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Mehl C, Müller T, Nau T, Bachmann C, Geraedts M. [Development of an indicator set for the evaluation of the quality of routine ambulatory health care for common disorders in children and adolescents]. Z Evid Fortbild Qual Gesundhwes 2024:S1865-9217(24)00049-7. [PMID: 38631959 DOI: 10.1016/j.zefq.2024.03.002] [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] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND In Germany, no consented quality indicator set (QI set) exists to date that can be used to assess the quality of pediatric care. Therefore, the aim of the project "Assessment of the quality of routine ambulatory health care for common disorders in children and adolescents" (QualiPäd) funded by the Innovation Committee of the Federal Joint Committee (grant no.: 01VSF19035) was to develop a QI set for the diseases asthma, atopic eczema, otitis media, tonsillitis, attention-deficit hyperactivity disorder (ADHD), depression and conduct disorder. METHODS For the observation period 2018/2019, quality indicators (QIs) were searched in indicator databases, guidelines and literature databases and complemented in part by newly formulated QIs (e.g., derived from guideline recommendations). The QIs were then assigned to content categories and dimensions according to Donabedian and OECD and reduced by removing duplicates. Finally, a panel of experts consulted the QIs using the modified RAND-UCLA Appropriateness Method (RAM). RESULTS The search resulted in a preliminary QI set of 2324 QIs. After the reduction steps and the evaluation of the experts, 282 QIs were included in the QI set (asthma: 72 QIs, atopic eczema: 25 QIs, otitis media: 31 QIs, tonsillitis: 12 QIs, ADHD: 53 QIs, depression: 43 QIs, conduct disorder: 46 QIs). The QIs are distributed among the following different categories: Therapy (138 QIs), Diagnostics (95 QIs), Patient-reported outcome measures/Patient-reported experience measures (PROM/PREM) (45 QIs), Practice management (31 QIs), and Health reporting (4 QIs). In the Donabedian model, 89% of the QIs capture process quality, 9% outcome quality, and 2% structural quality; according to the OECD classification, 61% measure effectiveness, 23% patient-centeredness, and 16% safety of care. CONCLUSION The consented QI set is currently being tested and can subsequently be used (possibly modified) to measure the quality of routine outpatient care for children and adolescents in Germany, in order to indicate the status quo and potential areas for improvement in outpatient care.
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Affiliation(s)
- Claudia Mehl
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland.
| | - Teresa Müller
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| | - Thorsten Nau
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| | - Christian Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
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Evers J, Geraedts M. Impact of nursing home characteristics on COVID-19 infections among residents and staff. Am J Infect Control 2024; 52:15-20. [PMID: 37591313 DOI: 10.1016/j.ajic.2023.08.011] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Excess mortality occurred in nursing homes during the SARS-CoV pandemic. This study aimed to identify risk factors for COVID-19 infection and mortality in nursing home residents and staff in Hesse, Germany. METHODS A retrospective cohort study of 687 nursing homes was performed. We used t tests and logistic regressions to quantify the role of nursing homes' size, location, staff qualification, and room occupancy as potential risk factors. RESULTS The bivariate statistics show that a higher proportion of infected staff and for-profit operations were associated with an increase in infections among residents and staff, while more single rooms and registered nurses showed protective effects. Our model calculations also show that the presence of a higher ratio of registered nurses was a significant protective factor against resident infection (odds ratios [OR]: 0.969, P = .002), resident mortality (OR: 0.973, P = .006), and safeguarded staff (OR: 0.979, P = .034). In contrast, more single rooms (OR: 0.993, P = .029) were protective for residents, while increased risk factors included more beds (OR: 1.006, P = .006 for residents' infections, OR: 1.008, P < .001 for mortality) and infected staff (OR: 2.363, P < .001 for residents' infections). For staff, medium population density (OR: 2.322, P = .016) and infected residents (OR: 1.308, P < .001) were associated with elevated risk. CONCLUSIONS Preventing infection outbreaks among residents and staff is crucial to reduce mortality. Strategies include increasing single-occupancy rooms, improving staff qualifications, and targeting facilities with lower registered nurse ratios and single-occupancy rooms for inspection.
