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Hospital Comparisons : Medical and Financial Data

Objectif

The long term overall objective of the project is the exploitation of MBI in order to make a contribution to the evaluation and improvement of medical practice. Indicators of effectiveness as well as quality of care are needed. In order to reach this objective information needs standardization.
The present project is aimed at designing a uniform model of reference for medical data including severity of cases as well as for resources and costs data related to hospital inpatients stays and at testing this model by hospital comparisons between countries. In order to compare case-mix, groupers (DRG, PMC, ...) have to be used.
A European approach towards resource management and strategic planning has been defined by specifying information standards needed across countries, as well as a methodology to measure resources and costs at institutional and inter institutional levels. A European Health Data Base (EHDB) was set up in order to test data availability and comparability as well as to validate models through macro comparisons using case mix, diagnosis related group (DRG) refined grouping, disease staging and microcomparions based on 3 diseases (cardiac valve replacement, diabetes mellitus and hip fracture). Presently this EHDB contains 274 164 medical record summaries sampled from 7 countries. This allowed the building of prototypes using Clipper, Prolog and SQL in order to compare uniform aggregates for different countries, with standard software tools for statistical comparisons. It showed the present feasibility to use case mix based on the European Minimum Basic Data Set (MBDS) and the difficulty in obtaining uniform data on resources and costs, other than length of stay, across countries. Medical data confidentiality was assured but not yet population based representatively. A number of problems have been identified, given the current state of development of the EHDB, which can be solved by international research and development projects in the near future. A review of methods used by the partners to test exhaustivity, reliability and accuracy of medical data in the MBDS was made and proposed to European countries. Available case mix grouping systems were tested within and between countries, using available MBDS as well as the existing experience with DRG utilization in diverse regions in Europe. A large number of results were obtained relating to length of stay and use of resources. The research concludes that hospitals from various European countries might learn a lot from each other if they agree to use uniform data sets and models.
The starting point is the determination of the uses and users (physicians, department hospital, public health authority, ...) and the inventory and assessment of the model existing in this field and outside Europe.
Theoretical model of reference will be proposed and model of reference for the next year will be elaborated based on the available data. This last model will be tested on the data provided by the different countries in order to validate the model and to identify commonalties and differences between hospitals and between countries.
Jointly a coherent strategy for the development and implementation of suitable standards and architectures that support the comparison of hospitals through combination of medical and financial data.
Main Deliverables :
Reassess the MBDS for medical data comparisons. Analysis of medical data related to resource and cost data. Assessment and direction of applicable standards and architectures. Validation, reporting and dissemination of results.

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Coordinateur

UCL ST LUC HOSPITAL
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Adresse


Belgique

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