1
|
Adrion C, Weiss B, Paul N, Berger E, Busse R, Marschall U, Caumanns J, Rosseau S, Mansmann U, Spies C. Enhanced Recovery after Intensive Care (ERIC): study protocol for a German stepped wedge cluster randomised controlled trial to evaluate the effectiveness of a critical care telehealth program on process quality and functional outcomes. BMJ Open 2020; 10:e036096. [PMID: 32978185 PMCID: PMC7520839 DOI: 10.1136/bmjopen-2019-036096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Survival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-term cognitive, psychological and/or physical impairments after ICU discharge, which is recognised as post-intensive care syndrome (PICS). There are evidence-based and consensus-based quality indicators (QIs) in intensive care medicine, which have a positive influence on patients' long-term outcomes if adhered to. METHODS AND ANALYSIS The protocol of a multicentre, pragmatic, stepped wedge cluster randomised controlled, quality improvement trial is presented. During 3 predefined steps, 12 academic hospitals in Berlin and Brandenburg, Germany, are randomly selected to move in a one-way crossover from the control to the intervention condition. After a multifactorial training programme on QIs and clinical outcomes for site personnel, ICUs will receive an adapted, interprofessional protocol for a complex telehealth intervention comprising of daily telemedical rounds at ICU. The targeted sample size is 1431 patients. The primary objective of this trial is to evaluate the effectiveness of the intervention on the adherence to eight QIs daily measured during the patient's ICU stay, compared with standard of care. Furthermore, the impact on long-term recovery such as PICS-related, patient-centred outcomes including health-related quality of life, mental health, clinical assessments of cognition and physical function, all-cause mortality and cost-effectiveness 3 and 6 months after ICU discharge will be evaluated. ETHICS AND DISSEMINATION This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/006/18). The results will be published in a peer-reviewed scientific journal and presented at international conferences. Study findings will also be disseminated via the website (www.eric-projekt.net). TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03671447).
Collapse
Affiliation(s)
- Christine Adrion
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Bjoern Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicolas Paul
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Berger
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | | | - Jörg Caumanns
- Fraunhofer Institute for Open Communication Systems, Berlin, Germany
| | - Simone Rosseau
- Weaning and Ventilation Centre, Ernst von Bergmann Klinikum, Bad Belzig, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
2
|
Rao P, Moore JK, Stewart R, Runions K, Bear N, Wong JWY, Holtmann M, Zepf FD. Bipolar disorder in children and adolescents: diagnostic inpatient rates from 2000 to 2013 in Germany. Int J Bipolar Disord 2016; 4:23. [PMID: 27837521 PMCID: PMC5106426 DOI: 10.1186/s40345-016-0064-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 10/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background Despite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain. We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors. Methods Nationwide German inpatient discharge diagnoses of BD and other related psychiatric disorders were mapped between 2008 and 2013 using registry data from the German Federal Health Monitoring System. This was compared with previously published data, 2000–2007, to assess long-term trends in diagnosis of BD at discharge. Long-term trends (2000–2013) were also computed. Results Discharge diagnosis of BD increased by 18% (2.02–2.46 per 100,000) in minors. There was a significant increase of 24.1% in adolescents 15–19 years old (6.56–8.14 per 100,000). BD, at discharge, as a proportion of all psychiatric disorders, increased from 0.26% in 2008 to 0.27% in 2013. When analysing long-term trends (2000–2013), the rates for BD increased significantly as did trends for all mental disorders, except for psychotic disorders, which fell by almost 14%. Between 2000 and 2013, the rate for depression in minors increased by 730%. Limitations The dataset consisted of cross-sectional administrative data points with diagnoses based on clinical criteria. Conclusions The rate of BD as a discharge diagnosis in German minors has increased significantly, consistently exceeding the general trend for a rise in rates for mental disorders. Overall, the rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses.
Collapse
Affiliation(s)
- Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia. .,Department of Health, Western Australia, Community Child and Adolescent Mental Health Services, Perth, WA, Australia.