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Affiliation(s)
- Janis Evers
- Institute for Health Services Research and Clinical Epidemiology, School of Medicine, Philipps University of Marburg, Germany.
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, School of Medicine, Philipps University of Marburg, Germany.
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Evers J, Geraedts M. Potential determinants of the quantity and duration of COVID-19 outbreaks in geriatric long-term care facilities. BMC Geriatr 2023; 23:759. [PMID: 37986144 PMCID: PMC10662170 DOI: 10.1186/s12877-023-04446-4] [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: 02/22/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND We analyzed potential factors for the number and duration of COVID-19 outbreaks in nursing homes based on routine and structural data. METHODS All outbreaks during 03/2020-01/2022 in N = 687 of a total of 879 geriatric long-term care facilities (LTCFs) in the Federal State of Hesse, Germany were analyzed using t-tests and logistic regressions in a retrospective cohort study. RESULTS Larger LTCFs have more (+ 1.57, p = .009) and longer outbreaks (+ 10.04 days, p > .001). A higher proportion of registered nurses reduces the number (-0.1, p = .036) and duration (-6.02 days, p > .001) of outbreaks. Single-bed rooms provide less duration of outbreaks (-4.5, p = .004). A higher proportion of infected residents (+ 24.26 days, p < .001) and staff (+ 22.98 days, p < .001) prolong outbreaks the most. LTCFs in areas with intermediate population density have an increased risk of prolonged outbreaks (OR: 1.537, p = .036). CONCLUSIONS To prevent outbreaks and shorten their duration, LTCFs should increase the proportion of registered nurses and single-bed rooms, and control staff infections.
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Affiliation(s)
- Janis Evers
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany.
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
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Evers J, Geraedts M. COVID-19 risks in private equity nursing homes in Hesse, Germany - a retrospective cohort study. BMC Geriatr 2023; 23:648. [PMID: 37821816 PMCID: PMC10568849 DOI: 10.1186/s12877-023-04361-8] [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: 04/26/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Private-equity-owned nursing homes (PENH) represent the strongest form of profit orientation in the nursing care market. Private equity firms aim to increase the profitability of nursing care facilities, which often leads to cost-cutting measures and the use of less qualified staff. Our study aims to fill the existing knowledge gap by examining the association between private equity ownership and COVID-19 related infections and deaths among residents and staff during the COVID-19 pandemic. METHODS We analyzed outbreak and mortality data for the period from 20/03/2020 to 05/01/2022 from 32 long-term care facilities in the Federal State of Hesse, Germany, which included 16 PENH that were propensity score matched on regional population density and number of beds with 16 non-PENH. We used logistic regression to determine the odds ratios (OR) for above-median values for the independent variables of PENH-status, number of beds, proportion of single rooms, registered nurses' ratio, and copayments. RESULTS PENH had substantially fewer outbreaks in number, but longer and larger outbreaks among nursing home residents, as well as a markedly increased proportion of deceased residents. The odds of the outcome "infections & deaths" were 5.38 (p <. 05) times higher among PENH compared to non-PENH. CONCLUSIONS The study indicates a need for further research into the quality of care in PENH to inform evidence-based policy decisions, given the higher infection and death rates. Improved documentation and public visibility of PENH is also recommended, in line with existing practices for for-profit and non-profit nursing homes in Germany. Given our findings, regulatory bodies should closely observe PENH operational practices.
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Affiliation(s)
- Janis Evers
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany.
