The framework programmes for research and for technological development funded several projects to develop indicators and methodologies to assess the performance of health systems, generic among them the ECHO project, medicine which the following results: a refined set of accurate performance indicators; reliable information on actual performance of five different European Healthcare systems (Danish, treatment English, Portuguese, Slovenian and Spanish), at geographical and hospital levels; Handbook: methodological insight on how to go about overcoming some of the classical hindrances for adequate performance measurement; A set of web-based analytical tools for replicating methods and analyses on more specific and local problems.
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 main results will soon be made publicly available on line for policy makers, managers, the scientific community and the general public, summarized in the ECHO Atlas reports. This Atlases will be complemented with a logged dynamic analytic tool targeted to public researchers 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
As a matter of illustration, some findings with direct impact on policy making are: 1) At population level, the burden of coronary ischemic disease does barely explain variation in revascularization; 2) coronary revascularization is performed differently across income quintiles, not always coherent with need; 3) case-fatality rates varies dramatically across high-volume hospitals, irrespective of the differences in patient case-mix; 4) In-country variation remains moderately high and stable over time in potentially avoidable admissions. At the same time, the average standardized rate is decreasing just in some countries; or 5) Variation in lower-value procedures is huge, within and across countries.
The success of this pilot involving the 5 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.
Project web-site: www.echo-health.eu
Key words: Healthcare performance management; healthcare quality; healthcare quality indicators; healthcare outcomes; healthcare utilization; equity in healthcare; healthcare efficiency; geographical analysis