healthcare system – AQuAS Blog

What are the SISCAT atlas of variations all about?

19 Jan

atles-variacions-siscat — Laura Muñoz (Atlas of variations SISCAT), Laia Domingo (RaCat), Olga Martínez (RaCat)

At present, if you live in the region of Terres de l’Ebre and need to be operated on to have a knee replacement, it is quite probable that the type of technique used is one which preserves the posterior cruciate ligament. On the other hand, if you go and live in Girona, the chances of having the same kind of knee replacement will be a lot less, but in contrast, the type of technique chosen will be that of stabilising the posterior.

If you live in Girona and have respiratory difficulties susceptible for home-based CPAP treatment (continuous positive airway pressure), you will more likely be prescribed this therapy than if you live in Lleida or the Terres de l’Ebre. If you live in Lleida, in contrast, there is more probability of you being prescribed oxygen therapy at home than if you live in the Terres de l’Ebre region and suffer from some kind of respiratory disease that could benefit from this treatment. And if you live in the coastal neighbourhoods of Barcelona you will more likely be prescribed mechanical ventilation at home than if you live in a neighbourhood situated further inland for those respiratory ventilation disorders that might need this technique.

Why does this happen? There is no evidence to suggest which type of intervention is most suitable and it is simply the fact that the health professionals of one region are more inclined than those of another to choose one technique over another. This variability reveals the existence of schools linked to certain hospital centres that condition the choice of the type of intervention or technique used.

This is the type of information that the Atlas of variations in clinical practice of the Catalan Healthcare System (SISCAT) make available to health professionals and the entire population, and which has been led and developed by AQuAS since 2011.

The aim of these atlases is to identify, describe and reduce the variability that can lead to increased well-being, quality and an improvement in the use of available resources. Up to the present, 7 atlases have been developed in which the variations in hip and knee arthroplasty operations have been analysed, as well as the variability in home-based respiratory therapies (oxygen therapy, mechanical ventilation and continuous positive airway pressure), the variation in intravenous thrombolysis in patients with ischemic stroke and the variability and in renal replacement therapy in patients with chronic kidney failure (haemodialysis, peritoneal dialysis and kidney transplant).

One of the sources of data for this study, in fact, the most widely used, is the basic minimum group of data obtained at the time of a hospital discharge (CMBD-AH, the Catalan acronym) where the results are presented as activity rates, reasons for standardised uses and variability statistics. The methodology that lies behind this initiative can be seen here. The basic strategy of all the analyses is to compare the rates of use (numerator: for example, hospital admittances) of the inhabitants in a region (denominator: for example, basic area of health), regardless of the centre where patients have been treated or admitted. In addition, both the rates and the reasons for use are reflected in maps to better visualise the data which is another interesting point nowadays.

Apart from all this, it is important to stress that all the atlases include actions and recommendations for planners (Health Department), insurer (CatSalut), providers and professionals, and which have been developed by a unique team of experts with whom the results of the atlases are discussed.

This year, we have decided to take another step forward and convert the publications we have had till now in a static format (PDF), into dynamic publications that facilitate greater interaction with the data and, therefore, a more global view of the clinical practice analysed.

This is an example of the visualisation of the interactive hip and knee arthroplasty atlas which feeds off the data in the Catalan Arthroplasty Registry (RaCat):

Next year, you will be able to know whether there are variations in the Catalan territory regarding hospitalisations for back surgery, in the repair of abdominal aortic aneurysms and in gastrointestinal cancer surgery (esophagus, pancreatic, liver, stomach and rectal cancer).

We cannot end this post without thanking all the speakers that made the presentations seminar of the Atlas of variations in clinical practice of SISCAT possible last 21 November, and especially to Enrique Bernal-Delgado, the key professional in the analysis initiative and in mapping the variations of clinical practice in the Spanish National Health System.

As far as AQuAS is concerned, it is one of our work lines which was begun some time ago now which has recently generated publications such as this article on respiratory diseases and this article on kidney disease.

And I ask myself, …. now that we have the tools to identify and describe the variability in clinical practices which are carried out in Catalonia, why don’t we try and explain them? The atlases of variations in clinical practice of SISCAT are a key tool to ask ourselves questions.

Post written by Laura Muñoz, statistician.

In memory of professor Joan Rodés

12 Jan

With his passing away, Dr Joan Rodés (1938-2017) will be remembered by many people in person, and in many fields, for those who had the good fortune to know him as a doctor, researcher, manager and assessor (of politicians), as his was a life full to the brim. No matter which professional activity he took part in, and with the responsibilities he took on throughout his life, he left his mark and the accolades expressed these days are a clear demonstration of this.

