In Spain, the Atlas of Variations in Medical Practice in the National Health System, also known as Atlas VPM, is a pioneering initiative in Europe which was developed somewhere between research in healthcare services (1) and the support given to public decisions. For the last fifteen years, Atlas VPM has been systematically analysing the performance of the 17 health systems that make up the Spanish Healthcare System. The variations in diverse surgical procedures have in this way come under scrutiny as have those in oncology and orthopaedics, in the variability of hospitalisations in risk populations (chronic patients or mental health patients), in the variation in the treatment of certain pathologies such as coronary heart disease or cerebrovascular ischaemic disease, or in hospital care received by population subgroups such as children or the aged.
Atlas of variations of procedures of questionable value
The “Atlas of unjustified variations in procedures of questionable value” is the latest Atlas of the series and provides a local context for the aforementioned value for money. This project was created in 2013 as a combined initiative between the Atlas VPM and the National Network of Health Technology Assessment Agencies, with the goal of supporting a national strategy aimed at reducing the use of questionable value procedures by encouraging the use of better alternatives or by redirecting resources to other more cost-effective activities.
Ideally, this Atlas establishes an empirical and dynamic performance target by using real terms of comparison obtained in similar health environments and by highlighting margins for improvement for each provider as well as making learning among peers possible when designing strategies for corrective adjustments.
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After almost fifteen years since the project was launched, ten Atlases have been generated (in different formats) as well as innumerable thematic and methodological articles. Nevertheless, the impact of these research efforts goes beyond merely having created an awareness of the existence of a serious problem difficult to resolve; 1) the provision of services in Spain does not seem to follow a pattern related to the health needs of the population so that the access to effective healthcare and insurance seems to depend on one’s place of residence; 2) the marginal cost incurred when providing services often exceeds the marginal benefits of these; 3) the place where a service is provided is decisive in the health results a patient obtains as well as in the associated cost.
On the contrary, the Atlas VPM has also fostered the translation of these results into the arena of healthcare policies. We congratulate ourselves that AQuAS, with whom we have maintained a close collaboration over the years, is leading the creation of an Atlas for Catalonia. This is the first initiative that has, within the context of the National Health System in Spain, institutionalised the study of unjustified variability in healthcare.
(1) Atlas VPM originated and gained momentum within the much missed Network of Research in Results and Healthcare Services (RED IRYSS), coordinated at the time by AATRM under the guidance of Salvador Peiró finding inspiration in an epistemological and methodological approach known as The Dartmouth Atlas of Healthcare Quality.
Post written by Enrique Bernal-Delgado and Sandra García-Armesto for the Atlas VPM group. Unidad de Investigación en Servicios y Políticas de Salud. Instituto Aragonés de Ciencias de la Salud.
If this subject is of interest to you, a related event, Jornada de presentació dels Atles de variacions de la pràctica clínica del SISCAT, will take place in Barcelona next Monday 21 November. The aim of this event is to present publicly SISCAT’s Atlas of variations in medical practice and to promote its value for professionals as a tool in the management and assessment of the healthcare system.