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Group Group 2

Group 2



Nodo: Aragón


Instituto Aragonés de Ciencias de la Salud


Enrique Bernal-Delgado




Health Services Research - IIS Aragon (HSR-IIS Aragon) - ARAGON

Group coordinator:
Enrique Bernal-Delgado MD, PhD
Contact address:
Enrique Bernal-Delgado MD, PhD
13th San Juan Bosco, CIBA building, 50009 Zaragoza (Spain)

Group Description:

Health Services Research-IIS Aragon (HSR-IIS Aragon) is a group based at the Institute for Health Sciences in Aragon. Led by Enrique Bernal-Delgado, the group includes six researchers, with four PhD: Amaia Calderón-Larrañaga (epidemiologist), Sandra García-Armesto (health policy analyst), Natalia Martínez-Lizaga (biostatistician), Alexandra Prados-Torres (epidemiologist), Manuel Ridao-López (health economist), Miriam Seral-Rodríguez (data-manager).

Main research lines: HSR-IIS Aragon works on unwarranted variation in medical practice and outcomes, and healthcare performance analyses. Additionally, the group develops three cross-section research lines: development of risk-stratification tools with the purpose of predicting utilization; building research cohorts from clinical-administrative dataset and electronic clinical records, and adaptation of epidemiological methodology to health services research analysis.

Ongoing projects: Four major projects:

• Spatial-temporal evolution of unwarranted variation in clinical practice in the Spanish National Health Service (PI10/00494)
• ECHO -European Collaboration in Healthcare Optimization ( (FP7 242189)
• Multi-morbidity: epidemiology, utilization patterns and healthcare system responsiveness (PI11/01126)
• Elaboration of a disinvestment strategy in the SNS stemming from monitoring unwarranted variations in lower-value procedures (PI12/01884)

Research outputs: Publications of particular interest in peer-review journals are: 

• García-Armesto S, Campillo-Artero C, Bernal-Delgado E. Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System. Health Policy 2013; 10(2-3): 180-5.
• Ibañez B, Librero J, Peiró S, Bernal-Delgado E. Shared component modeling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases. BMC Methods in Medical Research 2011; 11:172
• Prados-Torres A, Poblador-Plou B, Calderón Larrañaga A, et al. Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis. PLoS One. 2012; 7(2): e32190.

Transfer outputs: several worth mentioning

• The publication of a nation-wide Atlas of Variations in Medical Practice (8 issues have been published, and 2 more ongoing), including an Atlas of Potentially Avoidable Hospitalizations in Chronic Diseases (available at;
• A set of validated performance indicators, available for healthcare performance analyses on elderly people;
• A massive Data Warehouse compiling the universe of hospital discharges in Spain from 2002-onwards ready to build studies on elderly people.

© REDISSEC 2013. All rights reserved.

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