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Scholz K, Köster I, Meyer I, Selke GW, Schubert I. Prescribing of valproate and oral antiepileptics for women of childbearing age and during pregnancy in Germany between 2010 and 2020. Pharmacoepidemiol Drug Saf 2023; 32:1306-1314. [PMID: 37485793 DOI: 10.1002/pds.5670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To examine prescriptions of valproate and oral antiepileptic drugs (OAED) in Germany irrespective of the indication in women in general and particularly in women of childbearing age (13-49 years) and during pregnancy between 2010 and 2020, that is, before, during and after the implementation of the EU risk minimization measures (RMMs). METHODS Analysis of claims data. STUDY POPULATION all women continuously insured with the AOK health insurance fund in the respective observation year (2010-2020) and the previous year. OAED were identified by ATC code N03. Period of pregnancy was calculated based on birth information in claims data. MAIN OUTCOMES MEASURES (i) prevalent use of valproate/OAED: number of women with at least one prescription of valproate/OAED per year divided by all women of the study population (rate per 1000 women); (ii) percentage of OAED recipients with at least one valproate prescription during pregnancy (13-49 years) in the respective observation year. RESULTS Prevalence rate/1000 women for valproate use decreased by -31.33% across all age groups (2010-2014: -7.48%; 2014-2018: -16.47%; 2018-2020: -11,17%) with a strong reduction in women 13-49 years between 2014 and 2018 (-28.74%). The rate for OAED across all age groups rose from 33.43/1000 women in 2010 to 41.03/1000 (+22,73%). Valproate use during pregnancy of women with OAED declined from 1.29% in 2010 to 0.59% in 2020 (-54,26%) (2010-2014: -5.14%; 2014-2018: -42.31%; 2018-2020: -16.69%). CONCLUSION Even if, due to the descriptive nature of the study, no causal relationship can be postulated between the RMMs and the strong decrease in valproate prescriptions, our results are compatible with the hypothesis that the measures have improved drug therapy safety.
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Affiliation(s)
- Katrin Scholz
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Köster
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingo Meyer
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gisbert W Selke
- Research Area: Drug Information Systems and Analyses, AOK Research Institute (WIdO), Berlin, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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2
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Schubert I, Lappe V, Marschall U, Grandt D. Missing PPI prescriptions while overprescribing? Eur J Clin Pharmacol 2023; 79:1579-1581. [PMID: 37725121 PMCID: PMC10618296 DOI: 10.1007/s00228-023-03564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Ingrid Schubert
- PMV Forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931, Cologne, Germany.
| | - Veronika Lappe
- PMV Forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931, Cologne, Germany
| | - Ursula Marschall
- Head of Department Medicine/Health Care Research, BARMER, 42285, Wuppertal, Germany
| | - Daniel Grandt
- Klinik für Innere Medizin I, Klinikum Saarbrücken gGmbH, 66119, Saarbrücken, Germany
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Lappe V, Greiner GG, Linnenkamp U, Viehmann A, Adamczewski H, Kaltheuner M, Weber D, Schubert I, Icks A. Gestational diabetes in Germany-prevalence, trend during the past decade and utilization of follow-up care: an observational study. Sci Rep 2023; 13:16157. [PMID: 37758812 PMCID: PMC10533812 DOI: 10.1038/s41598-023-43382-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. Information on key figures such as screening rates, prevalence of GDM or utilization of follow-up care and associated factors varies widely and is often lacking. The aim of our study is to provide information on screening rates for and prevalence of GDM as well as utilization of follow-up care in Germany. We used data (2010-2020) from a large, nationwide statutory health insurance containing information on inpatient and outpatient care, including diagnoses, medication and treatments. Descriptive analyses were performed to assess screening rates, prevalence of GDM and participation rates in follow-up care. A log-binomial regression model was calculated to analyze associated factors. Screening rates among pregnant women increased from 40.2% (2010) to 93.3% (2020) and prevalence from 9.4% (2010) to 15.1% (2020). The proportion of women attending follow-up care remained stable over time (around 42%). Age, educational level, insulin prescription, hypertension and obesity were positively associated with participation in follow-up care. Although over 90% of women in Germany are screened for GDM during pregnancy, follow-up care is used much less. Further research is needed to understand the trends in GDM healthcare (from screening to follow-up care) and the reasons for women's (non-)participation, as well as the attitudes and routines of the healthcare providers involved.
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Affiliation(s)
- Veronika Lappe
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | - Gregory Gordon Greiner
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Ute Linnenkamp
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anja Viehmann
- Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | | | | | - Dietmar Weber
- WinDiab gGmbH, Geranienweg 7a, 41564, Kaarst, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Munich-Neuherberg, Germany
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Markser A, Blaschke K, Meyer I, Jessen F, Schubert I, Albus C. Claims data analysis of the health care utilization for patients with coronary heart disease and mental comorbidity. J Psychosom Res 2023; 172:111430. [PMID: 37421747 DOI: 10.1016/j.jpsychores.2023.111430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Mental disorders (MD) are a common comorbidity in patients with coronary heart disease (CHD) and have a significant impact on morbidity and mortality. The aim of this study was to determine to what extent mental disorders are diagnosed as comorbidity in patients with CHD and whether adequate therapeutic measures are taken. METHODS Claims data from 4435 Cologne citizens with diagnosed CHD and a hospital stay due to CHD in 2015 were examined through a longitudinal analysis. The data were analyzed descriptively with regard to mental disorders, investigating diagnostic examinations performed, prescriptions for psychotropic drugs, and utilization of psychotherapy. We differentiated between pre-existing MD, existing in the year before the CHD-related hospital stay, and incident MD with new onset during or within six months after hospitalization. RESULTS Psychodiagnostic examinations for mental disorders occurred very rarely during cardiological hospitalization (0.04%) and psychiatric/psychosomatic consultation sessions rarely (5%). The longitudinal analysis showed a high rate of pre-existing MDs (56%, n = 2490) and a new diagnosis of mental disorders in 7% (n = 302) of the patients. Within one year after inpatient treatment for CHD, psychotropic medication was prescribed in 64-67% of patients with newly diagnosed affective or neurotic, adjustment/somatoform disorder and 10-13% received outpatient psychotherapy. CONCLUSION The results indicate low rates of inpatient diagnostic examinations and low rates of adequate treatment of mental disorders in patients from Cologne with CHD and new onset mental disorders. The rate of prescriptions of psychopharmacotherapy after hospitalization due to CHD exceeds that of the utilization of outpatient psychotherapy.
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Affiliation(s)
- Anna Markser
- Dept. of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany.
| | - Katja Blaschke
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Ingo Meyer
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Frank Jessen
- Dept. of Psychiatry and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, North Rhine-Westphalia, Germany.
| | - Ingrid Schubert
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Christian Albus
- Dept. of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany.
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van de Sand H, Pützer E, Filip J, Marschall U, Meyer I, Schäfer K, Schubert I. The Frequency of Peripheral Hearing Impairment in Children and Adolescents as Determined From Routine Health Insurance Data. Dtsch Arztebl Int 2023; 120:461-462. [PMID: 37594464 PMCID: PMC10481940 DOI: 10.3238/arztebl.m2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/21/2022] [Accepted: 02/02/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Heike van de Sand
- * Joint first authors
- PMV Research Group, Medical Faculty and Cologne University Hospital, University of Cologne
| | - Elena Pützer
- * Joint first authors
- Chair of Education and Aural Rehabilitation of People who are Deaf or Hard of Hearing, University of Cologne
| | - Jasmin Filip
- Chair of Education and Aural Rehabilitation of People who are Deaf or Hard of Hearing, University of Cologne
| | - Ursula Marschall
- Barmer Institute for Health System Research – bifg, Barmer, Wuppertal
| | - Ingo Meyer
- PMV Research Group, Medical Faculty and Cologne University Hospital, University of Cologne
| | - Karolin Schäfer
- * Joint first authors
- Chair of Education and Aural Rehabilitation of People who are Deaf or Hard of Hearing, University of Cologne
| | - Ingrid Schubert
- * Joint first authors
- PMV Research Group, Medical Faculty and Cologne University Hospital, University of Cologne
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6
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Schubert I, Strohm PC. [Assessment of osteosynthesis in X-ray images]. Radiologie (Heidelb) 2023; 63:57-68. [PMID: 36598525 DOI: 10.1007/s00117-022-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/05/2023]
Abstract
Osteosynthesis refers to various surgical procedures, closed or open, for the treatment of fractures of any age. To document and control the osteosynthesis and the healing process X‑ray controls of the affected skeletal segment are performed during the operation and at regular intervals. To assess the quality of an osteosynthesis or to identify a complication, a comprehensive and systematic image review is useful. This includes the assessment of the restoration of the functional anatomy, the position of the material in relation to the surrounding structures, an evaluation of the stability as far as this is possible, and a control of the bone healing in a functionally correct position.
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Affiliation(s)
- I Schubert
- Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland.
| | - P C Strohm
- Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland
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7
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Schneider P, Keller P, Schubert I, Bender M, Trautmann C, Dürr M. Bond-specific fragmentation of oligopeptides via electronic stopping of swift heavy ions in molecular films. Sci Rep 2022; 12:17975. [PMID: 36289262 PMCID: PMC9605986 DOI: 10.1038/s41598-022-21744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Highly bond-specific fragmentation of oligopeptides induced by swift heavy ion (SHI) irradiation was investigated by means of mass spectrometry. In pronounced contrast to measurements of samples irradiated with keV ions, oligopeptides which were exposed to 946 MeV Au ions show a high abundance of specific fragments. The highly bond-specific nature of SHI-induced fragmentation is attributed to electronic stopping as the most relevant energy loss mechanism for SHI in the oligopeptide samples in combination with the subsequent coupling between the excited electronic and the atomic subsystem. Fragmentation induced by SHI is observed to be further influenced by the structure of the oligopeptides, suggesting that electronic excitation and/or the electronic-vibrational coupling depend on the details of the molecular structure.