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
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Ebbeler D, Schneider M, Busse O, Berger K, Dröge P, Günster C, Misselwitz B, Timmesfeld N, Geraedts M. Associations between structure- and process-orientated measures and stroke long term mortality - an observational study based on routine data. J Stroke Cerebrovasc Dis 2023; 32:107241. [PMID: 37516024 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107241] [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] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVES Various measures are used to improve the quality of stroke care. In Germany, these include concentrating treatment in specialized facilities (stroke units), mandatory quality comparisons of hospitals in some German states, and treatment according to prespecified structure and process specifications (neurological complex treatment 8-981 or 8-98b). These measures have previously only been analyzed individually and regarding short-term patient outcomes. This study analyzes these measures in combination, considering patients' comorbidities as well as stroke severity in a longitudinal perspective. MATERIALS/METHODS Analyses were based on data from 243,415 insurees of Germany's biggest health insurance (AOK) admitted to hospitals between 2007 and 2017 with cerebral infarction. Mortality risk was calculated using Cox regressions adjusted for various covariates. Kaplan-Meier analyses were differentiated by treatment site (stroke unit/external quality assurance/ Federal State Consortium of Quality Assurance Hesse - LAGQH) were performed, followed by log-rank tests and p-value adjustment. Trend analyses were performed for treatment types in combination with treatment sites. RESULTS All analyses showed significant advantages for patients who received Neurological Complex Treatment, especially when the treatment was performed under external quality assurance conditions and/or in stroke units. There was an increasing frequency of specialized stroke treatment. CONCLUSIONS Quality-enhancing structures and processes are associated with a lower mortality risk after stroke. There appears to be evidence of a cascading benefit from the implementation of neurological complex treatment, external quality assurance, and ultimately, stroke units. Consecutively, care should be concentrated in hospitals that meet these specifications. However, since measures are often applied in combination, it remains unclear which specific measures are crucial for patient outcome.
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Affiliation(s)
- Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Philipps University of Marburg, Karl-von-Frisch-Straße 4, Marburg 35043, Germany.
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Philipps University of Marburg, Karl-von-Frisch-Straße 4, Marburg 35043, Germany
| | - Otto Busse
- Stroke Unit Certification Committee, German Stroke Society, Berlin 10117, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster 48149, Germany
| | - Patrik Dröge
- AOK Research Institute, AOK Federal Association, Berlin 10178, Germany
| | - Christian Günster
- AOK Research Institute, AOK Federal Association, Berlin 10178, Germany
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse (LAGQH), Eschborn 65760, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum 44789, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps University of Marburg, Karl-von-Frisch-Straße 4, Marburg 35043, Germany
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Brauer L, Geraedts M. Exploring regional healthcare utilisation and quality of care for endometriosis in rural areas in Hesse, Germany: a mixed methods study protocol. BMJ Open 2023; 13:e074259. [PMID: 37620261 PMCID: PMC10450047 DOI: 10.1136/bmjopen-2023-074259] [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: 03/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The need of a regional healthcare monitoring in order to evaluate quality and utilisation of health services in smaller scale is internationally and in Germany well established. Little is known about variation in healthcare in rural German areas, especially for women's health. In particular, endometriosis is highly prevalent and known to be unsatisfactorily treated. Thus, this study aims to investigate utilisation and quality of care, the influence of structural determinants on quality and the patient's experiences on endometriosis healthcare in rural Hesse. METHODS AND ANALYSIS We will use a mixed methods approach to ensure reliable mapping of the care situation for endometriosis patients in seven counties in Central and Eastern Hesse. First, retrospective secondary utilisation data and quality indicators will be used to describe possible regional variation in the treatment of endometriosis in the outpatient and inpatient sector. Second, we compare structural determinants of regions with quality of care. Third, we conduct qualitative, semistructured interviews with endometriosis patients on their perspective and experiences in those chosen rural regions. Data will then be analysed using descriptive statistics, small area variation analyses and multifactorial analyses of variance (ANOVAs). The interview will be interpreted using the experience-focused phenomenological approach. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of Philipps-University Marburg. Utilisation data and structural determinants are anonymised and partly aggregated. The interview will use tokens for pseudonymisation to prevent the collected data from being assigned to an individual person. Also, informed consent will be obtained from patients.The results of this study will be reported to the scientific community in peer-reviewed journals and at conferences. A summary of the key findings will be provided to the interviewed patients and the Endometriosis Association Germany.
