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EuroREACH Case Study on Diabetes Care


To look at episodes of diabetes care in Estonia, Finland and Israel using data linkage to compare national person-level utilization data to assess outcomes of diabetes care over time.

Key Findings

  • Cross-country assessment of performance requires substantial effort to prepare information and the use data.
  • Lack of comparable data must be addressed by developing a common protocol to be used by all collaborators. 
  • Data pre-processing must be carefully conducted to guarantee technical quality.
  • Regulations on privacy and confidentiality must be considered in cross-country comparisons of performance.


Spotlight map


Numerous policy papers discuss how to compare quality or efficacy by using an "ideal" dataset. However, such ideal data is neither collected nor available to the degree of detail necessary for evaluating performance of health systems or health service providers. Read more

The EuroREACH project set up a study to maximize information from the data already collected and available for use and to illustrate the efforts required to make this happen. This study provides information about which research questions could be addressed and which questions can be reliably answered when individual level administrative data on health service use is collected.


For the purposes of this study anonymous person-level data from three countries (Estonia, Finland and Israel) was used. To mitigate  legal, ownership, confidentiality and privacy concerns, a stepwise decentralized approach was developed.


This coordinated approach allowed for internationally comparable data in calculating many relevant performance indicators which are novel in cross-country comparison of individual level data. Read more

Main Conclusion

Comprehensive cross-country performance assessment of episodes of care can be achieved with the help of detailed data specifications and by creating standardized data sets. Equally important is the development of common analytical programs to produce performance measures from the standardized data sets. Similar indicators, as used for diabetes in this case study can be developed for other diseases or chronic health disorders.

Case study article in Health Policy:

Kiivet R, Sund R, Linna M, Silverman B, Pisarev H, Friedman N. (2013) Methodological challenges in international performance measurement using patient-level administrative data. Health Policy (2013).