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Affiliation(s)
- P. Schneider
- grid.8664.c0000 0001 2165 8627Institut für Angewandte Physik and Zentrum für Materialforschung, Justus-Liebig-Universität Giessen, Heinrich-Buff-Ring 16, 35392 Giessen, Germany
| | - P. Keller
- grid.8664.c0000 0001 2165 8627Institut für Angewandte Physik and Zentrum für Materialforschung, Justus-Liebig-Universität Giessen, Heinrich-Buff-Ring 16, 35392 Giessen, Germany
| | - I. Schubert
- grid.159791.20000 0000 9127 4365GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, 64291 Darmstadt, Germany
| | - M. Bender
- grid.159791.20000 0000 9127 4365GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, 64291 Darmstadt, Germany ,grid.449475.f0000 0001 0669 6924Fachbereich Ingenieurwissenschaften, Hochschule RheinMain, Kurt-Schumacher-Ring 18, 65197 Wiesbaden, Germany
| | - C. Trautmann
- grid.159791.20000 0000 9127 4365GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, 64291 Darmstadt, Germany ,grid.6546.10000 0001 0940 1669Fachbereich Materialwissenschaften, Technische Universität Darmstadt, Alarich-Weiss-Strasse 2, 64287 Darmstadt, Germany
| | - M. Dürr
- grid.8664.c0000 0001 2165 8627Institut für Angewandte Physik and Zentrum für Materialforschung, Justus-Liebig-Universität Giessen, Heinrich-Buff-Ring 16, 35392 Giessen, Germany
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Blaschke K, Hellmich M, Samel C, Listl S, Schubert I. Association between Periodontal Treatment and Healthcare Costs in Patients with Coronary Heart Disease: A Cohort Study Based on German Claims Data. Dent J (Basel) 2022; 10:dj10070133. [PMID: 35877407 PMCID: PMC9320253 DOI: 10.3390/dj10070133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
There is empirical evidence of an association between periodontitis and coronary heart disease (CHD). However, it is uncertain whether periodontal treatment in CHD patients might lead to reduced healthcare costs. This study aims to assess the association between periodontal treatment and healthcare costs in newly diagnosed CHD patients. Data from 21,263 adults who were continuously insured between 2011 and 2016 and who were newly diagnosed with CHD in 2013 were selected from a German claims database. The study population was differentiated by the utilization of periodontal treatment. The average treatment effect (ATE) of periodontal treatment on healthcare costs (total, inpatient, outpatient, drugs) was investigated using weighted Poisson regression models conditional on covariates and is shown as a ratio (of geometric means). Periodontal treatment was documented for 4.7% of the persons in the study population. Newly diagnosed CHD patients showed an ATE of 0.98 for total healthcare cost (95% CI 0.90–1.06), 0.79 for inpatient costs (95% CI 0.61–1.04), and 0.95 for drug costs (95% CI 0.87–1.04). A statistically significant 7% increase in outpatient costs was shown (95% CI 1.01–1.13). Despite a lack of statistical significance in most cases, the study provides evidence of a meaningful decrease in inpatient costs after periodontal treatment. Further studies are needed.
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Affiliation(s)
- Katja Blaschke
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
- Correspondence:
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (M.H.); (C.S.)
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (M.H.); (C.S.)
| | - Stefan Listl
- Department of Dentistry—Quality and Safety of Oral Healthcare, Radboud University—Radboudumc (RIHS), 6525 EX Nijmegen, The Netherlands;
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
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Stelzer D, Graf E, Köster I, Ihle P, Günster C, Dröge P, Klöss A, Mehl C, Farin-Glattacker E, Geraedts M, Schubert I, Siegel A, Vach W. Correction to: 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. BMC Health Serv Res 2022; 22:482. [PMID: 35410208 PMCID: PMC9003996 DOI: 10.1186/s12913-022-07881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dominikus Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Ingrid Köster
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - Peter Ihle
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - Christian Günster
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Patrik Dröge
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Andreas Klöss
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Ingrid Schubert
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
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Stelzer D, Graf E, Köster I, Ihle P, Günster C, Dröge P, Klöss A, Mehl C, Farin-Glattacker E, Geraedts M, Schubert I, Siegel A, Vach W. 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. BMC Health Serv Res 2022; 22:247. [PMID: 35197048 PMCID: PMC8867633 DOI: 10.1186/s12913-022-07573-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Dominikus Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Ingrid Köster
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - Peter Ihle
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - Christian Günster
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Patrik Dröge
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Andreas Klöss
- Health Services and Quality Research, Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Ingrid Schubert
- PMV research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University of Tübingen, Tübingen, Germany
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
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Schubert I, Geraedts M. In Reply. Dtsch Arztebl Int 2022; 119:116. [PMID: 35438631 PMCID: PMC9131186 DOI: 10.3238/arztebl.m2022.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ingrid Schubert
- *PMV forschungsgruppe an der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinischen Fakultät und Uniklinik der Universität zu Köln
| | - Max Geraedts
- **Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg
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Dinh TS, Brueckle MS, González-González AI, Fessler J, Marschall U, Schubert-Zsilavesz M, Gerlach FM, Harder S, van den Akker M, Schubert I, Muth C. Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis. J Pers Med 2022; 12:jpm12010069. [PMID: 35055383 PMCID: PMC8778077 DOI: 10.3390/jpm12010069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the following five methods: formal prioritization in focus groups; systematic guideline review of evidence-based multimorbidity/polypharmacy guidelines; evidence search/synthesis and recommendation development; multidisciplinary consent of recommendations; feasibility test of updated guideline. We identified the need for a better description of the target group, decision support, prioritization of medication, consideration of patient preferences and anticholinergic properties, and of healthcare interfaces. We conducted a systematic guideline review of eight guidelines and extracted and synthesized recommendations using the Ariadne principles. We also included 48 systematic reviews. We formulated and agreed upon 34 recommendations for the revised guideline. During the feasibility test, guideline use enabled 57% of GPs to identify problems, leading to medication changes in 49% and self-assessed improvement in 56% of patients. Although 58% of GPs felt that it was too long, 92% recommended it. Polypharmacy should be systematically reviewed at least annually. Patients, family members, and healthcare professionals should monitor and adjust it using prospective process validation, taking into account patient preferences and agreed treatment goals.
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Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
- Correspondence:
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
| | - Ana Isabel González-González
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
| | - Joachim Fessler
- Gemeinschaftspraxis für Allgemeinmedizin, 65439 Floersheim, Germany;
| | - Ursula Marschall
- Department Medicine/Health Care Research, Barmer, Lichtscheider Str. 89, 42285 Wuppertal, Germany;
| | - Manfred Schubert-Zsilavesz
- Institute of Pharmaceutical Chemistry/ZAFES, Goethe University, Max-von-Laue-Str. 9, 60438 Frankfurt am Main, Germany;
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
| | - Sebastian Harder
- Institute for Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany;
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
- Department of Familiy Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 30, Blok J, 3000 Leuven, Belgium
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstrasse 52, 50931 Cologne, Germany;
| | - Christiane Muth
- Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.-S.B.); (A.I.G.-G.); (F.M.G.); (M.v.d.A.); (C.M.)
- Department of General Practice and Family Medicine, Medical Faculty East-Westphalia, University of Bielefeld, Universitaetsstrasse 25, 33615 Bielefeld, Germany
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Köster I, Mehl C, Siegel A, Graf E, Stelzer D, Farin-Glattacker E, Geraedts M, Schubert I. [Correction: Operationalization of Quality Indicators with Routine Data Using the Example of the Evaluation of "Integrated Care Healthy Kinzigtal"]. Gesundheitswesen 2021; 83:e58. [PMID: 34879395 DOI: 10.1055/a-1701-7037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ingrid Köster
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Claudia Mehl
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Achim Siegel
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Erika Graf
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Dominikus Stelzer
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Erik Farin-Glattacker
- Universitätsklinikum Freiburg, Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung, Freiburg, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Ingrid Schubert
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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Blaschke K, Hellmich M, Samel C, Listl S, Schubert I. Corrigendum to "The impact of periodontal treatment on healthcare costs in newly diagnosed diabetes patients: Evidence from a German claims database" [Diabetes Res. Clin. Pract. 172 (2021) 108641]. Diabetes Res Clin Pract 2021; 182:109098. [PMID: 34763903 DOI: 10.1016/j.diabres.2021.109098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katja Blaschke
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University - Radboudumc (RIHS), Nijmegen, the Netherlands; Medical Faculty, Department of Conservative Dentistry, Section for Translational Health Economics, Heidelberg University, Heidelberg, Germany.
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Köster I, Mehl C, Siegel A, Graf E, Stelzer D, Farin-Glattacker E, Geraedts M, Schubert I. [Operationalization of Quality Indicators with Routine Data Using the Example of the Evaluation of "Integrated Care Healthy Kinzigtal"]. Gesundheitswesen 2021; 83:S87-S96. [PMID: 34758505 DOI: 10.1055/a-1585-1735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM As part of the 10-year evaluation of Gesundes Kinzigtal Integrated Care (IVGK, Innovation Fund Project 01VSF16002), a multidisciplinary group of experts agreed on 101 quality indicators (QI) to evaluate the quality of regionally integrated care with its focus on health and prevention programs. One criterion was that the selected QI should in principle be suitable for mapping using routine data. The aim of the study was to investigate how many and in what way the QI developed can actually be mapped in Germany with routine data and for what reasons operationalization was restricted or not possible. MATERIAL AND METHODS The operationalization of the QIs was performed using pseudonymized billing data of the AOK Baden-Württemberg from 2006 to 2015, which the Scientific Institute of the AOK (WIdO) provided to the evaluation team. All operationalized indicators were binary coded (criterion fulfilled yes/no). The diagnoses, procedures, or drugs named in the numerator and denominator definitions were operationalized using ICD-10 codes (inclusion and exclusion diagnoses), EBM codes, OPS codes, ATC codes. Indicator prevalences were examined over time to check for abnormalities as an indication of possible misscoding. RESULTS Ninety of the 101 indicators were operationalizable with routine data. Fourteen of the 90 indicators could only be operationalized with restrictions, as corresponding service codes were only introduced or existing codes were changed during the observation period. Seventy-six of 90 indicators could be operationalized without restrictions. In this context, 15 of these 76 indicators required pre- and follow-up periods, which meant that they could not be presented for all years. Eleven of 101 QIs could not be operationalized because EBM codes were only introduced after 2015 or were not recorded as individual services for all physician groups (e. g., spirometry and long-term ECG). Striking trends in indicator prevalences could be explained. CONCLUSION Routine data enable resource-saving quality monitoring. A change in the data basis during the observation period, for example through the introduction or deletion of billing codes, makes the longitudinal, routine data-based quality assessment more difficult, but enables further or new indicators to be operationalized for later periods.