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Affiliation(s)
- Lara Brauer
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Hessen, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Hessen, Germany
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Veit C, Bierbaum T, Wesselmann S, Stock S, Heidecke CD, Apfelbacher C, Benz S, Dreinhöfer KE, Hauptmann M, Hoffmann F, Hoffmann W, Kaiser T, Klinkhammer-Schalke M, Koller M, Kostuj T, Ortmann O, Schmitt J, Schünemann H, Geraedts M. [Routine Practice Data for Health Care Analyses: Part 3 of the Manual]. Gesundheitswesen 2023; 85:718-724. [PMID: 36535653 PMCID: PMC10444518 DOI: 10.1055/a-1966-0104] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Analyses of health and health care (hereafter referred to as "health care analyses") usually aim to make transparent the structures, processes, results and interrelationships of health care and to record the degree to which health care systems and their actors have achieved their goals. Health care-related data are an indispensable source of data for many health care analyses. A prerequisite for the examination of a degree of goal achievement is first of all an agreement on those goals that are to be achieved by the system and its substructures, as well as the identification of the determinants of the achievement of the objectives. Primarily it must be examined how safely, effectively and patient-centred systems, facilities and service providers are operating. It also addresses issues of need, accessibility, utilisation, timeliness, appropriateness, patient safety, coordination, continuity, and health economic efficiency and equity of health care. The results of health care include system services (outputs), on the one hand, and results (outcomes), on the other, whereby the results (patient-reported outcomes) and experiences (patient-reported experiences) reported are of particular importance. Health care analyses answer basic questions of health care research: who does what, when, how, why and with which resources and effects in routine health care. Health care analyses thus provide the necessary findings and key figures to further develop health care in order to improve the quality of health care. The applications range from capacity analyses to following innovations up to the concept of regional and supra-regional monitoring of the quality of care given to the population. Given the progress of digitalisation in Health Care, direct data from the care processes will be increasingly available for health care research. This can support care givers significantly if the findings of the studies are applied precisely and correctly within an adequate methodological frame. This can lead to measurable improved health care quality for patients. Data from the process of health care provision have a high potential. Their use needs the same scientific scrutiny as in all other scientific studies.
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Affiliation(s)
- Christof Veit
- BQS Institut für Qualität und Patientensicherheit GmbH,
Hamburg, Germany
| | - Thomas Bierbaum
- Geschäftsstelle, Deutsches Netzwerk Versorgungsforschung,
Berlin, Germany
| | - Simone Wesselmann
- Zertifizierung, Deutsche Krebsgesellschaft eV, Frankfurt am Main,
Germany
| | - Stephanie Stock
- Institut für Gesundheitsökonomie, Uniklinik
Köln, Cologne, Germany
| | - Claus-Dieter Heidecke
- Leitung, Institut für Qualitätssicherung und
Transparenz im Gesundheitswesen (IQTIG), Berlin, Germany
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto
von Guericke Universitat Magdeburg, Magdeburg, Germany
| | - Stefan Benz
- Kliniken Böblingen, Klinikverbund Südwest GmbH,
Sindelfingen, Germany
| | - Karsten E. Dreinhöfer
- Orthopädie und Unfallchirurgie, Medical Park AG, Berlin,
Germany
- Orthopädie und Unfallchirurgie, Charite Universitatsmedizin
Berlin, Berlin, Germany
| | - Michael Hauptmann
- Departement für Versorgungsforschung, Medizinische Hochschule
Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky
Universität Oldenburg, Oldenburg, Germany
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universität
Greifswald, Greifswald, Germany
| | - Thomas Kaiser
- Ressort Arzneimittelbewertung, Institut für Qualität
und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Köln,
Germany
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg, Institut für
Qualitätssicherung und Versorgungsforschung, Universität
Regensburg, Regensburg, Germany
- Tumorcenter Regensburg, Institut for Quality assurance and Health