| | - Julie K Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Paediatric Consultation-Liaison Program, Department of Health, Western Australia, Child and Adolescent Mental Health Services, Perth, WA, Australia
| | - Richard Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Kevin Runions
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Natasha Bear
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Clinical Research and Education, Child and Adolescent Health Service, Department of Health, Western Australia, Perth, WA, Australia
| | - Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Martin Holtmann
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr University Bochum, Hamm, Germany
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, Australia
| |
Collapse
|
3
|
Ultsch B, Siedler A, Rieck T, Reinhold T, Krause G, Wichmann O. Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis 2011; 11:173. [PMID: 21679419 PMCID: PMC3141411 DOI: 10.1186/1471-2334-11-173] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) is caused by a reactivation of the varicella-zoster-virus (VZV) and mainly affects individuals aged≥50 years. Vaccines have been licensed or are under development that can protect against HZ and its main complication postherpetic neuralgia (PHN). In Germany, the burden of disease caused by HZ is not well known. To support the decision making process related to a potential vaccination recommendation, we estimated annual HZ disease burden in people aged≥50 years in Germany by utilizing various data sources. METHODS We assessed for 2007 and 2008 HZ-outpatient incidence (number of cases per 1,000 person-years, PY) by utilizing the Association of Statutory Health Insurance Physicians (ASHIP) database, which contains nationwide routine outpatient data. For the same time period annual number of HZ-inpatients and HZ-associated deaths were identified by using the Federal Health Monitoring System (FHM). PHN-incidence and loss of quality-adjusted life years (QALYs) caused by HZ were calculated by multiplying number of identified HZ-patients with upper and lower limit estimates for proportion of HZ-cases developing PHN and HZ-related QALY, respectively. RESULTS For the study period we identified an annual average of 306,511 HZ-outpatients aged 50+, resulting in a HZ-incidence of 9.6/1,000 PY. A total 14,249 HZ-associated inpatients and 66 deaths were reported in both years on average. HZ-incidence increased by age from 6.21 in people 50-54 years to 13.19 per 1,000 PY in people aged≥90 years. Females were significantly more frequently affected than males in terms of outpatient HZ-incidence (11.12 vs. 7.8 per 1,000 PY), inpatient HZ-incidence (0.51 vs. 0.38 per 1,000 PY) and mortality (0.29 vs. 0.10 per 100,000 PY). PHN-incidence was estimated to range between 0.43 and 1.33 per 1,000 PY. Based on these figures, there were between 3,065 to 24,094 QALYs lost due to HZ in persons aged≥50 years in Germany per annum. CONCLUSION Our study provides important baseline estimates for HZ-related disease burden in Germany. HZ poses a considerable burden on the health care system in Germany both in terms of outpatient and inpatient services. Follow-up assessments of HZ disease burden are needed to monitor the impact of VZV-vaccinations in Germany.
Collapse
Affiliation(s)
- Bernhard Ultsch
- Immunization Unit, Robert Koch Institute, 13086 Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
4
|
Holtmann M, Duketis E, Poustka L, Zepf FD, Poustka F, Bölte S. Bipolar disorder in children and adolescents in Germany: national trends in the rates of inpatients, 2000-2007. Bipolar Disord 2010; 12:155-63. [PMID: 20402708 DOI: 10.1111/j.1399-5618.2010.00794.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Increasing admission and prevalence rates of bipolar disorder (BD) are a matter of controversy in international child and adolescent psychiatry. We seek to contribute to this discussion by presenting data obtained in a population of German children and adolescents. METHODS Nationwide, whole population changes in inpatient admissions of BD and other psychiatric disorders between 2000 and 2007 were analyzed in individuals aged up to 19 years using registry data from the German Federal Health Monitoring System. RESULTS Inpatient admissions for BD in individuals aged up to 19 years increased from 1.13 to 1.91 per 100,000 or 68.5% between 2000 and 2007 (odds ratio: 1.69; 95% confidence interval: 1.41-2.02), with a nonsignificant decline in children less than 15 years and the largest relative increase in adolescents aged 15-19 years. Inpatient rates for depressive disorders increased by 219.6% and for hyperkinetic disorder by 111.3%. Conduct disorders increased by 18.1%, considerably less than the 38.1% general rise for all mental disorders in children and adolescents. The only significant decline in a diagnostic category occurred for psychotic disorders (-11.8%). BD inpatient admission represented only 0.22% of all mental disorder admissions in 2000 and 0.27% in 2007. CONCLUSIONS An elevation of inpatient admissions of BD in Germany in adolescents was detected, exceeding the general trend for increased mental disorder admissions. The results may indicate a higher clinical awareness and appreciation of mood symptoms at earlier ages and, in part, a reconceptualization of previously diagnosed psychotic disorders in youth. However, a diagnosis of BD in youngsters is still extremely rare in Germany. Diagnoses were based on the judgment of the treating physician. A correction for multiple admissions in the data set is not possible.
Collapse
Affiliation(s)
- Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University Bochum, Hamm, Germany.
| | | | | | | | | | | |
Collapse
|
5
|
Abstract
In the health care system, there is increasing demand for health economic analyses to achieve cost reductions or increase efficiency. Apart from classical literature or study-based analyses in health economics, routinely obtained data may complement hitherto missing information for the general medical care situation. By analysing care structures and comparing applied or newly introduced technologies, results can be achieved faster and the significance for payers increased as compared to primary studies. Routinely obtained and potentially usable databases are frequently generated from surveys or from administrative data sources. In spite of clear limitations, these data are interesting in health economics based upon reflection of reality in utilization of services. They can contribute to improved understanding of general medical care and aid in identifying economically appropriate technologies and therapeutic strategies.
Collapse
|