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Leading institute
Principal investigator
Enrique Bernal-Delgado
Is the Research network active
End of project
Health systems » Health system performance » Quality » Care
Health systems » Health system performance » Costs/expenditure
Health systems » Health system performance » Access
Health status » Mortality » Age- and cause-specific mortality » Non-communicable diseases (excluding cancer)
Free keywords
Delivery of Health Care
hospital in-patient data
Indicator set
Aim of the Research Network

ECHO aimed at building a common knowledge infrastructure based on existing datasets, which ultimately allowed international healthcare performance comparisons.
Conceived as a pilot study, ECHO set about the task of bringing together patient-level data from Denmark, England, Portugal, Slovenia and Spain, and contextual information -demographic, socioeconomic, and healthcare supply data.
This knowledge infrastructure allows evaluating more than 40 performance indicators, carefully developed to avoid inappropriate cross-country comparisons.
The ECHO knowledge infrastructure allows the study of several performance dimensions (equity, effectiveness, safety and efficiency) at the international, national, regional, and even provider level.

Start date: 01/03/2010
Participating Institutions
7 countries : Spain, Denmark, Portugal, Austria, United Kingdom, Slovenia and International
Institution Country Website
INSTITUTO ARAGONES DE CIENCIAS DE LA SALUD (IACS) Spain Institute for Health Sciences in Aragon (IACS) website
University of Southern Denmark (SDU) Denmark University of Sourther Denmark - Statens Institut of Folkesundhed (National Ins…
Escola Nacional de Saude Publica Portugal Escola Nacional de Saude Publica - Universidade Nova de Lisboa
Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik (UMIT) Austria UMIT - The health and Life Sciences University
University of York United Kingdom University of York - Health Services and Policy Research Group
Nacionalni Inštitut za Javno Zdravje (NIJZ) Slovenia Nacionalni Inštitut za Javno Zdravje (NIJZ) - National Institute of Public Heal…
European Health Management Association (EHMA) International European Health Management Association (EHMA)
Organization of participation
one representative from each country
Method for gathering data from partners
Partners send data in a certain format (e.g. CSV, xml)
Method for transferring data from partners
Via mail
Data security for data transfer
Data encryption
Data security for data access
Data encryption
Title Free keywords Type of output Topics Link
The ECHO Project official website
European Journal of Public Health Special Issue: Unwarranted variations in health care performance across Europe: Lessons from the ECHO Project
Handbook on methodology: ECHO information system quality report EUROPEAN COLLABORATION FOR HEALTHCARE OPTIMIZATION (ECHO)
ECHO Atlas Information Tool
ECHO eHandbook on Methodology
ECHO indicators set
European Collaboration for Healthcare Optimisation (ECHO) Indicators Definition Crosswalks
European Collaboration for Healthcare Optimisation (ECHO) Data Model Specification
ECHO Atlas N1 on Lower-Value Care (LVC)
ECHO Atlas N2 on Potentially Avoidable Hospitalisations (PAH)
ECHO Atlas N3 on Coronary revascularization (CV)
Hospital Surgical Volumes and Mortality after Coronary Artery Bypass Grafting: Using International
Acknowledging the role of patient heterogeneity in-hospital outcome reporting: Mortality after acute myocardial infarction in five European countries
Capacity Building Activity that could be offered
ECHO eHandbook on Methodology - training materials

Keywords: methodology, variation metrics, efficiency, international comparison, bench-marking, health system performance, healthcare quality

The ECHO project consortium can offer training on the secondary use of administrative healthcare data to assess healthcare performance across and within countries. Particularly, ECHO published freely online a Handbook on Methodology providing insight into: 

  • The ECHO performance assessment model 
  • Issues in the international comparison of healthcare performance and healthcare quality indicators
  • Variation metrics and different approaches to measuring variations in medical practice and measuring socioeconomic equity
  • Measuring efficiency as part of healthcare performance assessment

Additionally, the ECHO project coordination office can offer technical and methodological training on:

  • The ECHO research infrastructure, 
  • Use of the ECHO Atlas Tool for health system assessment and international comparison, and
  • Data Quality Assessment and Data Quality Assurance measures
Is the data collection relevant to Covid-19?
Is the analysis relevant to Covid-19?
Is the capacity building relevant to Covid-19?
Is the interaction with policy makers / knowledge translation relevant to Covid-19?
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Updated on 26 May 2021