Services Research, University of Regensburg, Regensburg, Germany
| | - Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum
Regensburg, Regensburg, Germany
| | - Tanja Kostuj
- Klinik für Orthopädie und Unfallchirurgie, Klinikum
Lippe, Lemgo, Germany
| | - Olaf Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe,
Universität Regensburg Fakultät für Medizin, Regensburg,
Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung,
Universitätsklinikum Carl Gustav Carus an der Technischen
Universität Dresden, Dresden, Germany
| | - Holger Schünemann
- Cochrane Canada and Mc Master GRADE Centre, WHO Collaborating Centre
for Infectious Diseases, Research and Methods, Hamilton, Canada
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology,
Philipps-Universität Marburg, Marburg, Germany
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Geraedts M, Schneider M, Vorbeck L. Replik zum Leserbrief von J. Rauh und D. Boywitt „Bei der
Bewertung von Krankenhäusern muss fallzahlabhängige Unsicherheit
berücksichtig werden“. Gesundheitswesen 2023; 85:481. [PMID: 37172596 DOI: 10.1055/a-2020-6571] [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: 05/15/2023]
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Schmitt J, Bierbaum T, Geraedts M, Gothe H, Härter M, Hoffmann F, Ihle P, Kramer U, Klinkhammer-Schalke M, Kuske S, March S, Reese JP, Schoffer O, Swart E, Vollmar HC, Walther F, Hoffmann W. Das Gesundheitsdatennutzungsgesetz – Potenzial für
eine bessere Forschung und Gesundheitsversorgung. Gesundheitswesen 2023; 85:215-222. [PMID: 36977473 PMCID: PMC10125338 DOI: 10.1055/a-2050-0429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
- Deutsches Netzwerk Versorgungsforschung, Berlin
| | | | - Max Geraedts
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg
| | - Holger Gothe
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
- Hochschule Hannover, Fakultät III, Abt. Information und Kommunikation (IK), Hannover
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden
- Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS)
| | - Martin Härter
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin
| | - Falk Hoffmann
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg
| | - Peter Ihle
- Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS)
- PMV forschungsgruppe, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln
| | - Ursula Kramer
- Deutsches Netzwerk Versorgungsforschung, Berlin
- sanawork Gesundheitskommunikation, Waldkirch
| | - Monika Klinkhammer-Schalke
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg
| | - Silke Kuske
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Fliedner Fachhochschule Düsseldorf, Düsseldorf
| | - Stefanie March
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Hochschule Magdeburg-Stendal, Fachbereich Soziale Arbeit, Gesundheit und Medien
| | - Jens-Peter Reese
- Professur für Versorgungsforschung und Public Health Institut für Klinische Epidemiologie und Biometrie Julius-Maximilians-Universität Würzburg
| | - Olaf Schoffer
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
- Deutsches Netzwerk Versorgungsforschung, Berlin
| | - Enno Swart
- Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS)
- Institut für Sozialmedizin und Gesundheitssystemforschung (ISMG), Medizinische Fakultät, Otto-von-Guericke Universität Magdeburg, Magdeburg
| | - Horst Christian Vollmar
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Abteilung für Allgemeinmedizin (AM RUB), Medizinische Fakultät, Ruhr-Universität Bochum, Bochum
| | - Felix Walther
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Wolfgang Hoffmann
- Deutsches Netzwerk Versorgungsforschung, Berlin
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald
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10
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Müller T, Mehl C, Nau T, Bachmann C, Geraedts M. Process over outcome quality in paediatrics? An analysis of outpatient healthcare quality indicators for seven common diseases. BMJ Open Qual 2023; 12:bmjoq-2022-002125. [PMID: 36801819 PMCID: PMC9944293 DOI: 10.1136/bmjoq-2022-002125] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/05/2023] [Indexed: 02/19/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the scope, quality dimensions and treatment aspects covered by existing quality indicators (QIs) for the somatic diseases bronchial asthma, atopic eczema, otitis media and tonsillitis as well as the psychiatric disorders attention deficit hyperactivity disorder (ADHD), depression and conduct disorder in paediatrics. METHODS QIs were identified