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EuroREACH Case Study Method

Background of Case Study:

Within the EuroREACH project three participating countries (Estonia, Finland and Israel) were considered to have comprehensive person-level data with person IDs available so that relevant health events of individuals can be easily followed-up in time. The focus was decided to be on chronic diseases and diabetes was selected to be examined as a case study.

Important experiences in terms of methodological issues data comparability, linkage and data protection that were made in the course of conducting the EuroREACH case study can be found here.


Project Name: EuroREACH
Governance: 7th EU Research Framework Programme
Coverage: Estonia, Finland and Israel
Objectives: Explore what types of personal-level data are available for performance measurement at national level.
Refine available indicators for performance evaluation according to the data available.
Develop data processing algorithms accompanied with methodological guidance on how to overcome the challenges for performance measurement when using national administrative health databases.
Evaluated Dimension: Health care system performance: the processes, inputs, and outcome of the health care system as well as its efficiency and equity.
Health system design and context: pertinent country and health system policy and delivery characteristics, which will influence the health system in terms of its costs, expenditure and utilization patterns.
Methodology The existing national administrative health databases containing individual health service use data were used to follow the medical history, treatment pathways and outcomes as well as resource use of patients with chronic disease for 8 consecutive years. This allows to measure performance (outcomes and resource use) taking into account the nature of diseases and patient characteristics.
Contact: EuroREACH
Website Project: EuroREACH
Paper: Kiivet R, et al. Methodological challenges in international performance measurement using patient-level administrative data. Health Policy (2013)
Results: The case study showed that several clinically important aspects of quality of care as well as health policy issues of cost-effectiveness and efficiency of health systems can be assessed by using the national administrative health data systems, in case those collecting person-level health service data.
A structured study protocol and detailed data specifications were developed to generate standardized data sets, in each country, for long-term follow up of incident cohort of diabetic persons as well as shared analyzing programs to produce performance measures from the standardized data sets.
This stepwise decentralized approach and use of anonymous person-level data allowed us to mitigate any legal, ownership, confidentiality andprivacy concerns and to create internationally comparative data with the extent of detail that is seldom seen before.
By working with actual patient-level data we could refine the existing indicators of performance and quality of care of diabetes and even to propose some "new ones" such as regular use of medication and event-free time from the start of diabetes treatment.