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

Sandra García-Armesto, Ester Angulo-Pueyo, Natalia Martínez-Lizaga, Céu Mateus, Inês Joaquim, Enrique Bernal-Delgado, E. Bernal-Delgado, S. García-Armesto, N. Martínez-Lizaga, M. Seral, F. Estupiñán, M. Comendeiro, E. Angulo-Pueyo, M. Ridao, C. Baixaulí, J. Librero, T. Christiansen, L. C. Thygesen, K. Bloor, R. Cookson & 10 others N. Gutacker, C. Nunes, A. M. Yäbek, M. Galsworthy, T. Albreht, J. Munck, B. Güntert, J. Bremner, P. Giepmans, O. Dix

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 excessexpenditure 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 lowrisk 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.

Original languageEnglish
Pages (from-to)44-51
Number of pages8
JournalEuropean Journal of Public Health
Volume25
Issue numberSuppl. 1
DOIs
Publication statusPublished - 2015

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Portugal
Denmark
Demography
Slovenia
Proxy
England
Spain
Obstetrics
Observational Studies
Delivery of Health Care
Costs and Cost Analysis
Pregnancy

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García-Armesto, Sandra ; Angulo-Pueyo, Ester ; Martínez-Lizaga, Natalia ; Mateus, Céu ; Joaquim, Inês ; Bernal-Delgado, Enrique ; Bernal-Delgado, E. ; García-Armesto, S. ; Martínez-Lizaga, N. ; Seral, M. ; Estupiñán, F. ; Comendeiro, M. ; Angulo-Pueyo, E. ; Ridao, M. ; Baixaulí, C. ; Librero, J. ; Christiansen, T. ; Thygesen, L. C. ; Bloor, K. ; Cookson, R. ; Gutacker, N. ; Nunes, C. ; Yäbek, A. M. ; Galsworthy, M. ; Albreht, T. ; Munck, J. ; Güntert, B. ; Bremner, J. ; Giepmans, P. ; Dix, O. / 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.
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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 excessexpenditure 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 lowrisk 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.",
author = "Sandra Garc{\'i}a-Armesto and Ester Angulo-Pueyo and Natalia Mart{\'i}nez-Lizaga and C{\'e}u Mateus and In{\^e}s Joaquim and Enrique Bernal-Delgado and E. Bernal-Delgado and S. Garc{\'i}a-Armesto and N. Mart{\'i}nez-Lizaga and M. Seral and F. Estupi{\~n}{\'a}n and M. Comendeiro and E. Angulo-Pueyo and M. Ridao and C. Baixaul{\'i} and J. Librero and T. Christiansen and Thygesen, {L. C.} and K. Bloor and R. Cookson and N. Gutacker and C. Nunes and Y{\"a}bek, {A. M.} and M. Galsworthy and T. Albreht and J. Munck and B. G{\"u}ntert and J. Bremner and P. Giepmans and O. Dix",
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doi = "10.1093/eurpub/cku224",
language = "English",
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pages = "44--51",
journal = "The European Journal of Public Health",
issn = "1101-1262",
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García-Armesto, S, Angulo-Pueyo, E, Martínez-Lizaga, N, Mateus, C, Joaquim, I, Bernal-Delgado, E, Bernal-Delgado, E, García-Armesto, S, Martínez-Lizaga, N, Seral, M, Estupiñán, F, Comendeiro, M, Angulo-Pueyo, E, Ridao, M, Baixaulí, C, Librero, J, Christiansen, T, Thygesen, LC, Bloor, K, Cookson, R, Gutacker, N, Nunes, C, Yäbek, AM, Galsworthy, M, Albreht, T, Munck, J, Güntert, B, Bremner, J, Giepmans, P & Dix, O 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

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, Céu; Joaquim, Inês; Bernal-Delgado, Enrique; Bernal-Delgado, E.; García-Armesto, S.; Martínez-Lizaga, N.; Seral, M.; Estupiñán, F.; Comendeiro, M.; Angulo-Pueyo, E.; Ridao, M.; Baixaulí, C.; Librero, J.; Christiansen, T.; Thygesen, L. C.; Bloor, K.; Cookson, R.; Gutacker, N.; Nunes, C.; Yäbek, A. M.; Galsworthy, M.; Albreht, T.; Munck, J.; Güntert, B.; Bremner, J.; Giepmans, P.; Dix, O.

In: European Journal of Public Health, Vol. 25, No. Suppl. 1, 2015, p. 44-51.

Research output: Contribution to journalArticle

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, Céu

AU - Joaquim, Inês

AU - Bernal-Delgado, Enrique

AU - Bernal-Delgado, E.

AU - García-Armesto, S.

AU - Martínez-Lizaga, N.

AU - Seral, M.

AU - Estupiñán, F.

AU - Comendeiro, M.

AU - Angulo-Pueyo, E.

AU - Ridao, M.

AU - Baixaulí, C.

AU - Librero, J.

AU - Christiansen, T.

AU - Thygesen, L. C.

AU - Bloor, K.

AU - Cookson, R.

AU - Gutacker, N.

AU - Nunes, C.

AU - Yäbek, A. M.

AU - Galsworthy, M.

AU - Albreht, T.

AU - Munck, J.

AU - Güntert, B.

AU - Bremner, J.

AU - Giepmans, P.

AU - Dix, O.

N1 - PMID: 25690129 WOS: 000362970700008

PY - 2015

Y1 - 2015

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 excessexpenditure 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 lowrisk 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.

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 excessexpenditure 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 lowrisk 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.

UR - http://www.scopus.com/inward/record.url?scp=84929050384&partnerID=8YFLogxK

U2 - 10.1093/eurpub/cku224

DO - 10.1093/eurpub/cku224

M3 - Article

VL - 25

SP - 44

EP - 51

JO - The European Journal of Public Health

JF - The European Journal of Public Health

SN - 1101-1262

IS - Suppl. 1

ER -