through an analysis of the guidelines and a systematic search of literature and indicator databases. Subsequently, two researchers independently assigned the QIs to the quality dimensions according to Donabedian and Organisation for Economic Cooperation and Development (OECD) and to the content categories covering the treatment process. RESULTS We found 1268 QIs for bronchial asthma, 335 QIs for depression, 199 QIs for ADHD, 115 QIs for otitis media, 72 QIs for conduct disorder, 52 QIs for tonsillitis and 50 QIs for atopic eczema. Of these, 78% focused on process quality, 20% on outcome quality and 2% on structural quality. Using OECD criteria, 72% of the QIs were assigned to effectiveness, 17% to patient-centredness, 11% to patient safety and 1% to efficiency. The QIs covered the following categories: diagnostics (30%), therapy (38%), patient-reported outcome measures/ observer-reported outcome measures/patient-reported experience measures (in sum 11%), health monitoring (11%) and office management (11%). CONCLUSION Most QIs focused on the dimensions of effectiveness and process quality, and on the categories of diagnostics and therapy, with outcome-focused and patient-focused QIs being under-represented. Possible reasons for this striking imbalance could be the easier measurability and clearer assignment of accountability in comparison to the QIs of outcome quality, patient-centredness and patient safety. To produce a more balanced picture of the quality of healthcare, the future development of QIs should prioritise the currently under-represented dimensions.
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Affiliation(s)
- Teresa Müller
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Thorsten Nau
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Christian Bachmann
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
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Abstract
BACKGROUND Free hospital choice is promoted in health policy through public quality reporting. Previous studies on hospital choice mostly survey patients for specific elective procedures. This study examines all full inpatient surgical patients and compares them to those in other specialties. Research questions are: How many patients make their own decisions about the hospital? How much time do they have before admission? Where do they obtain information and what are their important decision criteria? MATERIALS AND METHODS This study evaluates cross-sectional primary data on hospital choice collected by questionnaire from 1925 consecutively hospitalised patients from 11 medical specialties and 3 levels of care, including 438 surgical patients from 6 general surgery departments. RESULTS Three quarters of surgical patients decide on the hospital themselves. Their own previous experience with the hospital is an important source of information and decision-making criterion for a good half of the patients, along with relatives and outpatient treatment providers as well as the hospital reputation. CONCLUSION Many surgical patients decide in favour of a hospital because of the trust they have built up through previous treatment in the hospital, which they experience as satisfactory. The professional quality of treatment is thus the greatest impact factor on patients, their relatives and outpatient treatment providers. It is important to actively and specifically address and clarify possible dissatisfaction on the part of the patient before discharge.
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Affiliation(s)
- Werner de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | | | - Max Geraedts
- Medizin, Philipps-Universität Marburg Fachbereich Medizin, Marburg, Germany
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12
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de Cruppé W, Assheuer M, Geraedts M, Beine K. Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study. BMC Psychiatry 2023; 23:52. [PMID: 36658554 PMCID: PMC9850567 DOI: 10.1186/s12888-023-04545-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Continuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care. METHODS Prospective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables. RESULTS Higher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care. CONCLUSION Our results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients' motives as well as methodological reasons for non-participation remain considerable potential sources for bias. TRIAL REGISTRATION This prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.
