The European Collaboration for Health Optimization (ECHO) is an international effort to bring health care information from several European countries into a single data warehouse (DWH); specifically, patient-level data from hospital admissions, demographic and socio-economic information at geographic level and supply information at both hospital and geographic levels. Countries participating in the project are Austria , Denmark, England, Portugal, Slovenia and Spain. ECHO aims at describing and analysing health care performance in terms of utilisation of effective (or lower-value) procedures, equitable access to effective care, quality and efficiency in terms of opportunity costs and technical efficiency. Unlike traditional international health care performance assessment, ECHO draws out unwarranted differences in performance, within and across countries, at different levels of analysis – hospital, health care area and region.
WHY THIS REPORT?
ECHO, as its scientific predecessors the Dartmouth Atlas of Health Care, www.dartmouthatlas.organd the Atlas of Variations in Medical Practice in the Spanish National Health Service,www.atlasvpm.orgis built upon the use of routinely collected clinical and administrative data. In this case, however, using information from six different countries. As a consequence, ECHO have devoted specific efforts on building a single homogeneous and sound information system, assure the robustness of raw data used to build the ECHO performance indicators, and reduce the risks of systematic information biases. In order to attain this aim, ECHO has faced several critical tasks: developing a logic model of data that allows the production of comparable performance indicators from raw information, transforming reliably raw data formats and categories into a common standard, allocating admission into geographic units and hospital-providers, tracking down hospitals’ merging processes, linking the different files composing the DWH, building crosswalks across different classification systems, and associating this information to hospital discharges.
WHAT IS THIS REPORT ABOUT?
Should ECHO evidence on health care performance is able to impact decision making will depend on its capacity to assure that data issues are not an alternative explanation of the differences in performance reported. Thus, this report aims at describing, systematically and in detail, all the steps involved in the construction of the DWH, as well as those issues that could potentially be involved in jeopardizing the reliability of the ECHO outputs. The report also compiles a list of recommendations addressed to better use the information stored in the DWH, pointing out to those specific issues that should be taken into account to properly interpret the ECHO performance indicators. The scope of this report is confined to the assessment of the data structure and the outputs generated from it. Original datasets, as they were released for the Health or Data Authorities, were not subject of judgment.