ECHO aims to describe and analyse health care performance in terms of utilization of effective (or lower-value) procedures, equitable access to effective care, quality and safety, and efficiency in terms of opportunity costs and technical efficiency.
ECHO was developed based on the experience of different research initiatives (specifically, theDartmouth Atlas of Healthcareand theAtlas of Variations in Medical Practice in the Spanish Healthcare System) and quality projects fostered by policy-oriented organizations(Agency for Research and Quality in Healthcareand OECD Health Division),and has operationally defined performance dimensions using a bundle of indicators built using administrative and clinical information recorded in hospital discharges.
Given that ECHO compares different healthcare systems, which use different classification systems, there is a need of construction “crosswalks” across the different national coding languages (see Table). ECHO crosswalks have been developed taking using ICD-9-CM as the classification of reference (the aforementioned initiatives were also based on this classification system) and subsequently face-validated in each participanting country.
Codification of diagnosis and procedures by country:
In the following sections, the ECHO performance indicators are defined, the corresponding crosswalks are detailed, and some observations on the use of the indicators are provided.