To AQuAS (originally AATM), Joan Rodés has been an exceptional figure and I say this without any rhetoric whatsoever. When the Agency was created in 1994, he presided its scientific board of assessors and at the end of 1999, when the institution became known as Catalan Agency for Health Tecnology Assessment and Research (CAHTA), in Catalan Agència d’Avaluació de Tecnologia i Recerca Mèdiques (AATRM), he presided its Administrative Board, a position that he held till 2010. It was in that period (2000-2006) that, due to my responsabilities within the Agency as Managing Director, I was able to get to know this great personality more closely, very much a big strong fellow (in Catalan, a homenot) was Joan, as Josep Pla would say. At that time, we saw each other often, and I had frequent exchanges with him, aside from the more or less termly meetings of the Administrative Board. I did this in that minute office of the haematology services and later in that of the General Manager at the Hospital Clinic.

No matter what the position he occupied, he was always watchful -very much so- of events at the Agency, being a great facilitator of its duties. It was like this, without a doubt, because with Joan Rodés there was no need to convince him of the importance of informing well about decisions taken in the health services, using the most updated and precise knowledge that was available, not only that regarding the benefits and risks to health of medical interventions, but also in terms of its economic, ethical and social impact. For him and I quote his words literally from the AATRM Newsletter, 10 years of the Agency, of November 2004:

“critical assessment and continued learning are basic tools that need to be maintained and improved, not only by the Agency, in its everyday activity, but also by all the multiple actors and stakeholders in the health system (professionals, managers, politicians and citizens) that wish to continue sustaining this element of such importance for our social well-being”

I said this because of his role of facilitator as highest representative of the Agency giving constant support to the activities it carried out, but also because of his extensive experience and network of relationships that contributed to giving strength to many initiatives that were then being undertaken, especially in the field of research and its assessment. I was able to discuss this with him on many occasions at a later date, and I never once perceived an interventionist or managerial attitude; quite the opposite, always with a laissez-faire approach where each one had to do their assigned task (the technicians and managing director of the Agency, the scientific board and the administrative board) while facilitating that of others.

It has always been a great pleasure for me -a privilege better said- to have maintained contact at dinners and get-togethers, even during the last period in which his respiratory illness worsened, but he would still go to IDIBAPS from time to time despite this. I cannot end without saying that during those times when we would talk about any and everything (medicine, science, politics, society, the past, present and future) we had a really good laugh. Then as now that you have left us, you are and will very much be in my thoughts.

Post written by Joan MV Pons

agencia-2004-ca — Joan Rodés presiding an Administrative Board of AATRM in 2004

Never before have we been so healthy and at the same time, never before have we been so sick

21 Apr

When I was born in 1950, life expectancy at birth was 65 years. I have now reached the 65-year mark and as such, according to the data, I should be starting to lose expectations. Fortunately, in recent years, medicine, health and lifestyles have improved and my reviewed life expectancy has increased, according to data from Idescat, by 20 years. This means that I have gained one year of life for every 3 years I have lived. That’s not bad! I am delighted with the figures, but there is one thing that worries me. That thing is called healthy life expectancy. This is calculated by combining mortality data which gives us life expectancy, together with morbidity data which can tell us how many years we are expected to be unhealthy. My healthy life expectancy is currently 12 years, in other words, I can spend 12 of the 20 years I have remaining healthy, and 8 unhealthy. Statistically speaking, that is.

And what diseases face me on the road ahead? Well the most serious life-threatening diseases are cardiovascular disease and cancer. Suffice to say that many of the gains we have achieved in terms of extending life expectancy have come from reducing cardiovascular mortality. Cancer is also in decline, thanks to improvements and research in health. Certain types of cancer are less common due to the decrease in the number of people who smoke. For example, lung cancer is declining in men but has increased in women. For other forms of cancer, there is now very effective treatment and medication that can relegate the disease to chronic status. However, despite the fact that these diseases are serious, they do not have us visiting the doctor every day. We visit the doctor complaining from high blood pressure, cholesterol, diabetes, heart failure, etc. Some of these diseases are linked to the largest public health problem today: obesity. Tobacco or alcohol are no longer the major public health problems, but instead it is obesity. The number of cases of are growing day by day and it is considered to be the root cause of certain diseases such as diabetes.

Obesity is caused by two factors: overeating and taking less exercise than we should. Most modern developments result in us doing less exercise: elevators, escalators, teleconferencing, etc., and a lot of the media input encourage us to eat more or to consume sugary drinks. The combination of these factors mean that today around 15% of the Catalan population is obese.

