Atlas VPM: two decades informing on unwarranted variations in health care in Spain

Since the early 2000’s, the Atlas of Variations in Medical Practice in the Spanish National Health System (namely, Atlas VPM) has been analysing and informing unwarranted variations in health care provision and outcomes in the Spanish Health System. Atlas VPM covers a two-fold perspective: a geographic one, where unwarranted variations would reflect the uneven exposure of the population to health care as a consequence of the place of residence; and, a provider-specific approach, where unwarranted variations would reflect differences in utilisation and outcomes that are at provider-level. Building on routine data (hospital and primary care electronic records, administrative data, geographic information, etc.) Atlas VPM has adapted the classical small area methods and has included a large panoply of techniques, such as Bayesian methods, hierarchical modelling or time-series forecasting. Led by the Data Science for Health Services and Policy Research group at the Institute for Health Sciences in Aragon, Atlas VPM implies a linkage and exchange process with the 17 Departments of Health of the Spanish regions where the research agenda is shared and research outcomes are translated into profiling and benchmarking interactive tools meant to facilitate clinical and policy decision-making.