Éva Belicza

Health care performance comparison using a disease-based approach: The EuroHOPE project

This article describes the methodological challenges associated with disease-based international comparison of health system performance and how they have been addressed in the EuroHOPE (European Health Care Outcomes, Performance and Efficiency) project. The project uses linkable patient-level data available from national sources of Finland, Hungary, Italy, The Netherlands, Norway, Scotland and Sweden. The data allow measuring the outcome and the use of resources in uniformly-defined patient groups using standardized risk adjustment procedures in the participating countries. The project concentrates on five important disease groups: acute myocardial infarction (AMI), ischemic stroke, hip fracture, breast cancer and very low birth weight and preterm infants (VLBWI). The essentials of data gathering, the definition of the episode of care, the developed indicators concerning baseline statistics, treatment process, cost and outcomes are described. The preliminary results indicate that the disease-based approach is attractive for international performance analyses, because it produces various measures not only at country level but also at regional and hospital level across countries. The possibility of linking hospital discharge register to other databases and the availability of comprehensive register data will determine whether the approach can be expanded to other diseases and countries.

Comparing ischaemic stroke in six European countries. The EuroHOPE register study.

The incidence of hospitalizations, treatment and case fatality of ischaemic stroke were assessed utilizing a comprehensive multinational database to attempt to compare the healthcare systems in six European countries, aiming also to identify the limitations and make suggestions for future improvements in the between‐country comparisons.

European Regional Differences in All‐Cause Mortality and Length of Stay for Patients with Hip Fracture

The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data.

European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture

The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data.

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary.

Applicability of the brief version of the World Health Organization’s quality of life questionnaire in Hungary

Bevezetes:Az eletminőseg, mint szubjektiv megitelesen alapulo kozerzeti-parameter alkalmas egy nepesseg, illetve kulonboző betegcsoportok egeszsegi allapotanak jellemzesere, valamint egyes terapias vagy prevencios beavatkozasok hatasanak megitelesere. Celkitűzes: Az eletminőseg meresere alkalmas tobbfele modszer kozul az Egeszsegugyi Vilagszervezet altal kifejlesztett kerdőiv roviditett valtozata hazai alkalmazhatosaganak es megbizhatosaganak vizsgalata. Modszerek: Kerdőives adatgyűjtesen alapulo keresztmetszeti vizsgalat tortent Csongrad megyeben az 1000, illetve 2000 fő alatti nepessegszamu kozsegekben, valamint kontroll telepuleskent egy kisvarosban, osszesen 814 fő koreben. Az eletminőseg kerdőiv megbizhatosaga es ervenyessege az egyes targykorokon beluli Cronbach-fele alfa, ANOVA es Kruskal-Wallis-proba, valamint a Spearman rho korrelacios egyutthato alapjan kerult ertekelesre. Eredmenyek: Az eletminőseg negy dimenziojanak/targykorenek – fizikai, pszichologiai, tarsas kapcsolatok, kornyezet – atlagertekei gyakorlatilag nem kulonboztek egymastol. Az egyes targykorokre, illetve az osszes kerdesre vonatkozo belső konzisztenciavizsgalat Cronbach-fele alfa-ertekei minden esetben meghaladtak a minimalisan elvarhato 0,7-es erteket. Az eletminőseg egyes targykoreire szamitott atlagok az eletkor előrehaladtaval csokkentek. Az egeszsegesek valamennyi targykort szignifikansan jobbnak iteltek, mint a betegek. A korrelacios vizsgalatok szerint az eletminőseg valamennyi dimenzioja szoros pozitiv osszefuggest mutatott az altalanos eletminőseggel, az egeszseggel valo elegedettseggel, es az egeszseg onertekelesevel, valamint mas, a szocialis vagy az egeszsegugyi helyzetet erintő kerdesekre adott valaszokkal. Kovetkeztetes: A kerdőiv hazai viszonyokra adaptalt valtozata alkalmasnak bizonyult a kulonboző demografiai, szocialis helyzetű es egeszsegi allapotu egyenek eletminősegenek megitelesere, a betegek es egeszsegesek elkulonitesere. A kerdőiv egyszerűen, gyorsan kitolthető, konnyen ertekelhető, es lehetőve teszi a magyar nepesseg koreben az eletminőseg mereset, valamint annak nemzetkozi adatokkal valo osszeveteset. Introduction: Quality of life, as a subjective parameter of the general condition, is suitable for characterization of the health status of populations or patient groups, and for studying the effects of therapic or preventive interventions. Aims: To test the applicability and reliability in Hungary of the abbreviated form of the quality of life questionnaire developed by WHO, one of several ways to measure the quality of life. Methods: Questionnaire-based cross-sectional investigation was performed among altogether 814 persons, in small settlements of population under 1000 and 2000, and in a small town for control, in Csongrad county, Hungary. The reliability and validity of the quality of life questionnaire was tested, within each group of questions, by means of Cronbach’s alpha, ANOVA and Kruskal-Wallis tests, and by Spearman’s rho correlation coefficient. Results: The mean values of the four domains of quality of life – physical, psychological, social and environmental – showed no noteworthy differences. The Cronbach’s alpha figures of the internal consistency test on separate groups of questions and on all questions were in all cases above the expected minimum of 0.7. The means calculated for each domain of quality of life were decreasing with increasing age. Healthy people estimated each aspect of quality of life as significantly better, compared to the sick. Correlation tests showed that all dimensions of the quality of life were in close positive correlation with the general quality of life, with the level of satisfaction with the own health, with the self-assessed health, and with the responses given on other questions related to the social or health situation of the questioned. Conclusion: The variation of the questionnaire, adapted to Hungarian conditions, proved to be suitable for testing the quality of life of persons with various demographical, social and health conditions, and for distinction between the healthy and the sick. The sheet, which can be filled in quickly and easily, enables the measurement of quality of life in the Hungarian population, and the comparison of that with international data.Applicability of the brief version of the World Health Organizations quality of life questionnaire in Hungary. Introduction: Quality of life, as a subjective parameter of the general condition, is suitable for characterization of the health status of populations or patient groups, and for studying the effects of therapic or preventive interventions. Aims: To test the applicability and reliability in Hungary of the abbreviated form of the quality of life questionnaire developed by WHO, one of several ways to measure the quality of life. Methods: Questionnaire-based cross-sectional investigation was performed among altogether 814 persons, in small settlements of population under 1000 and 2000, and in a small town for control, in Csongrad county, Hungary. The reliability and validity of the quality of life questionnaire was tested, within each group of questions, by means of Cronbachs alpha, ANOVA and Kruskal-Wallis tests, and by Spearmans rho correla- tion coefficient. Results: The mean values of the four domains of quality of life - physical, psychological, social and envi- ronmental - showed no noteworthy differences. The Cronbachs alpha figures of the internal consistency test on separate groups of questions and on all questions were in all cases above the expected minimum of 0.7. The means calculated for each domain of quality of life were decreasing with increasing age. Healthy people estimated each aspect of quality of life as significantly better, compared to the sick. Correlation tests showed that all dimensions of the quality of life were in close positive correlation with the general quality of life, with the level of satisfaction with the own health, with the self-assessed health, and with the responses given on other questions related to the social or health situation of the questioned. Conclusion: The variation of the questionnaire, adapted to Hungarian conditions, proved to be suitable for testing the quality of life of persons with various demographical, social and health conditions, and for distinction between the healthy and the sick. The sheet, which can be filled in quickly and easily, enables the measurement of quality of life in the Hungarian population, and the comparison of that with international data.

Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries.

Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.

Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.

Regional differences in the utilisation of coronary angiography as initial investigation for the evaluation of patients with suspected coronary artery disease

investigation for the evaluation of patients with suspected coronary artery disease István Kósa ⁎, Attila Nemes , Éva Belicza , Ferenc Király , István Vassányi a,1 a Research & Development Center of Health Informatic, Faculty of Information Technology, University of Pannonia, Veszprém, Hungary b Cardiac Rehabilitation Centre of Military Hospital, Balatonfüred, Hungary c 2nd Department of Medicine and Cardiology Center, Medical Faculty, AlbertSzent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary d Health Services Management Training Center, Faculty of Health Care, Semmelweis University, Budapest, Hungary

[Study of incidence and treatment of acute myocardial infarction by evaluating the financing database: 2004-2009].

UNLABELLED In Hungary we have no comprehensive data on hospital care and short and long term prognosis of patients with myocardial infarction. AIMS To collect data on number, hospital care and prognosis of patients treated for myocardial infarction in all Hungarian hospitals. METHODS Authors studied the number of patients treated in hospital for acute myocardial infarction, the frequency of revascularization by coronary angioplasty during treatment, as well as the 30 and 365 day mortality of patients by the evaluation of the financing database of the National Health Insurance Fund for 6 years (2004-2009). RESULTS There has been no major change during the observation period in the number of patients treated in hospital for myocardial infarction (approximately 16,500 cases/year). The incidence in males (calculated by the number of patients treated in hospital) is higher in any age group compared to females; this difference is lower in older age groups. During the observation period the 30 and 365 day mortality has decreased by 1.8% (18.9% vs. 17.1% and 29.9% vs. 28.1%, respectively), which was caused by a decrease in the mortality of patients above age 70. The percentage of revascularization by coronary angioplasty during the treatment of myocardial infarction has significantly increased (18.2% vs. 49.8%). The International Classification of Diseases does not differentiate between the different forms of myocardial infarction, therefore the prognostic effects of coronary angioplasty cannot be evaluated in this respect. CONCLUSIONS Authors conclude that the financing database is suitable to evaluate the major aspects of care and to support healthcare management decisions, while the appropriateness of treatment and the effectiveness of different interventions can be assessed by prospective databases satisfying the needs of special aspects and can therefore be used for detailed assessments.