The most common disease in people over 65 years old today is called polypharmacy, in other words, the use of more than three types of medications on a daily basis. In many cases this can be more than 10 different drugs and there are some people who have a daily consumption of 20 drugs. Each drug is prescribed to address a particular health problem, and health problems have multiplied. Nowadays, we don’t have only one disease, we have several, and each disease has its own therapeutic arsenal. Doctors must monitor patients, not only to control the disease, but also to ensure they prescribe drugs that do not have adverse effects on the patient’s other conditions. When visiting our GP, they have to take into account a number of parameters, and a visit to the hospital can mean appointments with a number of different medical services. One of the most serious health issues today is derived from interactions between different drugs or therapeutic activities that can act as obstacles to each other.

Medicine has come a long way since I was born. We have discovered so much about diseases and we now have much more effective medicines and surgery to cure many conditions. Nevertheless, medicine is poorly prepared for the new patient: elderly, with several diseases, some mental (Alzheimer’s, dementia, depression, etc.), without family, and prescribed a lot of different medication. Because the system cannot cope with the complexity, they end up sending the patient to an elderly care nursing home.

For several years, voices have been raised in healthcare circles demanding the reorganization of services to meet the demands of these new patients. These voices have difficulty making themselves heard and it is very difficult to change the way health services operate. We have reduced mortality thanks to specialization and superspecilisation with diseases being defined with greater precision, but the patient has been reduced to a sack of diseases. The new medical perspective asks to view the patient as a whole and not only each one of the diseases they suffer from. There is still much work to do.

The current paradox is that we have never been so healthy and at the same time, we have never been so sick. Never before have we been able to live for so long in good health and never before have we lived so long with so many diseases to trouble us, to restrict us and make us dependent on health services. Faced with this situation, health services must adapt and patients must take a more active role in caring for their diseases.

Post written by Bohígas (@bohigasl), economist.

The Observatory, gateway to health open data

14 Apr

Núvol Open data The information generated by the interaction of citizens and the healthcare system keeps increasing in size. Just to get an idea, last year, only in Catalonia there were nearly 45 million consultations in primary care centres, more than 700.000 patients were hospitalised, and over 150 million prescriptions were made. However, there is much more stored in administrative records (diagnostic tests, medical imaging, hospital prescriptions, expenditures, etc.) which are kept and managed in large databases. Government officials are responsible for the safe keeping of this information, and it may use it to improve the quality of healthcare and for healthcare planning purposes.

Furthermore, advances in the development, interoperability and crosslinking of the different information systems are making it easier to gather a large amount of data that will contribute to better characterise both the general and the patient population, and they are essential to assess the results of healthcare policies.

There is a wealth of opportunities with the increasing amount of data, all of them available in electronic formats and with more quality, and with the better linking between administrative databases. Thus, the information gathered leads to new ways of generating knowledge, especially when multiple data sources are combined (genetic, environmental, socio-economic, etc.) and made available to the citizens.

This turns information into a valuable asset for planning and assessment, but also for third parties, especially in research and in initiatives aimed at enhancing the use of open data.

Open data are a actually a philosophy, as they represent a practice that encourages the free access of data for everyone, without technical limitations. This means that the original files containing the data are available to the public in the most structured way as possible. This enables any computer system to read them, and even to easily develop software based on them.

This trend towards freeing the access to data is parallel to the need of the Catalan healthcare system of managing the whole life cycle of information, from the generation of information to the knowledge dissemination.

Information and communication technologies, and information systems become key strategic allies to achieve the above objectives, and to succeed in the integration, transparency, assessment and accountability by the healthcare system and its different actors.

In the case of Catalonia, the Autonomous Government is committed to a progressive disclosure of the available public data while respecting the privacy, safety and property limitations applicable in each case through the Open Data portal, where all data are indexed and characterised. This is done following the international trends regarding the disclosure of public data, and it counts with the advice from the W3C experts (World Wide Web Consortium).

The Department of Health is thus also joining the initiative of supporting free access to data and public information. This will enable to further advance towards an open government system, based on the values of transparency, service and efficiency, on promoting the generation of value through reusing public information, on easing the internal organisation of the information systems, and on fostering interoperability among the components of the healthcare system.

The Catalan Health System Observatory collaborates in this project by favouring the knowledge about the healthcare sector in Catalonia, and by supplying the citizens with health information to assess the healthcare system itself, to support decision-making and to favour transparency and accountability. With this objective, the Observatory is strongly determined to unveil to the general public all the information regarding their healthcare system. Along with other products, the Observatory publishes on its website a set of health and healthcare activity indicators, consisting of texts, charts and open data files.

Additionally, all the data published in the Observatory reports (Results Centre, Crisis & health, etc.) are also available to the public as open data formats and infographics. Finally, the Observatory website provides a link to the open data portal and a collection of health open data available up to date.

Check the open data available at the Observatory website!

Post written by Montse Mias (@mmias70) and Anna García-Altés (@annagaal).