Bernal-Delgado E, Christiansen T, Bloor K, Mateus C, Yazbeck A M, Munck J, Bremner J
1 Institute for Health Sciences in Aragon, IIS Aragon, Zaragoza, Spain 2 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
3 Centre of Health Economics Research, University of Southern Denmark, Denmark.
Eur J Public Health. 2015 Feb;25 Suppl 1:3-7. doi: 10.1093/eurpub/cku219.
Strengthening health-care effectiveness, increasing accessibility and improving resilience are key goals in the upcoming European Union health-care agenda. European Collaboration for Health-Care Optimization (ECHO), an international research project on health-care performance assessment funded by the seventh framework programme, has provided evidence and methodology to allow the attainment of those goals. This article aims at describing ECHO, analysing its main instruments and discussing some of the ECHO policy implications.
Using patient-level administrative data, a series of observational studies (ecological and cross-section with associated time-series analyses) were conducted to analyze population and patients' exposure to health care. Operationally, several performance dimensions such as health-care inequalities, quality, safety and efficiency were analyzed using a set of validated indicators. The main instruments in ECHO were: (i) building a homogeneous data infrastructure; (ii) constructing coding crosswalks to allow comparisons between countries; (iii) making geographical units of analysis comparable; and (iv) allowing comparisons through the use of common benchmarks.
ECHO has provided some innovations in international comparisons of health-care performance, mainly derived from the massive pooling of patient-level data and thus: (i) has expanded the usual approach based on average figures, providing insight into within and across country variation at various meaningful policy levels, (ii) the important effort made on data homogenization has increased comparability, increasing stakeholders' reliance on data and improving the acceptance of findings and (iii) has been able to provide more flexible and reliable benchmarking, allowing stakeholders to make critical use of the evidence.
加强医疗保健有效性、提高可及性并增强恢复力是即将到来的欧盟医疗保健议程中的关键目标。欧洲医疗保健优化协作组织（ECHO）是一个由第七框架计划资助的关于医疗保健绩效评估的国际研究项目，它提供了实现这些目标的证据和方法。本文旨在描述ECHO，分析其主要工具并讨论ECHO的一些政策影响。
利用患者层面的行政数据，开展了一系列观察性研究（生态研究以及带有相关时间序列分析的横断面研究），以分析人群和患者接受医疗保健的情况。在实际操作中，使用一组经过验证的指标对医疗保健不平等、质量、安全和效率等几个绩效维度进行了分析。ECHO的主要工具包括：（i）建立统一的数据基础设施；（ii）构建编码对照表以实现各国之间的比较；（iii）使分析的地理单位具有可比性；（iv）通过使用共同基准进行比较。
ECHO在医疗保健绩效的国际比较方面提供了一些创新，主要源于对患者层面数据的大规模汇总，因此：（i）扩展了基于平均数的常规方法，在多个有意义的政策层面上深入了解了国家内部和国家之间的差异；（ii）在数据同质化方面所做的重要努力提高了可比性，增强了利益相关者对数据的依赖，并提高了对研究结果的接受度；（iii）能够提供更灵活、可靠的基准，使利益相关者能够批判性地利用这些证据。
