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International Collaborative for Costs, Outcomes, and Needs in Care (ICCONIC)

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International Collaborative for Costs, Outcomes, and Needs in Care (ICCONIC)

Across health systems, high-need, high-cost (HNHC) patients tend to constitute a relatively small segment of the population while accounting for a disproportionately large share of healthcare expenditures. Little is known, however, about how patterns of healthcare utilization, spending, and outcomes for HNHC patients vary across health systems.

The ICCONIC effort is a partnership between collaborators from 18 countries in North America, Europe, Asia, and the Pacific. ICCONIC is committed to advancing the development of methods and measures in comparative health systems research. The collaborative's ultimate objective is to increase the availability of patient-level data, leverage data linkages to conduct cross-country analysis, and provide policymakers with insights into how different care strategies may influence care quality, cost, and outcomes.

  • Visit the ICCONIC Website

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outputs of this collaborative

The Guardian

England has highest death rates of older patients in western world, study finds

November 10, 2021
ICCONIC findings featured in a Guardian article.
Read Article
Health Services Research

International comparison of patient care trajectories: Insights from the ICCONIC project

November 10, 2021
Health systems across high-income countries have similar goals, which include maximizing quality of care, offering services responsive to patient needs, and ensuring efficient health care delivery. Health systems also face similar challenges, such as changing demographics, limited national resources, and ongoing rising health care costs.3 In response, national policy makers are working to identify effective strategies to address these challenges, which are heavily influenced by existing health system features. A group of particular concern is the growing number of high-need, high-cost (HNHC) patients, a clinically diverse set of patients with multiple medical needs, frailty, and multimorbidity. While constituting a relatively small proportion of the population, these patients account for a disproportionate share of medical expenditures across health systems.
Read Article
The Health Foundation

Caring for older patients with complex needs: How does England compare with 11 OECD countries?

November 10, 2021
Report of ICCONIC research to the Health Foundation.
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Health Services Research

A methodology for identifying high-need, high-cost patient personas for international comparisons

November 10, 2021
Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.
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The Commonwealth Fund

Medicare Patients Pay More for Drugs Than Older Adults in Other Countries; Congress Has an Opportunity to Move Forward

September 30, 2021
ICCONIC work featured in a CMWF To The Point blog.
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Health Services Research

International comparison of spending and utilization at the end of life for hip fracture patients

September 7, 2021
Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
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Health Services Research

Within and across country variations in treatment of patients with heart failure and diabetes

September 7, 2021
Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
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Health Services Research

Differences in health outcomes for high-need high-cost patients across high-income countries

August 11, 2021
Across 11 countries, there are meaningful differences in health system outcomes for two types of patients.
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Health Services Research

An international comparison of long-term care trajectories and spending following hip fracture

August 11, 2021
In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.
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Health Services Research

International comparison of health spending and utilization among people with complex multimorbidity

August 5, 2021
Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility-based rehabilitative care.
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