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Affiliation(s)
- Ingrid Köster
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Claudia Mehl
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Achim Siegel
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Erika Graf
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Dominikus Stelzer
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Erik Farin-Glattacker
- Universitätsklinikum Freiburg, Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung, Freiburg, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Ingrid Schubert
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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Schubert I, Dickschas J, Strohm PC. [Assessment of patellar dislocations in childhood and adolescence : Accident-related or predisposition-related?]. Unfallchirurg 2021; 124:902-908. [PMID: 34387708 DOI: 10.1007/s00113-021-01059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Numerous predisposing factors are known for patellar dislocations but the extent to which these or the trauma cause the dislocation is often unclear. AIM This study investigated whether the analysis of the accident mechanism and anatomical predisposition in juvenile patellar dislocations enables a conclusion as to the causality. MATERIAL AND METHODS Retrospective cohort study, evidence level III. In-house employers' liability insurance association (BG) cases with the diagnosis of patella dislocation in patients under 18 years were descriptively evaluated with respect to demographic and predisposing aspects as well as regarding accident information. The accident mechanisms were sorted into subgroups: direct impact, trivial trauma, fall, torsional trauma. RESULTS A total of 54 patellar dislocations were identified with a patient age of 14 years (range 9-18 years). A mild valgus configuration was found in 39% of the cases, on average normal torsion, a tibial tuberosity-trochlea groove (TTTG) distance of 17 mm (range 8-24mm), with 41% a high proportion of patella alta and a trochlear deformity in 57%. Only 20% of the children had no relevant predispositions. The trivial traumas showed the highest proportion of recurrent dislocations with 50% and in the other accident categories the proportion of first dislocations was >75%. In the fall cohort the rate of children without relevant predisposition was highest. CONCLUSION The predisposition rate in infantile patellar dislocations is high; however, falls are always significant accident events as well as medial direct impact. Torsional trauma is also a significant causative factor, unless high-grade trochlear dysplasia is present, whereas trivial traumas are not.
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Affiliation(s)
- I Schubert
- Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland.
| | - J Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland.,Friedrich-Alexander-Universität, Erlangen, Deutschland
| | - P C Strohm
- Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland.,Albert-Ludwigs-Universität, Freiburg i. Br., Deutschland
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Schubert I, Stelzer D, Siegel A, Köster I, Mehl C, Ihle P, Günster C, Dröge P, Klöss A, Farin-Glattacker E, Graf E, Geraedts M. Ten-Year Evaluation of the Population-Based Integrated Health Care System "Gesundes Kinzigtal". Dtsch Arztebl Int 2021; 118:465-472. [PMID: 33867008 DOI: 10.3238/arztebl.m2021.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/15/2020] [Accepted: 02/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The population-based integrated health care system called "Gesundes Kinzigtal" (Integrierte Versorgung Gesundes Kinzigtal, IVGK) was initiated more than 10 years ago in the Kinzig River Valley region, which is located in the Black Forest in the German state of Baden-Württemberg. IVGK is intended to optimize health care while maximizing cost-effectiveness. It consists of programs for promoting health and for enabling cooperation among service providers, as well as of a shared-savings contract that has enabled resources to be saved every year. The goal of the present study was to investigate trends in the quality of care provided by IVGK over the past ten years in comparison to conventional care. METHODS This is a non-randomized observational study with a control-group design (Kinzig River Valley versus 13 structurally comparable control regions), employing data collected by AOK, a large statutory health-insurance provider in Germany, over the period 2006-2015. Quality assessment was conducted with the aid of a set of indicators, developed by the authors, that was based exclusively on claims data. The statistical analysis of the trends in these indicators over time was conducted with preset criteria for the relevance of any observed changes, as well as preset mechanisms of controlling for confounding factors. RESULTS For 88 of the 101 evaluable indicators, no relevant difference was seen between the trend over time in the region of the intervention and the average trend in the control regions. Relevant differences in favor of the IVGK were observed for six indicators, and negatively divergent trends compared to the controls were observed for seven indicators. In the main summarizing statistical analysis, no positive or negative difference was found between the Kinzig River Valley and the other regions with respect to trends in the health-care indicators over time. CONCLUSION An evaluation based on 101 indicators derived from health-insurance data did not reveal any improvement of the quality of care by IVGK and the totality of the programs that were implemented under it. However, under the conditions of the shared-savings contract, no relevant diminution in the quality of care was observed over a period of 10 years either, compared with structurally similar control regions without an integrated care model.
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Affiliation(s)
- Ingrid Schubert
- PMV research group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, Faculty of Medicine and University Hospital Cologne; Institute for Health Services Research and Clinical Epidemiology (IVE), Philipps-Universität Marburg; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg; Institute for Occupational and Social Medicine and Health Services Research, University of Tübingen; Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research (SEVERA), Faculty of Medicine and Medical Center, University of Freiburg; Scientific Institute of the AOK (WIdO), Berlin
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Blaschke K, Hellmich M, Samel C, Listl S, Schubert I. The impact of periodontal treatment on healthcare costs in newly diagnosed diabetes patients: Evidence from a German claims database. Diabetes Res Clin Pract 2021; 172:108641. [PMID: 33359573 DOI: 10.1016/j.diabres.2020.108641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
AIMS There is sufficient scientific evidence for the bidirectional association between periodontal diseases and diabetes. In this context, we hypothesized that periodontal treatment leads to lower healthcare costs in newly diagnosed diabetes patients by promoting a milder disease course. METHODS A total of 23,771 persons were investigated who were continuously insured by German health insurances between 2011 and 2016, 18 years or older, and newly diagnosed with diabetes in 2013. The study population was divided into a periodontal treatment and control group (no periodontal treatment). The average treatment effect of a periodontal treatment on various types of healthcare costs (inpatient, outpatient, drug costs) was analyzed by a doubly robust method. RESULTS Finally, 5.3% of the study population could be assigned to the treatment group. In newly diagnosed diabetes patients with periodontal treatment, a reduction in total healthcare costs (0.96, 95%CI 0.89; 1.04), inpatient costs (0.87, 95%CI 0.69; 1.08), diabetes-related drug costs (0.93, 95%CI 0.84; 1.03) and other drug costs (0.97, 95%CI 0.89; 1.05) could be shown compared to the control group. CONCLUSIONS This study provides evidence that periodontal treatment for diabetes patients reduces healthcare costs. Fewer diabetes-specific complications and hospitalizations are expected.
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Affiliation(s)
- Katja Blaschke
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University - Radboudumc (RIHS), Nijmegen, the Netherlands; Medical Faculty, Department of Conservative Dentistry, Section for Translational Health Economics, Heidelberg University, Heidelberg, Germany.
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Salm S, Blaschke K, Ihle P, Schubert I, Dresen A, Pfaff H, Scholten N. Mental disorders and utilization of mental health services in newly diagnosed cancer patients: An analysis of German health insurance claims data. Psychooncology 2020; 30:312-320. [PMID: 33089560 DOI: 10.1002/pon.5579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE People with cancer are often confronted not only with the burdens of medical treatment but also with psychological strain, which can lead to mental disorders (MD). To date, the prevalence of MD in newly diagnosed cancer patients and their utilization of mental health services (MHS) are mainly estimated through data of primary studies than considering healthcare-related claims data. METHODS Statutory health insurance claims data of the AOK/KV Hesse from 2011 to 2014 was analyzed. The number of incident cancer patients with MD and the utilization of MHS within the period of the quarter of incident cancer diagnosis and three subsequent quarters were determined. For incident cancer patients with an incident MD, the predictive values of sex, age group, and tumor entity on the documentation of MD diagnosis and utilization were investigated. RESULTS The 12-month prevalence of MD in incident cancer patients was 31.1% for depression, 11.2% for anxiety disorders, and 9.2% for post-traumatic stress/adjustment disorder (PTSD/AD). Of these, 65.9% received outpatient psychotherapy and 43.0% at least one psychopharmacological drug prescription. Men had a significantly lower chance of receiving an MD diagnosis following cancer. CONCLUSIONS The prevalence of MD observed was higher for depression and lower for PTSD/AD compared to meta-analyses of clinical trials. Male cancer patients had a lower chance of receiving an MD diagnosis than females, which coincides with existing results.
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Affiliation(s)
- Sandra Salm
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Katja Blaschke
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Ihle
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
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Abstract
Abstract
When atoms and molecules are exposed to intense low frequency laser fields, the dominant response is sequential tunnel ionization of charge states with increasing ionization potential. Sequential ionization is assumed to proceed as separate one electron processes. The theoretical analysis developed here reveals that in complex systems sequential tunnel ionization can be inhibited by Coulomb blocking. When ionization potentials of subsequent charge states are close to each other, multiple tunneling events can occur during a half cycle and in close proximity, so that a tunneled electron can block the next tunneling electron. In sub-nm clusters driven by near infrared single-cycle pulses, Coulomb blocking reduces two-electron sequential tunneling by up to 2-3 orders of magnitude.
