Ten-Year Evaluation of the Population-Based Integrated Health Care System "Gesundes Kinzigtal"

[Five Key Questions for Health Services Research: are SHI Claims Data Suitable for Your Research Project?]

Health services research examines the structures and processes of health care under everyday conditions. Routine data of the statutory health insurance (SHI) - the so-called routine practice data - represent real health care and are therefore an important data source for health services research. This paper presents 5 key questions that researchers and data-holding institutions can use to assess the suitability of this data source for answering their health services research question. The aim of these guiding questions is to generate a common understanding between researchers and data-holding institutions of the research project, the research objective, and the feasibility of implementation in health services research. The five guiding questions cover the formulation of the research question, the planned method, the target population, the relevant study periods, and the required information from SHI data. These methodologically oriented guiding questions are supplemented by the question of how the results of the research project could improve care. Thus, for researchers, the five guiding questions provide an initial structuring for data requests; for data-holding institutions, they provide a framework for considering possible involvement in or support of a research idea in health services research.

Effect of integrated perioperative rehabilitation intervention under the fast-track surgery concept on stress and complications in patients undergoing craniocerebral injury surgery

Objective

To observe the intervention effect of perioperative rehabilitation intervention of integrated medical care the concept of FTS on stress response and postoperative complications in patients undergoing craniocerebral injury surgery.

Methods

70 patients with Traumatic brain injury (TBI) admitted to the Department of Neurosurgery of our Hospital from January 2019 to December 2021 were as the research objects and were divided into general group and FTS group according to the random number table method, with 35 cases in each group. The general group was intervened with perioperative basic nursing measures for TBI, and the FTS group was intervened with perioperative rehabilitation model of integrated medical care under the concept of FTS on the basis of the general group. The two groups of patients were compared in hemodynamic indexes (heart rate, mean arterial pressure), stress hormone levels (CORT, GLU, E), changes in motor neurological function (GCS score, NHISS score, FMA score), occurrence of postoperative complications (infection, pressure sores, rebleeding, central hyperthermia), short-term quality of life (SF-36) before and after the intervention.

Results

After intervention, the levels of HR, MAP, COR, GLU, and E were significantly lower in FTS group than in the general group (all P < 0.05). After intervention, the Fugl-Meyer score and Barthel index score of upper and lower extremities in both groups were significantly higher than those before intervention, and the FTS group was higher than the general group, and the difference was statistically significant (P < 0.05). After the intervention, the NIHSS scores were significantly lower in both groups than before the intervention, and the FTS group was lower than the general group, and the differences were statistically significant (P < 0.05). Short-term physical function, somatic pain, physical function, general health status, social function, energy, mental health, and emotional function scores were significantly higher in the FTS group than in thegeneral group, and all differences were statistically significant (P < 0.05). The total incidence of infection, pressure ulcers, rebleeding, central high fever and other complications in the FTS group was significantly lower than that in the general group (P < 0.05).

Conclusion

The implementation of integrated perioperative rehabilitation interventions under the concept of FTS for patients with TBI can significantly alleviate patients' stress, promote recovery, reduce the incidence of complications, and improve short-term quality of life, which is worthy of clinical promotion.

Development of indicators to assess quality and patient pathways in interdisciplinary care for patients with 14 ambulatory-care-sensitive conditions in Germany

BACKGROUND

In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients.

METHODS

Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients.

RESULTS

The process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure.

CONCLUSION

Our set of indicators provides useful information on patients' health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care.

Assessing the effect of a regional integrated care model over ten years using quality indicators based on claims data - the basic statistical methodology of the INTEGRAL project

BACKGROUND

The regional integrated health care model "Healthy Kinzigtal" started in 2006 with the goal of optimizing health care and economic efficiency. The INTEGRAL project aimed at evaluating the effect of this model on the quality of care over the first 10 years.

METHODS

This methodological protocol supplements the study protocol and the main publication of the project. Comparing quality indicators based on claims data between the intervention region and 13 structurally similar control regions constitutes the basic scientific approach. Methodological key issues in performing such a comparison are identified and solutions are presented.

RESULTS

A key step in the analysis is the assessment of a potential trend in prevalence for a single quality indicator over time in the intervention region compared to the corresponding trends in the control regions. This step has to take into account that there may be a common - not necessarily linear - trend in the indicator over time and that trends can also appear by chance. Conceptual and statistical approaches were developed to handle this key step and to assess in addition the overall evidence for an intervention effect across all indicators. The methodology can be extended in several directions of interest.

CONCLUSIONS

We believe that our approach can handle the major statistical challenges: population differences are addressed by standardization; we offer transparency with respect to the derivation of the key figures; global time trends and structural changes do not invalidate the analyses; the regional variation in time trends is taken into account. Overall, the project demanded substantial efforts to ensure adequateness, validity and transparency.