EURHOBOP- European Hospital Benchmarking by Outcomes in Acute Coronary Syndrome Processes
Executive Agency for Health and Consumers
IMAS-IMIM (Barcelona-SPAIN); DEASL (Rome-ITALY); ATTIKON-HCS (Athens-GREECE); HMGU (Neuherberg-GERMANY); FMUP (Porto-PORTUGAL); AEPMCV (Toulouse-FRANCE); THL (Helsinki-FINLAND); HOPE (Brussels-BELGIUM); ISS (Rome-ITALY)
EU Member States efforts are aimed at improving the quality of the provided health care systems and at tackling inequalities among European citizens.
Coronary heart disease kills more than 2.000.000 people in Europe every year and, if acute cases (> 700.000 in age range 35-64 years) are not adequately managed, it may result in a high case fatality currently >35%.
General objective: EURHOBOP seeks to validate a set of predictive mathematical functions that include determinants of in-hospital case fatality outcome indicator, to assess the quality of management of myocardial infarction (MI) or unstable angina (UA) patients, and of the following procedures: coronary angiography, thrombolysis, percutaneous intervention. The indicators will be adjusted for patient, hospital and country characteristics and will permit hospitals to benchmark their performance in these procedures.
Methods and means: It will be consider in-hospital case-fatality as the outcome indicator in patients admitted for an acute coronary syndrome (ACS) who receive a discharge diagnosis of MI or unstable angina (UA) and undergo coronary angiography, thrombolysis, or percutaneous revascularisation (angioplasty with or without stenting) for general MI and UA patient management. It will be validate several risk functions (GLM multilevel models) with different levels of adjustment, developed in EUPHORIC DG SANCO project 2004-08, and we will develop new ones. The validation will be performed on a sample of 200 consecutive MI or UA patients from 10 hospitals per participant country (70 in all).
1. To analyse the accuracy of outcome prediction by preliminary benchmarking functions developed in EUPHORIC project, for in-hospital case-fatality after coronary angiography, thrombolysis, percutaneous intervention, and MI-UA management.
2. To explore the feasibility of including other indicators of performance in the benchmarking models. It will be explore the feasibility of including other simple indicators of performance for the same procedures and condition management, such as admission duration, one-year readmission rates, or TIMI risk score to further adjust the benchmarking system European hospitals.
3. To determine whether outcomes in these procedures and general MI and UA management differ by sex. We aim to determine whether outcome inequalities exist between men and women in the use of these procedures and in disease management in European hospitals, and look for the reasons for any inequalities we may find.
4. Once the final versions of the benchmarking functions are validated, they will be posted on the project web site with appropriate disclaimer and user contract 3 specifications and a large sample of European hospitals invited to register and use them to benchmark themselves. The possibility will also be offered to allow public presentation of their results in the EURHOBOP project web site summarized in a downloadable report. The response rate will be used as an indicator of diffusion and impact on target group. A 25% response rate would be regarded as an important achievement.
The expected results consist of a set of validated hospital mathematical functions suitable to benchmarking European Hospitals by cardiovascular disease management performance and for European citizens to determine their risk of in-hospital death when submitted to these procedures.