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Potential of geographical variation analysis for realigning providers to value-based care: ECHO case study on lower-value indications of C-section in five European countries

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Potential of geographical variation analysis for realigning providers to value-based care : ECHO case study on lower-value indications of C-section in five European countries. / García-Armesto, Sandra; Angulo-Pueyo, Ester; Martínez-Lizaga, Natalia; Mateus, Ceu; Joaquim, Inês; Bernal-Delgado, Enrique; ECHO Consortium.

In: European Journal of Public Health, Vol. 25 , No. Suppl 1, 02.2015, p. 44-51.

Research output: Contribution to journalJournal article

Harvard

García-Armesto, S, Angulo-Pueyo, E, Martínez-Lizaga, N, Mateus, C, Joaquim, I, Bernal-Delgado, E & ECHO Consortium 2015, 'Potential of geographical variation analysis for realigning providers to value-based care: ECHO case study on lower-value indications of C-section in five European countries', European Journal of Public Health, vol. 25 , no. Suppl 1, pp. 44-51. https://doi.org/10.1093/eurpub/cku224

APA

García-Armesto, S., Angulo-Pueyo, E., Martínez-Lizaga, N., Mateus, C., Joaquim, I., Bernal-Delgado, E., & ECHO Consortium (2015). Potential of geographical variation analysis for realigning providers to value-based care: ECHO case study on lower-value indications of C-section in five European countries. European Journal of Public Health, 25 (Suppl 1), 44-51. https://doi.org/10.1093/eurpub/cku224

Vancouver

García-Armesto S, Angulo-Pueyo E, Martínez-Lizaga N, Mateus C, Joaquim I, Bernal-Delgado E et al. Potential of geographical variation analysis for realigning providers to value-based care: ECHO case study on lower-value indications of C-section in five European countries. European Journal of Public Health. 2015 Feb;25 (Suppl 1):44-51. https://doi.org/10.1093/eurpub/cku224

Author

García-Armesto, Sandra ; Angulo-Pueyo, Ester ; Martínez-Lizaga, Natalia ; Mateus, Ceu ; Joaquim, Inês ; Bernal-Delgado, Enrique ; ECHO Consortium. / Potential of geographical variation analysis for realigning providers to value-based care : ECHO case study on lower-value indications of C-section in five European countries. In: European Journal of Public Health. 2015 ; Vol. 25 , No. Suppl 1. pp. 44-51.

Bibtex

@article{0f5d4feeabec48c29155b32d9879cd65,
title = "Potential of geographical variation analysis for realigning providers to value-based care: ECHO case study on lower-value indications of C-section in five European countries",
abstract = "BACKGROUND: Although C-section is a highly effective procedure, literature abounds with evidence of overuse and particularly misuse, in lower-value indications such as low-risk deliveries. This study aims to quantify utilization of C-section in low-risk cases, mapping out areas showing excess-usage in each country and to estimate excess-expenditure as a proxy of the opportunity cost borne by healthcare systems.METHODS: Observational, ecologic study on deliveries in 913 sub-national administrative areas of five European countries (Denmark, England, Portugal, Slovenia and Spain) from 2002 to 2009. The study includes a cross-section analysis with 2009 data and a time-trend analysis for the whole period. Main endpoints: age-standardized utilization rates of C-section in low-risk pregnancies and deliveries per 100 deliveries. Secondary endpoints: Estimated excess-cases per geographical unit of analysis in two scenarios of minimized utilization.RESULTS: C-section is widely used in all examined countries (ranging from 19{\%} of Slovenian deliveries to 33{\%} of deliveries in Portugal). With the exception of Portugal, there are no systematic variations in intensity of use across areas in the same country. Cross-country comparison of lower-value C-section leaves Denmark with 10{\%} and Portugal with 2{\%}, the highest and lowest. Such behaviour was stable over the period of analysis. Within each country, the scattered geographical patterns of use intensity speak for local drivers playing a major role within the national trend.CONCLUSION: The analysis conducted suggests plenty of room for enhancing value in obstetric care and equity in women's access to such within the countries studied. The analysis of geographical variations in lower-value care can constitute a powerful screening tool.",
keywords = "Adult, Cesarean Section, Cross-Sectional Studies, Delivery of Health Care, Europe, Female, Geography, Health Expenditures, Health Services Accessibility, Health Services Misuse, Humans, Pregnancy, Quality of Health Care, Residence Characteristics, Socioeconomic Factors",
author = "Sandra Garc{\'i}a-Armesto and Ester Angulo-Pueyo and Natalia Mart{\'i}nez-Lizaga and Ceu Mateus and In{\^e}s Joaquim and Enrique Bernal-Delgado and {ECHO Consortium}",
year = "2015",
month = "2",
doi = "10.1093/eurpub/cku224",
language = "English",
volume = "25",
pages = "44--51",
journal = "European Journal of Public Health",
issn = "1101-1262",
publisher = "OXFORD UNIV PRESS",
number = "Suppl 1",