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Möllers T, Perna L, Stocker H, Ihle P, Schubert I, Schöttker B, Frölich L, Brenner H. New use of psychotropic medication after hospitalization among people with dementia. Int J Geriatr Psychiatry 2020; 35:640-649. [PMID: 32100308 DOI: 10.1002/gps.5282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/13/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Psychotropic medication is commonly used among people with dementia (PWD), but it shows modest efficacy and it has been associated with severe adverse events. Hospitalizations are an opportunity for medication management as well as treatment recommendations for outpatient physicians. The aim of this study was to asses factors associated with new use of psychotropic medication after hospitalization among PWD. METHODS We conducted a retrospective dynamic cohort study from 2004 to 2015 using claims data from a German health insurance company. PWD were identified by an algorithm that included ICD-10 diagnosis and diagnostic measures. The medication classes included were antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication. The assessment period was up to 30 days after discharge from the hospital across four hospitalizations. RESULTS The main predictors for new use of psychotropic medication were similar across medication classes. Neuropsychiatric symptoms (NPS) and the need of care were associated with higher odds of new use of antidepressants, antipsychotics, and anxiolytics or hypnotics/sedatives. A hospital stay due to dementia was an independent predictor for new use across medication classes as well. Delirium increased the odds for new use of antipsychotics and anxiolytics or hypnotics/sedatives. CONCLUSIONS Factors associated with new use of psychotropic medication included delirium, NPS, and the need of care in PWD. The findings highlight the need for preventive interventions and non-medical treatment options in regards to delirium and NPS as well as for a more intensive use of screening tools for inappropriate medication use among PWD. Key points The percentage of new users was 1.8%, 7.1%, 2.1%, and 2.5% across hospitalizations for antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication, respectively. 83.0%, 61.9%, 56.9%, and 88.1% of new users received antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication for more than 6 weeks. Delirium and neuropsychiatric symptoms were associated with significantly increased odds of new psychotropic medication use. Hospital stays due to dementia and the need of care were predictors for new use of psychotropic medication.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Department of Translational Research in Psychiatry, Max Planck Institute for Psychiatry, Munich, Germany
| | - Hannah Stocker
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ben Schöttker
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Lutz Frölich
- Department of Gerontopsychiatry, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Hermann Brenner
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Geraedts M, Mehl C, Schmitz J, Siegel A, Graf E, Stelzer D, Farin-Glattacker E, Ihle P, Köster I, Dröge P, Günster C, Haas N, Gröne O, Schubert I. [Development of an indicator set for the evaluation of the population-based integrated healthcare model 'Gesundes Kinzigtal' (Healthy Kinzigtal)]. Z Evid Fortbild Qual Gesundhwes 2020; 150-152:54-64. [PMID: 32467041 DOI: 10.1016/j.zefq.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The project "INTEGRAL-10-year evaluation of the population-based integrated health care model 'Gesundes Kinzigtal' (Healthy Kinzigtal)" (ICM-GK) is funded by the Innovation Committee of the Federal Joint Committee (G-BA) (grant no. 01VSF16002). The evaluation is to be based on a set of indicators that can be captured in routine data. On the one hand, they can be used to assess ICM-GK programs that are program-specific and geared towards prevention and disease management. On the other hand, possible negative side effects of the ICM-GK, which is designed as a "shared savings contract", are to be examined by also observing care needs not covered by the ICM-GK contract. Since an indicator set for the evaluation of regional integrated care (IC) programs in Germany is not yet available, a suitable indicator set should be developed. METHODS RESULTS: The methodological framework links the OECD concept for quality assessment of health systems with Kessner's tracer methodology. Disease groups with a high prevalence ("common diseases"), prevention potential and potential for improvement through IC were selected as tracers. The literature search resulted in 239 QIs and the QI database search in 293 QIs, which were supplemented by 21 QIs from the focus groups. Out of a total of 553 QIs, 251 QIs remained after removal of duplicates and comparison with the data basis. This preliminary QI set was reduced to 101 QIs by consensus. In addition, 48 health reporting indicators were supplemented which serve to classify regional quality results. The final QI set maps the following 19 disease categories/tracers: heart failure (16 QIs), myocardial infarction (4 QIs), CHD (10 QIs), stroke (6 QIs), metabolic syndrome (7 QIs of which 5 were diabetes-related), COPD (6 QIs), asthma (3 QIs), chronic pain (5 QIs), back pain (3 QIs), geriatrics (7 QIs), dementia (8 QIs), osteoporosis (3 QIs), rheumatism (3 QIs), multiple sclerosis (2 QIs), depression (4 QIs), antibiotic therapy (3 QIs), drug safety (1 QI), child care (5 QIs), early detection/prevention (5 QIs). 33 of these QIs are dedicated to five tracers that are not explicitly ICM-GK programs. Most QIs assess aspects of the effectiveness of care for the chronically ill and measure process quality. DISCUSSION The set of indicators initially enables the quality assessment of regional, cross-indication care quality in the population-based integrated health care model 'Gesundes Kinzigtal' on the basis of routine data. Although the QI set focuses on effectiveness and process quality, it also includes QIs for preventive and acute care, coordination of care, patient orientation and safety, and outcomes. In contrast to other QI sets, both primary care and specialist health care and integrated, cross-sectoral and cross-professional care aspects have been considered. The benefits of the QI set for comparisons of regional quality and the evaluation of different IC programs remain to be tested. CONCLUSION On the basis of a broadly based research and participatory development process, a set of indicators has been developed that enables comprehensive evaluation of the regional quality of care of cross-indication, integrated care models focusing on common diseases. In order to be able to increasingly evaluate aspects of care coordination and patient orientation, health promotion as well as nursing, palliative and emergency care in the future, it would be helpful if routine data were collected or made accessible in these areas as well.
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Affiliation(s)
- Max Geraedts
- Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland.
| | - Claudia Mehl
- Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - Jutta Schmitz
- Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - Achim Siegel
- Universitätsklinikum Tübingen, Universität Tübingen, Tübingen, Deutschland
| | - Erika Graf
- Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | | | | | - Peter Ihle
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Ingrid Köster
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Patrik Dröge
- Wissenschaftliches Institut der Ortskrankenkassen, Berlin, Deutschland
| | - Christian Günster
- Wissenschaftliches Institut der Ortskrankenkassen, Berlin, Deutschland
| | | | - Oliver Gröne
- OptiMedis AG & London School of Hygiene and Tropical Medicine, London, Großbritannien
| | - Ingrid Schubert
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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Swart E, Gothe H, Ihle P, March S, Schubert I, Stallmann C, Hoffmann F. Sonderheft Methodische Aspekte der
Sekundärdatenanalyse. Gesundheitswesen 2020; 82:S91-S93. [DOI: 10.1055/a-1099-0789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mit dem vorliegenden zweiten Sonderheft zu Datenlinkage und spezifischen Methoden der
Sekundärdatenanalyse ergänzen wir die neun Beiträge, die im
vorangegangenen Sonderheft methodische Herausforderungen bei der Aufbereitung und
Validierung verschiedener Sekundärdatenquellen thematisiert haben. Ein
besonderes Augenmerk liegt auf dem individuellen Datenlinkage verschiedener
Sekundärdatenquellen untereinander und/oder mit Primärdaten.
Dieser methodische Zugang hat nicht erst seit der Bestandsaufnahme zum Datenlinkage
in Deutschland 1 und der
Veröffentlichung der Guten Praxis Datenlinkage 2 zunehmende Relevanz in der Epidemiologie und Versorgungsforschung
erhalten. Daneben werden in diesem Heft aktuelle Ansätze zur
Datenvalidierung, zur Kontrollbildung und zur Aufbereitung und Nutzung von
Klartextangaben vorgestellt.
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Affiliation(s)
- Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | - Holger Gothe
- IGES Institut, Berlin
- Medizinische Fakultät, Lehrstuhl
Gesundheitswissenschaften/Public Health, TU Dresden,
Dresden
- Department für Public Health, Versorgungsforschung und Health
Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Peter Ihle
- PMV forschungsgruppe, Universität zu Köln
| | - Stefanie March
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | | | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | - Falk Hoffmann
- Department für Versorgungsforschung, Fakultät Medizin
und Gesundheitswissenschaften, Carl von Ossietzky Universität
Oldenburg
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Swart E, Gothe H, Hoffmann F, Ihle P, Schubert I, Stallmann C, March S. Sonderheft Methodische Aspekte der Sekundärdatenanalyse
(I). Gesundheitswesen 2020; 82:217-220. [DOI: 10.1055/a-1127-4944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Die wissenschaftliche Nutzung von Sekundärdaten, nicht allein von solchen der
gesetzlichen Krankenversicherung (GKV), hat sich in den vergangenen Jahren fest in
der Versorgungsforschung etabliert. Das zeigen das Memorandum Methoden der
Versorgungsforschung 1 und Grundlagenwerke der
Sekundärdatenanalyse 2. Gleichwohl
entwickelt sich eine hohe Dynamik in diesem Forschungszweig, einerseits durch die
zahlreichen durch den Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA)
geförderten Projekte mit Nutzung von Sekundärdaten, andererseits
durch die rasant zunehmenden wissenschaftlichen Studien mit einem individuellen
Datenlinkage von Primär- und Sekundärdaten oder
Sekundärdaten unterschiedlicher Dateneigner. Weiterhin geraten zunehmend
Sekundärdaten jenseits der weithin bekannten GKV-Abrechnungsdaten in den
Fokus der Wissenschaft. Daher erscheint es den Herausgebern sinnvoll,
ergänzend zu den in früheren Jahren etablierten oder neu
publizierten Standards der Sekundärdatenanalyse 3
4
5 einen breiten methodischen Überblick
zu geben über die für die Sekundärdatenanalyse
zugänglichen Datenquellen, über methodische Herausforderungen bei
deren Erschließung, Validierung und Aufbereitung sowie neue methodische
Ansätze bei der Analyse der Daten zu diskutieren.
