Institute for Health and Welfare (THL).
At the focal point is the evaluation of five key public health problems or diseases: acute myocardial infarction (AMI), stroke, hip fracture, breast cancer, and low-birth-weight infants. In addition, using data from Nordic hospitals, productivity will be related to quality of care.
Aims of the EuroHOPE are seven-folded:
While there is still research work to be completed until the project reaches its aimed terminal, hard work has yielded several results already. The project has published two articles in Health Policy (Häkkinen et al. Health care performance comparison using a disease-based approach: The EuroHOPE project., Health Policy. 2013 Sep;112(1-2):100-9; and Medin et al. International hospital productivity comparison: Experiences from the Nordic countries, Health Policy. 2013 Sep;112(1-2):80-87.).
Also, the following remarkable country, and regional level differences and variation have been found in the patient groups EuroHOPE is focusing on.
AMI AMI patients are treated very different in EuroHOPE countries. Rates for having PCI conducted within 2 first days since infarction vary from Netherlands’ 9 % up to Swedes’ 40 %. In same manner, a lot of variation emerges for one year mortality from Norway’s 12 % up to Hungary’s nearly 29 %, all figures age and sex standardised.
Stroke Features are not any different for ischemic stroke patients. Variation for standardised mean length of first hospital episode stay is from Hungary’s 10 days up to Scotland’s 16 days. It remains to be studied whether Hungary’s short length of stay is a factor for their highest standardised one year mortality (31 %) while the best in mortality figures is doing Italy (15 %).
Hip fracture Hip fracture patients get off the bed soonest in Norway (LoS 9.5 days) while in Italy patients are in hospital nearly 10 days more (19 days). In contrast, their one year mortality figures are the lowest (19 %) while the Hungary is having almost 40 % one year age and sex standardised mortality.
Breast cancer The pilot data show variation in the incidence rate of invasive cancer from 167.8 per 100,000 in Norway to 222.4 per 100,000 in Sweden. The stage of cancer is an important factor in predicting recurrence and survival. The data have revealed large amounts of missing data in tumour pathology. There seems to be large differences between countries in the proportion of patients treated with surgery but this is still to be verified. Only small variation between countries exists for one year breast cancer mortality. Scotland's five year breast cancer mortality is considerably higher than that of Finland and Sweden. Very little birth weight infants Vast variance for mean length of first hospital episode exists between and within countries. Lengths of stay varied from Norwegian minimum of 19 days to Swedish maximum stay of 69 days. For standardised one year mortality the variance was similar being the highest in Hungary with 32 % and lowest in Sweden with slightly above 1 %.
Nordic Hospital comparison The productivity of Finnish hospitals is considerably higher than in other Nordic countries (Figure 1). However, strong variation exists within countries.
The findings from the EuroHOPE studies clearly indicate the need for seeking the answer for the differences. That is the main aim of the whole project and research on seeking for explanatory features for regional and country level differences is currently on and will be published in set of clinical articles in specialised journals while main outcomes are to be collected in a supplement issue of Health Economics. Also, benchmarking will be made available for wide audience through a web-based application, Atlas, where one is able to compare standardised key indicators between and within countries yielded from the project. The application is currently on pilot testing and will be available on the project website in the Spring 2014.
Implementing European-wide benchmarking on outcomes, quality and costs, which enables decision-makers as well as health professionals at different levels to learn from the best practices.