}

RIS

TY - JOUR

T1 - Potential of geographical variation analysis for realigning providers to value-based care

T2 - ECHO case study on lower-value indications of C-section in five European countries

AU - García-Armesto, Sandra

AU - Angulo-Pueyo, Ester

AU - Martínez-Lizaga, Natalia

AU - Mateus, Ceu

AU - Joaquim, Inês

AU - Bernal-Delgado, Enrique

AU - ECHO Consortium

PY - 2015/2

Y1 - 2015/2

N2 - BACKGROUND: Although C-section is a highly effective procedure, literature abounds with evidence of overuse and particularly misuse, in lower-value indications such as low-risk deliveries. This study aims to quantify utilization of C-section in low-risk cases, mapping out areas showing excess-usage in each country and to estimate excess-expenditure as a proxy of the opportunity cost borne by healthcare systems.METHODS: Observational, ecologic study on deliveries in 913 sub-national administrative areas of five European countries (Denmark, England, Portugal, Slovenia and Spain) from 2002 to 2009. The study includes a cross-section analysis with 2009 data and a time-trend analysis for the whole period. Main endpoints: age-standardized utilization rates of C-section in low-risk pregnancies and deliveries per 100 deliveries. Secondary endpoints: Estimated excess-cases per geographical unit of analysis in two scenarios of minimized utilization.RESULTS: C-section is widely used in all examined countries (ranging from 19% of Slovenian deliveries to 33% of deliveries in Portugal). With the exception of Portugal, there are no systematic variations in intensity of use across areas in the same country. Cross-country comparison of lower-value C-section leaves Denmark with 10% and Portugal with 2%, the highest and lowest. Such behaviour was stable over the period of analysis. Within each country, the scattered geographical patterns of use intensity speak for local drivers playing a major role within the national trend.CONCLUSION: The analysis conducted suggests plenty of room for enhancing value in obstetric care and equity in women's access to such within the countries studied. The analysis of geographical variations in lower-value care can constitute a powerful screening tool.

AB - BACKGROUND: Although C-section is a highly effective procedure, literature abounds with evidence of overuse and particularly misuse, in lower-value indications such as low-risk deliveries. This study aims to quantify utilization of C-section in low-risk cases, mapping out areas showing excess-usage in each country and to estimate excess-expenditure as a proxy of the opportunity cost borne by healthcare systems.METHODS: Observational, ecologic study on deliveries in 913 sub-national administrative areas of five European countries (Denmark, England, Portugal, Slovenia and Spain) from 2002 to 2009. The study includes a cross-section analysis with 2009 data and a time-trend analysis for the whole period. Main endpoints: age-standardized utilization rates of C-section in low-risk pregnancies and deliveries per 100 deliveries. Secondary endpoints: Estimated excess-cases per geographical unit of analysis in two scenarios of minimized utilization.RESULTS: C-section is widely used in all examined countries (ranging from 19% of Slovenian deliveries to 33% of deliveries in Portugal). With the exception of Portugal, there are no systematic variations in intensity of use across areas in the same country. Cross-country comparison of lower-value C-section leaves Denmark with 10% and Portugal with 2%, the highest and lowest. Such behaviour was stable over the period of analysis. Within each country, the scattered geographical patterns of use intensity speak for local drivers playing a major role within the national trend.CONCLUSION: The analysis conducted suggests plenty of room for enhancing value in obstetric care and equity in women's access to such within the countries studied. The analysis of geographical variations in lower-value care can constitute a powerful screening tool.

KW - Adult

KW - Cesarean Section

KW - Cross-Sectional Studies

KW - Delivery of Health Care

KW - Europe

KW - Female

KW - Geography

KW - Health Expenditures

KW - Health Services Accessibility

KW - Health Services Misuse

KW - Humans

KW - Pregnancy

KW - Quality of Health Care

KW - Residence Characteristics

KW - Socioeconomic Factors

U2 - 10.1093/eurpub/cku224

DO - 10.1093/eurpub/cku224

M3 - Journal article

C2 - 25690129

VL - 25

SP - 44

EP - 51

JO - European Journal of Public Health

JF - European Journal of Public Health

SN - 1101-1262

IS - Suppl 1

ER -