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Affiliation(s)
- Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | - Holger Gothe
- IGES Institut, Berlin
- Medizinische Fakultät, Lehrstuhl Gesundheitswissenschaften
/ Public Health, TU Dresden, Dresden
- Department für Public Health, Versorgungsforschung und Health
Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Falk Hoffmann
- Department für Versorgungsforschung, Fakultät Medizin
und Gesundheitswissenschaften, Carl von Ossietzky Universität
Oldenburg
| | - Peter Ihle
- PMV forschungsgruppe, Universität zu Köln
| | | | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | - Stefanie March
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
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Swart E, Gothe H, Ihle P, March S, Schubert I, Stallmann C, Hoffmann F. Sonderheft Methodische Aspekte der Sekundärdatenanalyse
(II). Gesundheitswesen 2020; 82:221-223. [DOI: 10.1055/a-1127-4976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mit dem vorliegenden zweiten Sonderheft zu Datenlinkage und spezifischen Methoden der
Sekundärdatenanalyse ergänzen wir die neun Beiträge, die im
vorangegangenen Sonderheft methodische Herausforderungen bei der Aufbereitung und
Validierung verschiedener Sekundärdatenquellen thematisiert haben. Ein
besonderes Augenmerk liegt auf dem individuellen Datenlinkage verschiedener
Sekundärdatenquellen untereinander und/oder mit Primärdaten.
Dieser methodische Zugang hat nicht erst seit der Bestandsaufnahme zum Datenlinkage
in Deutschland 1 und der
Veröffentlichung der Guten Praxis Datenlinkage 2 zunehmende Relevanz in der Epidemiologie und Versorgungsforschung
erhalten. Daneben werden in diesem Heft aktuelle Ansätze zur
Datenvalidierung, zur Kontrollbildung und zur Aufbereitung und Nutzung von
Klartextangaben vorgestellt.
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Affiliation(s)
- Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | - Holger Gothe
- IGES Institut, Berlin
- Medizinische Fakultät, Lehrstuhl
Gesundheitswissenschaften/Public Health, TU Dresden,
Dresden
- Department für Public Health, Versorgungsforschung und Health
Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Peter Ihle
- PMV forschungsgruppe, Universität zu Köln
| | - Stefanie March
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | | | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitssystemforschung,
Medizinische Fakultät, Otto-von-Guericke-Universität
Magdeburg
| | - Falk Hoffmann
- Department für Versorgungsforschung, Fakultät Medizin
und Gesundheitswissenschaften, Carl von Ossietzky Universität
Oldenburg
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Swart E, Gothe H, Hoffmann F, Ihle P, Schubert I, Stallmann C, March S. Sonderheft Methodische Aspekte der Sekundärdatenanalyse. Gesundheitswesen 2020; 82:S1-S3. [DOI: 10.1055/a-1083-5461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Die wissenschaftliche Nutzung von Sekundärdaten, nicht allein von solchen der gesetzlichen Krankenversicherung (GKV), hat sich in den vergangenen Jahren fest in der Versorgungsforschung etabliert. Das zeigen das Memorandum Methoden der Versorgungsforschung 1 und Grundlagenwerke der Sekundärdatenanalyse 2. Gleichwohl entwickelt sich eine hohe Dynamik in diesem Forschungszweig, einerseits durch die zahlreichen durch den Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA) geförderten Projekte mit Nutzung von Sekundärdaten, andererseits durch die rasant zunehmenden wissenschaftlichen Studien mit einem individuellen Datenlinkage von Primär- und Sekundärdaten oder Sekundärdaten unterschiedlicher Dateneigner.
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Affiliation(s)
- Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg
| | - Holger Gothe
- IGES Institut, Berlin
- Medizinische Fakultät, Lehrstuhl Gesundheitswissenschaften / Public Health, TU Dresden, Dresden
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Falk Hoffmann
- Department für Versorgungsforschung, Fakultät Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg
| | - Peter Ihle
- PMV forschungsgruppe, Universität zu Köln
| | | | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg
| | - Stefanie March
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg
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Schubert I. Explanation of Methods Is Needed. Dtsch Arztebl Int 2020; 117:98. [PMID: 32102731 PMCID: PMC7075460 DOI: 10.3238/arztebl.2020.0098a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ingrid Schubert
- *PMV forschungsgruppe, Medizinische Fakultät und Uniklinikum Köln
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28
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Seitz MW, Listl S, Bartols A, Schubert I, Blaschke K, Haux C, Van Der Zande MM. Current Knowledge on Correlations Between Highly Prevalent Dental Conditions and Chronic Diseases: An Umbrella Review. Prev Chronic Dis 2019; 16:E132. [PMID: 31560644 PMCID: PMC6795069 DOI: 10.5888/pcd16.180641] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Studies have investigated the relationships between chronic systemic and dental conditions, but it remains unclear how such knowledge can be used in clinical practice. In this article, we provide an overview of existing systematic reviews, identifying and evaluating the most frequently reported dental–chronic disease correlations and common risk factors. Methods We conducted a systematic review of existing systematic reviews (umbrella review) published between 1995 and 2017 and indexed in 4 databases. We focused on the 3 most prevalent dental conditions and 10 chronic systemic diseases with the highest burden of disease in Germany. Two independent reviewers assessed all articles for eligibility and methodologic quality using the AMSTAR criteria and extracted data from the included studies. Results Of the initially identified 1,249 systematic reviews, 32 were included for qualitative synthesis. The dental condition with most frequently observed correlations to chronic systemic diseases was periodontitis. The chronic systemic disease with the most frequently observed correlations with a dental condition was type 2 diabetes mellitus (T2DM). Most dental–chronic disease correlations were found between periodontitis and T2DM and periodontitis and cardiovascular disease. Frequently reported common risk factors were smoking, age, sex, and overweight. Using the AMSTAR criteria, 2 studies were assessed as low quality, 26 studies as moderate quality, and 4 studies as high quality. Conclusion The quality of included systematic reviews was heterogeneous. The most frequently reported correlations were found for periodontitis with T2DM and for periodontitis with cardiovascular disease. However, the strength of evidence for these and other disease correlations is limited, and the evidence to assess the causality of these disease correlations remains unclear. Future research should focus on the causality of disease links in order to provide more decisive evidence with respect to the design of intersectoral care processes.
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Affiliation(s)
- Max W Seitz
- Institute of Medical Biometry and Informatics, University of Heidelberg, Marsilius-Arkaden Turm West, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany. E-mail:
| | - Stefan Listl
- Section for Translational Health Economics, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Quality and Safety of Oral Healthcare, Nijmegen, The Netherlands
| | - Andreas Bartols
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany.,Christian-Albrechts-University Kiel, Clinic for Conservative Dentistry and Periodontology, Kiel, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katja Blaschke
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Haux
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Marieke M Van Der Zande
- Section for Translational Health Economics, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Quality and Safety of Oral Healthcare, Nijmegen, The Netherlands
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29
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Blaschke K, Seitz MW, Schubert I, Listl S. Methodological approaches for investigating links between dental and chronic diseases with claims data: A scoping study. J Public Health Dent 2019; 79:334-342. [PMID: 31418874 DOI: 10.1111/jphd.12335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to provide an overview of methodological approaches to assess the relationship between dental diseases and other noncommunicable diseases on the basis of claims data. METHODS Based on the methodological framework of Arksey and O'Malley, a scoping study was conducted. By searching electronic databases (PubMed, Web of Science, and LILACS), appropriate articles were identified. After extracting relevant information and entering it into a data-charting form, the study characteristics and the methodological approaches were summarized descriptively. RESULTS Fifty-one articles were identified for inclusion in the analysis. Most of the selected studies (78 percent) originated from Taiwan and employed a cohort design. The majority of studies considered dental diseases, particularly periodontal disease (PD) measures, but no common standard was identified for the definition of PD. Unmeasured confounding, misclassification, and surveillance bias were reported to be the main limitations of the claims data analyses. CONCLUSIONS Claims data provide a very useful information source to further delineate the relationship between PDs and other noncommunicable diseases. If diagnostic codes are available, they seem to be the most suitable tool to assess PD in claims-based studies. In databases that do not contain dental diagnostic codes, e.g., databases in Germany and the United States, the identification of PD is a particular challenge. The inclusion of dental diagnostic codes in all claims databases is strongly recommended. Due to the public health relevance of PD, there is a need for more comprehensive documentation of dental parameters within claims data.
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Affiliation(s)
- Katja Blaschke
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max W Seitz
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Listl
- Section for Translational Health Economics, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany.,Department of Dentistry - Quality and Safety of Oral Healthcare, Radboudumc (RIHS), Radboud University, Nijmegen, The Netherlands
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30
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Blaschke K, Hermes-Moll K, Lappe V, Ihle P, Baumann W, Schubert I. [Cancer Patients and the Last Year of Life: Palliative Care, Hospitalization and Place of Death]. Gesundheitswesen 2019; 82:702-709. [PMID: 30974465 DOI: 10.1055/a-0829-6604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Palliative care patients frequently suffer from cancer diagnoses. Specialised palliative home care (German acronym 'SAPV') enables patients with complex symptoms and intensive care needs to receive home care until death. In the German Federal State of Hesse, the first SAPV teams were set up in 2009. Against this background, the aim of this study was (i) to investigate the utilization of SAPV and specialised inpatient palliative care in the last year of life of cancer patients, (ii) to detect the medical professions prescribing SAPV and (iii) to analyse the place of death and the hospitalization rate in the last 91 days of life. METHODS A retrospective secondary data analysis was conducted. Routine data from the statutory health insurance company AOK Hesse in Germany for 2009-2014 were analysed using descriptive statistical methods. The study population comprised breast, prostate, and colorectal cancer patients who died in the year of observation (2010-2014) and who were fully insured 360 days before death. RESULTS Depending on the year of observation, 492-545 breast, 546-625 prostate, and 709-752 colorectal cancer patients were included in the study. The analysis showed an increase of cancer patients receiving palliative care from 2010 to 2014. A higher proportion of breast, prostate, and colorectal cancer patients received SAPV as compared to services from palliative care units or inpatient hospices. All in all, over 90% of the SAPV prescriptions were issued by family doctors. The hospitalization rate of cancer patients in the last 91 days of life as well as the share of those dying in hospital decreased between 2010 and 2014. CONCLUSION The results must be assessed in the context of the implementation of SAPV in the state of Hesse. The increase of SAPV services and the reduction of hospitalizations at the end of life indicate a successful introduction of SAPV in the state of Hesse.
