Background to the ECHO project

The ECHO Project has its origins in the year 2002 in Spain with the Atlas VPM Project. This project was a nationwide Health Services Research (HSR) Program concerning the analysis of unwarranted variations in medical practice and healthcare outcomes in Spain. The idea was to compare healthcare geographically – region by region – with a view to giving powerful feedback to policy decision-makers and managers nationwide.

In order to do this, the project collaborated with the regional health authorities in Spain to acquire hospital data on the patient level. These data were then amassed into a central database and then an online analysis tool was built as a front-end to the database. This meant that policymakers, managers and other stakeholders could go directly to the Atlas website and themselves conduct research on key issues in a matter of seconds or minutes.

The project team also conducted their own research and Atlas VPM has published seven atlases, and several reports and papers. Among other issues these publications cover: unwarranted variations in general surgery, orthopaedics, paediatric hospitalizations, cardiovascular procedures, mental health hospital care, oncologic surgery, avoidable hospitalizations, c-section rates, and patient safety or mortality in cardiovascular procedures.
Given the experience with overcoming the technical and administrative hurdles associated with such a project – and also give the clear benefits quickly gained by the participating health authorities; a decision was made to repeat the project on a European scale. This was the origin of the ECHO project – an effort to bring together national hospital databases of several European countries. The Spanish team at IACS coordinated the application for a European Framework 7 grant, in collaboration with partners from Portugal, Slovenia, England, Denmark and Austria. The proposal was selected, and the kick off meeting of the ECHO project partners took place in March 2010.

To learn more about the Atlas project please visit:

The Atlas VPM project has an online tool used to dynamically produce graphs and maps about healthcare. Click to enlarge the picture

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