Transcript EuroHOPE SHEA - Amazon Web Services

International health care
performance comparison
using a microeconomic diseasebased strategy
Clas Rehnberg
Medical Management Centre
Karolinska Institutet
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Approaches to international efficiency
comparisons
 System level analysis
– WHO 2000, Afonso and St. Aubyn 2005, OECD
– Challenges in output measurement: How to measure the impact of health
services on health?
 Disease level analysis
– McKinsey healthcare productivity study, OECD aging-related disease (ARD)
project, Technological Change in Healthcare (TECH) Global Research
Network (AMI)
– Possible to relate inputs to outputs but requires nationally representative
patient level data
 Sub-sector level analysis
– Nordic hospital comparison study group (NHCSG)
– Requires that units (DMUs) are comparable and inputs and outputs can be
measured in a similar way
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EuroHOPE
 Applies both the disease level and the sub-sector level
approaches
 Develops methods to measure outcomes and costs of care of
specific diseases for evaluation of care given in the whole
treatment chain (not yet primary care due to lack of data)
 To develop methods for international comparative health service
research using register data
 To contemplate the relationship between outcomes/quality and
use of resources (e.g. costs) and compare them between
European countries, regions and providers
 To explore and reveal reasons behind differences in outcomes
and costs
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Partners

Centre for Health and Social Economics (CHESS),National Institute for
Health and Welfare, Finland

Centre for Research on Health and Social Care Management, Universita
Commerciale Luigi Bocconi, Milano, Italy

Health Services Management Training Centre, Semmelweis University,
Budapest, Hungary

National Institute of Public Health and the Environment, the
Netherlands

University of Oslo, Department of Health Management and Health
Economics, Norway

Ragnar Frisch Centre for Economic Research, Oslo, Norway

University of Edinburgh, Scotland

Medical Management Centre (MMC), Karolinska Institutet, Stockholm,
Sweden
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Faces of Eurohope
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Disease specific work
 Five diseases
– acute myocardial infarction (AMI)
– stroke
– hip fracture
– breast cancer
– very low birth weight infants
 Clinical experts from each of the participating countries
 Development of national, regional and hospital level indicators for
– access and utilisation of services
– treatment practices
– costs and outcomes
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EuroHOPE
Data
Comparison
of countries,
regions and
hospitals
National
National
discharge
EuroHOPE
register
database
Protocols
National
mortality
register
EuroHOPE
research
National
Other
EuroHOPE
national
comparison
registers
data
National
research and
bencmarking
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Policy Brief - EuroHOPE, 25th of September, Brussels
International
Eurohope
comparison
data
Anonymous
individual level
data used for
comparative
research
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Definitions of episodes
Total episode of care
First hospital episode
Admission to Admission to
ward A
ward B
Discharge
home or
nursinghome
Outpatient
visit
time
Procedure/treatment
in ward A
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Discharge to
another hospital
Medication
purchase
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Risk adjustement
• Estimation of regression coefficients from pooled data
(Finland, Italy, Sweden, Norway) and then calculate the ratio
of observed to expected no. of deaths/LOS
For each outcome, three different risk adjusted outputs were
produced:
• adjusted for sex and age only (M1),
• adjusted for sex, age, LOS previous year, disease specific
comorbidities based on primary and secondary diagnoses the
year prior to diagnosis (M2),
• same as M2 but comorbidities were based on both primary
and secondary diagnosis and medication purchase the year
prior to diagnosis (M3).
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2-day PCI rate (%) of AMI patients by country,
adjusted for age and sex
45.0
39.5
40.0
35.0
33.1
30.4
30.2
30.0
25.0
27.6
24.4
%
20.0
14.0
15.0
10.0
5.0
0.0
Finland
Hungary
Italy
Netherlands
Norway
Scotland
Sweden
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2-day PCI rate (%) of AMI patients per region
by country, adjusted for age and sex, with
confidence intervals
80 %
70 %
60 %
50 %
40 %
30 %
20 %
10 %
0%
FINLAND
HUNGARY
NETHERLANDS
NORWAY
SWEDEN
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Mean mortality (30-, 90-day and one-year (%)) of
stroke patients by country, adjusted for age and
sex
40.0
35.0
30.0
25.0
% 20.0
15.0
10.0
5.0
0.0
30-day
Finland
Hungary
90-day
Italy
Netherlands
one year
Scotland
Sweden
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Mean one-year mortality of stroke patients
per region by country, adjusted for age
and sex, with confidence intervals
50
45
40
35
30
% 25
20
15
10
5
FINLAND
HUNGARY
NETHERLANDS
SCOTLAND
SWEDEN
0
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Conclusions
 Large variation in use of resources and
outcomes between the countries, hospitals
and regions in all four diseases
 Potential for improving efficiency
 Benchmarking (where is the wisdom):
preliminary best performing regions in
EuroHOPE countries:
– AMI: Norway, Netherlands and Sweden
– Stroke: Finland and Sweden
– Hip Fracture: Sweden and Italy

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Productivity levels in Nordic hospitals 2005-2007
(Bootstrapped DEA estimates with 95% CI)
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Statistical associations with
productivity or efficiency

Positive association with
– Outpatient share

Negative association with
– Length of stay (LOS)
– (Traveling time)

No association with
–
–
–
–

Case mix index
Capital city
University hospital
(Activity based financing)
Results robust to choice of method
– Parametric: Stochastic Frontier Analysis (SFA)
– Non-parametric: Bootstrapped Data Envelopment Analysis (DEA)

Can quality differences be (part of) the explanation?
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Quality indicators still included




Readmissions (unplanned within 30 days)
Mortality (30 days, 365 days)
Charleson comorbidity index
Patient safety indices
Preliminary results for 2008-2009 data
30-day Mortality, Adjusted for DRG
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Sverre A.C. Kittelsen/ WP8 Research plan and progress
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Preliminary results for 2008-2009 data
Productivity quality trade-off
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Sverre A.C. Kittelsen/ WP8 Research plan and progress
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Next steps
 National and regional indicators to be published at
http://www.eurohope.info
 Health economic issues such as
– analyses of reasons behind differences in outcomes
and use of resources between the countries, regions
and hospitals
– relationship between outcomes and cost at country and
hospital level
EuroHOPE final conference: Stockholm, April 8th, 2014
Register before March 31st!
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