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Affiliation(s)
- Katja Blaschke
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln
| | - Kerstin Hermes-Moll
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen, (WINHO GmbH), Köln
| | - Veronika Lappe
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln
| | - Peter Ihle
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln
| | - Walter Baumann
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen, (WINHO GmbH), Köln
| | - Ingrid Schubert
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln
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31
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Selke Krulichová I, Selke GW, Eichler U, Lappe V, Godman B, Schubert I. Impact of EU risk assessment process and administrative regulations for manufacturers of combined hormonal contraceptive prescribing. An analysis of developments in Germany and the implications. Curr Med Res Opin 2019; 35:697-704. [PMID: 30362365 DOI: 10.1080/03007995.2018.1541317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Combined hormonal contraceptives (CHC) exhibit differing risks for cardiovascular and thrombotic events (VTE). A European referral process confirmed higher VTE risks for 3rd generation gestagens and drospirenone. CHC are now grouped in risk classes (RC) I, II, and III, with RC III having a higher risk than RC I and X (risk not yet known). Marketing authorization holders were obliged to implement pharmacovigilance measures and risk minimization measures including changes of prescribing information. The study assessed whether these activities induced changes in prescription patterns. METHODS German prescription data for 1.1 million women below 20 years of age were used to analyze the effects of interventions and potential influence factors using logistic regression. Descriptive statistics were calculated for prescriptions for 3.3 million women from January 2011 to March 2016. RESULTS Shares of RC I and RC X recipients rose substantially over the observation period, while RC III recipient share showed a steady decrease. The referral induced a slightly faster decrease in RC III and increase in RC X. The implementation of pharmacovigilance measures manifested no additional effect. CONCLUSION The decrease in RC III share already observed before the referral process can be explained with pre-existing discussions around CHC. The effect attributable to the referral was statistically significant, although very small. While evidence for a connection between interventions and prescription change is only indirect, the study shows that routine data are suitable for impact analyses, and monitoring prescribing patterns can be recommended as feedback after regulatory or political interventions. This is being followed up.
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Affiliation(s)
- Iva Selke Krulichová
- a Department of Medical Biophysics, Faculty of Medicine in Hradec Králové , Charles University , Hradec Králové , Czech Republic
| | | | - Uwe Eichler
- b AOK Research Institute (WIdO) , Berlin , Germany
| | - Veronika Lappe
- c PMV research group, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy of Children and Adolescents, Cologne University , Germany
| | - Brian Godman
- d Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK
- e Health Economics Centre , Liverpool University Management School , Liverpool , UK
- f Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm , Sweden
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa, South Africa
| | - Ingrid Schubert
- c PMV research group, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy of Children and Adolescents, Cologne University , Germany
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Ihle P, Krueger K, Schubert I, Griese-Mammen N, Parrau N, Laufs U, Schulz M. Comparison of Different Strategies to Measure Medication Adherence via Claims Data in Patients With Chronic Heart Failure. Clin Pharmacol Ther 2019; 106:211-218. [PMID: 30697693 PMCID: PMC6617982 DOI: 10.1002/cpt.1378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023]
Abstract
Medication adherence correlates with morbidity and mortality in patients with chronic heart failure (CHF), but is difficult to assess. We conducted a retrospective methodological cohort study in 3,808 CHF patients, calculating adherence as proportion of days covered (PDC) utilizing claims data from 2010 to 2015. We aimed to compare different parameters’ influence on the PDC of elderly CHF patients exemplifying a complex chronic disease. Investigated parameters were the assumed prescribed daily dose (PDD), stockpiling, and periods of hospital stay. Thereby, we investigated a new approach using the PDD assigned to different percentiles. The different dose assumptions had the biggest influence on the PDC, with variations from 41.9% to 83.7%. Stockpiling and hospital stays increased the values slightly. These results queries that a reliable PDC can be calculated with an assumed PDD. Hence, results based on an assumed PDD have to be interpreted carefully and should be presented with sensitivity analyses to show the PDC's possible range.
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Affiliation(s)
- Peter Ihle
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin Krueger
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Ingrid Schubert
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nina Griese-Mammen
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Natalie Parrau
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital, Leipzig University, Leipzig, Germany
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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Hagenström K, Augustin M, Köster I, Protz K, Petersen J, Schmitt J, Schubert I. Interne Diagnosevalidierung von Patienten mit einer floriden chronischen Wunde - Möglichkeiten der Identifizierung auf der Basis von Routinedaten. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2019; 140:22-34. [DOI: 10.1016/j.zefq.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/27/2018] [Accepted: 02/11/2019] [Indexed: 12/28/2022]
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Möllers T, Perna L, Ihle P, Schubert I, Bauer J, Brenner H. Factors Associated with Length of Stay in Hospital Patients with and Without Dementia. J Alzheimers Dis 2019; 67:1055-1065. [DOI: 10.3233/jad-180593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
- Medical Faculty, University of Heidelberg, Baden-Wuerttemberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
| | - Peter Ihle
- PMV Research Group, Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Ingrid Schubert
- PMV Research Group, Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Jürgen Bauer
- Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
- Center for Geriatric Medicine, University of Heidelberg, Agaplesion Bethanien Krankenhaus Heidelberg, Baden-Wuerttemberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
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Wicke FS, Glushan A, Schubert I, Köster I, Lübeck R, Hammer M, Beyer M, Karimova K. Performance of the adapted Diabetes Complications Severity Index translated to ICD-10. Am J Manag Care 2019; 25:e45-e49. [PMID: 30763043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the performance of the adapted Diabetes Complications Severity Index (aDCSI) translated to International Classification of Diseases, Tenth Revision (ICD-10) in predicting hospitalizations, mortality, and healthcare-associated costs. STUDY DESIGN Retrospective closed cohort study based on secondary data analysis. METHODS We translated the aDCSI to ICD-10 and calculated aDCSI scores based on health insurance claims data. To assess predictive performance, we used multivariate regression models to calculate risk ratios (RRs) of hospitalizations and mortality and linear predictors of cost. RESULTS We analyzed a sample of 157,115 patients with diabetes mellitus. RRs of hospitalizations (total and cause specific) rose with increasing aDCSI scores. Predicting total hospitalizations over a 4-year period, unadjusted RRs were 1.22 for an aDCSI score of 1 (compared with a score of 0), 1.55 for a score of 2, 1.77 for a score of 3, 2.11 for a score of 4, and 2.72 for scores of 5 and higher. Cause-specific hospitalizations and mortality showed similar results. Costs clearly increased in each successive score category. CONCLUSIONS Our study supports the validity of the aDCSI as a severity measure for complications of diabetes, as it correlates to and predicts total and cause-specific hospitalizations, mortality, and costs. The aDCSI's performance in ICD-10-coded data is comparable with that in International Classification of Diseases, Ninth Revision-coded data.
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Affiliation(s)
- Felix Sebastian Wicke
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
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Schubert I, Siegel A, Graf E, Farin-Glattacker E, Ihle P, Köster I, Stelzer D, Mehl C, Schmitz J, Dröge P, Günster C, Klöss A, Vach W, Geraedts M. Study protocol for a quasi-experimental claims-based study evaluating 10-year results of the population-based integrated healthcare model 'Gesundes Kinzigtal' (Healthy Kinzigtal): the INTEGRAL study. BMJ Open 2019; 9:e025945. [PMID: 30782755 PMCID: PMC6340628 DOI: 10.1136/bmjopen-2018-025945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 08/09/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Patients often experience interface problems when treated by different specialists and in different healthcare sectors. Integrated care concepts aim to reduce these problems. While most integrated healthcare models focus on individual diseases, the integrated care model 'Gesundes Kinzigtal' applies a population-based approach and addresses the full spectrum of morbidities for a population defined by area of residence-the Kinzigtal. A special feature of the model is the joint savings contract between the regional management company and the statutory health insurers. The INTEGRAL study aims at assessing the effectiveness of 'Gesundes Kinzigtal' under routine conditions in comparison to conventional care over a period of 10 years in order to understand the benefits but also the potential for (unintended) harms. METHODS AND ANALYSIS: Database Claims data from statutory health insurance funds 2005-2015. The evaluation consists of a quasi-experimental study, with Kinzigtal as intervention region, at least 10 further regions with a similar population and healthcare infrastructure as primary controls and an additional random sample of insurees from the federal state of Baden-Württemberg as secondary controls. Model-specific and 'non-specific' indicators adopted from the literature and enriched by focus group interviews will be used to evaluate the model's effectiveness and potential unintended consequences by analysing healthcare utilisation in general. Temporal trends per indicator in the intervention region will be compared with those in each control region. The overall variation in trends for the indicators across all regions provides information about the potential to modify an indicator due to local differences in the healthcare system. ETHICS AND DISSEMINATION Ethic Commission of the Faculty of Medicine, Philipps-University Marburg (ek_mr_geraedts_131117). Results will be discussed in workshops, submitted for publication in peer-review journals and presented at conferences. TRIAL REGISTRATION NUMBER DRKS00012804.
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Affiliation(s)
- Ingrid Schubert
- PMV Research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Cologne, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Peter Ihle
- PMV Research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Cologne, Germany
| | - Ingrid Köster
- PMV Research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Cologne, Germany
| | - Dominikus Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Claudia Mehl
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Jutta Schmitz
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Patrik Dröge
- Health Services and Quality Research, AOK Research Institute (WIdO), Berlin, Germany
| | - Christian Günster
- Health Services and Quality Research, AOK Research Institute (WIdO), Berlin, Germany
| | - Andreas Klöss
- Health Services and Quality Research, AOK Research Institute (WIdO), Berlin, Germany
| | - Werner Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
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Heidt V, Hermes-Moll K, Blaschke K, Lappe V, Ihle P, Schubert I, Baumann W. Anticancer therapy at the end of life of breast, prostate, and colorectal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy295.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schubert I, Thürmann PA. [Drug Therapy Safety: Digital and interprofessional for and with patients]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1059-1061. [PMID: 30109364 DOI: 10.1007/s00103-018-2799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ingrid Schubert
- PMV forschungsgruppe an der Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Universität zu Köln, Herderstraße 52, 50931, Köln, Deutschland.
| | - Petra A Thürmann
- Philipp Klee-Institut für Klinische Pharmakologie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland.
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Ihle P, Dippel F, Schubert I. Statin-associated myopathy. Assessment of frequency based on data of all statutory health insurance funds in Germany. Pharmacol Res Perspect 2018; 6:e00404. [PMID: 29760929 PMCID: PMC5943670 DOI: 10.1002/prp2.404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 01/14/2023] Open
Abstract
Aim of the study was to assess the incidence of statin-associated myopathy (SAM) under real-life conditions in Germany. DATABASE Administrative data (master data, diagnoses, prescriptions) for all individuals in Germany insured with the Statutory Health Insurance. Basic population: individuals 18 years and older who have been insured continually from 2009 to 2011 (52.9 million; 29.9 million men, 23.9 million women). Data access is provided by the German Institute of Medical Documentation and Information, DIMDI) according to the Data Transparency Regulation of 2012. Statins: identification with the ATC-Codes: C10AA, C10BA and C10BX. STUDY POPULATION incident statin users in 2010 with a diagnosis of lipid disorders (ICD-10-GM E78, excluding patients with: E78.1, E78.3, E78.6 in eight quarters before index prescription. Definition of SAM: documentation of myopathy (ICD-10-GM G72.0, G72.8; G72.9, M60.8, M60.9, M79.1) in the first statin prescription quarter or in one of the three following quarters. The first event is considered for the incidence estimate. The daily doses included in a package were classified as "days under therapy" (by assuming one DDD) and taken as exposition time. SAM was found in 1.9% of 531 672 incident statin users. The percentage differs according to the patterns of statin use: the lowest incidence is observed in those with only one prescription (1.3%), the highest incidence with 5.0% is observed in those who not only stopped the treatment within 365 days, but who also had their statin changed. Administrative data including diagnoses from ambulatory care provide a realistic estimate of SAM frequency in every day practice.
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Affiliation(s)
- Peter Ihle
- PMV forschungsgruppeDepartment of Child and Adolescent Psychiatry, Psychosomatic and PsychotherapyUniversity of CologneCologneGermany
| | | | - Ingrid Schubert
- PMV forschungsgruppeDepartment of Child and Adolescent Psychiatry, Psychosomatic and PsychotherapyUniversity of CologneCologneGermany
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Gabrys L, Heidemann C, Schmidt C, Baumert J, Teti A, Du Y, Paprott R, Ziese T, Banzer W, Böhme M, Borrmann B, Busse R, Freitag M, Hagen B, Holl R, Icks A, Kaltheuner M, Koch K, Kümmel S, Kuhn J, Kuß O, Laux G, Schubert I, Szecsenyi J, Uebel T, Zahn D, Scheidt-Nave C. Selecting and defining indicators for diabetes surveillance in Germany. J Health Monit 2018; 3:3-21. [PMID: 35586543 PMCID: PMC8852787 DOI: 10.17886/rki-gbe-2018-063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mainly because of the large number of people affected and associated significant health policy implications, the Robert Koch Institute (RKI) is developing a public health surveillance system using diabetes as an example. In a first step to ensure long-term and comparable data collection and establish efficient surveillance structures, the RKI has defined a set of relevant indicators for diabetes surveillance. An extensive review of the available literature followed by a structured process of consensus provided the basis for a harmonised set of 30 core and 10 supplementary indicators. They correspond to the following four fields of activity: (1) reducing diabetes risk, (2) improving diabetes early detection and treatment, (3) reducing diabetes complications, (4) reducing the disease burden and overall costs of the disease. In future, in addition to the primary data provided by RKI health monitoring diabetes surveillance needs to also consider the results from secondary data sources. Currently, barriers to accessing this data remain, which will have to be overcome, and gaps in the data closed. The RKI intentends to continuously update this set of indicators and at some point apply it also to further chronic diseases with high public health relevance.
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Affiliation(s)
| | | | | | | | | | - Yong Du
- Robert Koch Institute, Berlin
| | | | | | | | | | | | | | | | - Bernd Hagen
- Central Research Institute of Ambulatory Health Care in Germany, Cologne
| | | | - Andrea Icks
- Heinrich Heine University Düsseldorf.,German Diabetes Center Düsseldorf.,German Center for Diabetes Research, Neuherberg
| | | | - Klaus Koch
- Institute of Quality and Efficiency in Health Care, Cologne
| | - Stefanie Kümmel
- Institute for Applied Quality Improvement and Research in Health Care, Göttingen
| | - Joseph Kuhn
- Bavarian Health and Food Safety Authority, Oberschleißheim
| | - Oliver Kuß
- Institute for Biometrics and Epidemiology at the German Diabetes Center, Düsseldorf
| | | | | | | | - Til Uebel
- German College of General Practitioners and Family Physicians, Berlin
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Claessen H, Narres M, Haastert B, Arend W, Hoffmann F, Morbach S, Rümenapf G, Kvitkina T, Friedel H, Günster C, Schubert I, Ullrich W, Westerhoff B, Wilk A, Icks A. Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants. Clin Epidemiol 2018; 10:475-488. [PMID: 29719421 PMCID: PMC5916260 DOI: 10.2147/clep.s146484] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and purpose Lower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008–2012. Methods On the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression. Results A total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008–2012 from 81.2 (95% CI 77.5–84.9) to 58.4 (55.0–61.7), and from 206.1 (197.3–214.8) to 177.0 (169.7–184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9–14.8) to 11.6 ([11.2–12.0], 12.0), whereas the minor AR increased from 15.8 (15.3–16.3) to 17.0 (16.5–17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively). Conclusion In this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.
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Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | - Werner Arend
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany
| | - Gerhard Rümenapf
- Upper Rhine Vascular Center Speyer-Mahnheim, Diakonissen-Stiftungs-Krankenhaus, Speyer, Germany
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Heiko Friedel
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | | | - Ingrid Schubert
- PMV-Research Group, Department for Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Walter Ullrich
- BARMER GEK, Head Quarters, Product Development/Health Care Management, Team Medical Analysis/Health Care Programs, Wuppertal, Germany
| | - Benjamin Westerhoff
- BARMER GEK, Head Quarters, Product Development/Health Care Management, Team Medical Analysis/Health Care Programs, Wuppertal, Germany
| | - Adrian Wilk
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Stock S, Ihle P, Simic D, Rupprecht C, Schubert I, Lappe V, Kalbe E, Tebest R, Lorrek K. [Prevalence of dementia of insured persons with and without German citizenship : A study based on statuatory health insurance data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:404-411. [PMID: 29487974 DOI: 10.1007/s00103-018-2711-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Elderly people with a non-German background are a fast growing population in Germany. OBJECTIVES Is administrative prevalence of dementia and uptake of nursing-home care similar in the German and non-German insured? MATERIALS AND METHODS Based on routine data, administrative prevalence rates for dementia were calculated for 2013 from a full census of data from one large sickness fund. Patients with dementia (PWD) were identified via ICD-10 codes (F00; F01; F03; F05; G30). RESULTS Administrative prevalence of dementia was 2.67% in the study population; 3.06% in Germans, and 0.96% in non-Germans (p value <0.001). Age and sex adjusted prevalence was comparable in the insured with and without German citizenship, except in women aged 80-84 (17.2 vs. 15.4) and for men in the age groups 80-84 (16.5 vs. 14.2), 85-89 years (23.4 vs. 21.5), and above 90 years of age (32.3 vs. 26.3). Standardized to the population of all investigated insured, 31.4% of all Germans with dementia had no longterm care entitlement vs. 35.5% of all patients without German citizenship. Of German patients, 55.1% were institutionalized vs. 39.5% of all patients without German citizenship. CONCLUSIONS There was a higher prevalence of dementia in the very old insured without German citizenship compared to those with German citizenship, especially in men. Non-Germans showed lower uptake of nursing home care compared to Germans. Additionally, Germans had slightly higher nursing care entitlements. It should be investigated further how much of the difference is due to underdiagnosis, cultural differences, or lack of adequate diagnostic work-up.
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Affiliation(s)
- Stephanie Stock
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland.
| | - Peter Ihle
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Dusan Simic
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland
| | - Christoph Rupprecht
- Stabsbereich Politik - Gesundheitsökonomie - Presse, AOK Rheinland/Hamburg, Düsseldorf, Deutschland
| | - Ingrid Schubert
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Veronika Lappe
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Elke Kalbe
- Medizinische Psychologie, Neuropsychologie und Gender Studies, Centrum für Neuropsychologische Diagnostik und Intervention (CeNDI), Uniklinik Köln (AöR), Köln, Deutschland
| | - Ralf Tebest
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland
| | - Kristina Lorrek
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland
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Seitz MW, Haux C, Knaup P, Schubert I, Listl S. Approach Towards an Evidence-Oriented Knowledge and Data Acquisition for the Optimization of Interdisciplinary Care in Dentistry and General Medicine. Stud Health Technol Inform 2018; 247:671-674. [PMID: 29678045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Associations between dental and chronic-systemic diseases were observed frequently in medical research, however the findings of this research have so far found little relevance in everyday clinical treatment. Major problems are the assessment of evidence for correlations between such diseases and how to integrate current medical knowledge into the intersectoral care of dentists and general practitioners. On the example of dental and chronic-systemic diseases, the Dent@Prevent project develops an interdisciplinary decision support system (DSS), which provides the specialists with information relevant for the treatment of such cases. To provide the physicians with relevant medical knowledge, a mixed-methods approach is developed to acquire the knowledge in an evidence-oriented way. This procedure includes a literature review, routine data analyses, focus groups of dentists and general practitioners as well as the identification and integration of applicable guidelines and Patient Reported Measures (PRMs) into the treatment process. The developed mixed methods approach for an evidence-oriented knowledge acquisition indicates to be applicable and supportable for interdisciplinary projects. It can raise the systematic quality of the knowledge-acquisition process and can be applicable for an evidence-based system development. Further research is necessary to assess the impact on patient care and to evaluate possible applicability in other interdisciplinary areas.
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Affiliation(s)
- Max W Seitz
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Christian Haux
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Petra Knaup
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Ingrid Schubert
- University of Cologne, PMV forschungsgruppe, Cologne, Germany
| | - Stefan Listl
- University Hospital Heidelberg, Department of Conservative Dentistry, Division of Translational Health Economics, Heidelberg, Germany
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Karbach U, Ansmann L, Scholten N, Pfaff H, Albus C, Jessen F, Kuntz L, Rietz C, Schubert I, Schulz-Nieswandt F, Stock S, Strupp J, Voltz R. [Report from an ongoing research project: The Cologne Research and Development Network (CoRe-Net) and the value-based approach to healthcare]. Z Evid Fortbild Qual Gesundhwes 2017; 130:21-26. [PMID: 29269171 DOI: 10.1016/j.zefq.2017.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022]
Abstract
With the BMBF's funding program "Structural Development in Health Services Research" the Cologne Research and Development Network CoRe-Net is being set up by various partners from both clinical practice and health services research. The network focuses on the further development of healthcare according to the concept of learning organizations. On the basis of three research projects, the Cologne network CoRe-Net aims to establish itself in a sustainable manner and analyze healthcare delivery for two vulnerable patient groups. The two groups include a) deceased patients in Cologne and b) people suffering from heart disease and an associated mental comorbidity. The Cologne network CoRe-Net is based on M.E. Porter's value-based healthcare approach.
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Affiliation(s)
- Ute Karbach
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR) der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Deutschland; Zentrum für Versorgungsforschung Köln (ZVFK) der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Deutschland.
| | - Lena Ansmann
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR) der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Deutschland
| | - Nadine Scholten
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR) der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Deutschland
| | - Holger Pfaff
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR) der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Deutschland; Zentrum für Versorgungsforschung Köln (ZVFK) der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Deutschland
| | | | - Christian Albus
- Leiter der Klinik und Poliklinik für Psychosomatik und Psychotherapie, Medizinische Fakultät der Universität zu Köln, Uniklinik Köln
| | - Frank Jessen
- Direktor der Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität zu Köln, Uniklinik Köln
| | - Ludwig Kuntz
- Seminar für Allgemeine Betriebswirtschaftslehre und Management im Gesundheitswesen, Wirtschaft- und sozialwissenschaftliche Fakultät der Universität zu Köln
| | - Christian Rietz
- Department Heilpädagogik und Rehabilitation, Humanwissenschaftliche Fakultät der Universität zu Köln
| | - Ingrid Schubert
- Leiterin der PMV forschungsgruppe, Medizinische Fakultät der Universität zu Köln
| | - Frank Schulz-Nieswandt
- Seminar für Sozialpolitik und Seminar für Genossenschaftswesen, Wirtschaft- und sozialwissenschaftliche Fakultät der Universität zu Köln
| | - Stephanie Stock
- Kommissarische Leitung des Institut für Gesundheitsökonomie und Klinische Epidemiologie, Medizinische Fakultät der Universität zu Köln, Uniklinik Köln
| | - Julia Strupp
- Forschungskoordinatorin am Zentrum für Palliativmedizin, Medizinische Fakultät der Universität zu Köln, Uniklinik Köln
| | - Raymond Voltz
- Direktor des Zentrums für Palliativmedizin, Medizinische Fakultät der Universität zu Köln, Uniklinik Köln
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Krueger K, Griese-Mammen N, Schubert I, Kieble M, Botermann L, Laufs U, Kloft C, Schulz M. In search of a standard when analyzing medication adherence in patients with heart failure using claims data: a systematic review. Heart Fail Rev 2017; 23:63-71. [DOI: 10.1007/s10741-017-9656-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Farbmacher H, Ihle P, Schubert I, Winter J, Wuppermann A. Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care. Health Econ 2017; 26:1234-1248. [PMID: 27492210 DOI: 10.1002/hec.3395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/08/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
Nonlinear price schedules generally have heterogeneous effects on health-care demand. We develop and apply a finite mixture bivariate probit model to analyze whether there are heterogeneous reactions to the introduction of a nonlinear price schedule in the German statutory health insurance system. In administrative insurance claims data from the largest German health insurance plan, we find that some individuals strongly react to the new price schedule while a second group of individuals does not react. Post-estimation analyses reveal that the group of the individuals who do not react to the reform includes the relatively sick. These results are in line with forward-looking behavior: Individuals who are already sick expect that they will hit the kink in the price schedule and thus are less sensitive to the co-payment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Helmut Farbmacher
- Munich Center for the Economics of Aging (MEA), Max Planck Society, Munich, Germany
| | - Peter Ihle
- PMV forschungsgruppe at the Department of Child and Adolescents Psychiatry, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV forschungsgruppe at the Department of Child and Adolescents Psychiatry, University of Cologne, Cologne, Germany
| | - Joachim Winter
- Department of Economics, University of Munich, Munich, Germany
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Schubert I, Hammer A, Köster I. [Severity assessment strategies based on administrative data using stroke as an example]. Z Evid Fortbild Qual Gesundhwes 2017; 126:66-75. [PMID: 28807634 DOI: 10.1016/j.zefq.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Information on disease severity is relevant for many studies with claims data in health service research, but only limited information is available in routine data. Stroke serves as an example to analyse whether the combination of different information in claims data can provide insight into the severity of a disease. METHOD As a first step, a literature search was conducted. Strategies to assess the severity of a disease by means of routine data were examined with regard to approval and applicability to German sickness fund data. In order to apply and extend the identified procedures, the statutory health insurance sample AOK Hessen/KV Hessen (VSH) served as data source. It is an 18.75 % random sample of persons insured by the AOK Hessen, with 2013 being the most recent year. Stroke patients were identified by the ICD-10 GM code I63 and I64. Patients with said diagnoses being coded as a hospital discharge diagnosis in 2012 were included due to an acute event in 2012 (n=944). The follow-up time was one year. RESULTS Ten studies covering seven different methods to assess stroke severity were identified. Codes for coma (4.2 % of stroke patients in the SHI sample) as well as coma and/or the application of a PEG tube (9.8 % of the stroke patients) were applied as a proxy for disease severity of acute cases. Taking age, sex and comorbidity into consideration, patients in a coma show a significantly increased risk of mortality compared to those without coma. Three operationalisations were chosen as possible proxies for disease severity of stroke in the further course of disease: i) sequelae (hemiplegia, neurological neglect), ii) duration of the index inpatient stay, and iii) nursing care/ care level 3 for the first time after stroke. The latter proxy has the highest explanatory value for SHI costs. CONCLUSION The studies identified use many variables mainly based on hospital information in order to describe disease severity. With the exception of coma, these proxies were neither validated nor did the authors provide more detailed grounds for their use. An identified score for stroke severity could not be applied to SHI data. To develop a comparable score requires a linkage of clinical and administrative data. Since routine data include information from all sectors of care, it should be explored whether these data (for example, the patients' care needs) are suitable to assess disease severity. For validation, separate databases and, optimally, primary patient data are necessary.
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Affiliation(s)
- Ingrid Schubert
- PMV forschungsgruppe an der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln, Köln, Deutschland.
| | - Antje Hammer
- Institut für Patientensicherheit, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Ingrid Köster
- PMV forschungsgruppe an der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln, Köln, Deutschland.
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Abbas S, Ihle P, Adler JB, Engel S, Günster C, Holtmann M, Kortevoss A, Linder R, Maier W, Lehmkuhl G, Schubert I. Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders. Eur Child Adolesc Psychiatry 2017; 26:433-444. [PMID: 27628527 DOI: 10.1007/s00787-016-0900-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.
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Affiliation(s)
- Sascha Abbas
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany
| | - Peter Ihle
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany
| | | | - Susanne Engel
- Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | | | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Axel Kortevoss
- GeoMed Research Forschungsgesellschaft mbH, Bad Honnef, Germany
| | - Roland Linder
- Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Werner Maier
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Gerd Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
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Affiliation(s)
- Ingrid Schubert
- Research Group, Department for Child and Adolescent Psychiatry and Psychotherapy, University of Cologne
| | - Gerd Lehmkuhl
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne
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Lappe V, Köster I, Schubert I. [Anti-Diabetic Medication During the First Four Years of Treatment. A Study Based on Claims Data]. Dtsch Med Wochenschr 2017; 142:e20. [PMID: 28187465 DOI: 10.1055/s-0043-101127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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