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Affiliation(s)
- Werner de Cruppé
- Institute for Health Services Research and Clinical Epidemiology Philipps-Universität Marburg, Karl-Von-Frisch-Strasse 4, 35043 Marburg, Germany
| | - Michaela Assheuer
- Institute for Health Services Research and Clinical Epidemiology Philipps-Universität Marburg, Karl-Von-Frisch-Strasse 4, 35043 Marburg, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology Philipps-Universität Marburg, Karl-Von-Frisch-Strasse 4, 35043 Marburg, Germany
| | - Karl Beine
- School of Medicine, Faculty of Health, Institute for Health Systems Research, Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 WittenWitten, Germany
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13
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Geraedts M, Ebbeler D, Timmesfeld N, Kaps M, Berger K, Misselwitz B, Günster C, Dröge P, Schneider M. Long-term outcomes of stroke unit care in older stroke patients: a retrospective cohort study. Age Ageing 2022; 51:6691374. [PMID: 36057988 DOI: 10.1093/ageing/afac197] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND older patients are less frequently treated in stroke units (SUs). Clinicians do not seem convinced that older patients benefit from specialised treatment in SU similarly to younger patients. OBJECTIVE our study aimed to compare older patients' long-term outcomes with and without SU treatment. METHODS this study used routinely collected health data of 232,447 patients admitted to hospitals in Germany between 2007 and 2017 who were diagnosed with ischaemic stroke (ICD 10 I63). The sample included 29,885 patients aged ≥90 years. The outcomes analysed were 10-, 30- and 90-day, and 1-, 3- and 5-year mortality and the combinations of death or recurrence, inpatient treatment and increase in long-term care needs. Bivariate chi-square tests and multivariable logistic regression analyses were used, adjusting for the covariates age, sex, co-morbidity, long-term care needs before stroke and socioeconomic status of the patients' region of origin. RESULTS between 2007 and 2017, 57.1% of patients aged <90 years and 49.6% of those aged ≥90 years were treated in a SU. The 1-year mortality rate of ≥90-year-olds was 56.9 and 61.9% with and without SU treatment, respectively. The multivariable-adjusted risk of death in ≥90-year-olds with SU treatment was odds ratio (OR) = 0.67 (95% confidence interval [CI] = 0.62-0.73) 10 days after the initial event and OR = 0.76 (95% CI = 0.71-0.82) 3 years after stroke. CONCLUSIONS even very old patients with stroke benefit from SU treatment in the short and long term. Therefore, SU treatment should be the norm even in older patients.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
| | - Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital of Giessen/Marburg, Justus-Liebig-University of Giessen, 35392 Giessen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westphalian-Wilhelms-University of Muenster, 48149 Münster, Germany
| | | | - Christian Günster
- WIdO - AOK Research Institute, AOK Federal Association, 10178 Berlin, Germany
| | - Patrik Dröge
- WIdO - AOK Research Institute, AOK Federal Association, 10178 Berlin, Germany
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
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14
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Geraedts M, Bierbaum T, Gröne O, Härter M, Hildebrandt H, Hoffmann W, Klinkhammer-Schalke M, Köberlein-Neu J, Schmitt J. Methoden und Indikatorensets für die Evaluation regionaler
sektorverbindender Versorgungsmodelle. Gesundheitswesen 2022. [DOI: 10.1055/a-1824-1627] [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: 10/18/2022]
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15
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Ignatyev Y, Habicht J, Schwarz J, Neumann A, Schmitt J, Pfennig A, Geraedts M, Heinze M. [Biometric properties of QUALIFY: a tool for assessing quality indicators]. Z Evid Fortbild Qual Gesundhwes 2022; 170:7-13. [PMID: 35450830 DOI: 10.1016/j.zefq.2021.11.008] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Accurate health care evaluation using quality indicators (QIs) is of vital clinical importance for a quality-oriented health care system. The QUALIFY tool is the current research standard for assessing QIs of health care; however, its biometric properties in psychiatry have not yet been evaluated empirically. Our aim was to evaluate the internal consistency and structure of QUALIFY. METHODS This study applies a literature-based post-hoc analytical design to a sample of 289 QIs of mental health care. First, the indicators were assessed on the basis of nineteen ordinal QUALIFY criteria as a single measuring tool. Second, using Cronbach's alpha the internal consistency of the measuring tool was evaluated and the structure of QUALIFY using an explorative principal component analysis was tested. RESULTS AND DISCUSSION The tool showed an acceptable internal consistency (Cronbach's α=0.75), with three criteria (consideration of potential risks/side effects when using the indicator, implementation barriers taken into account, and the ability to influence the indicator) being inconsistent with the full scale. If these three criteria were not taken into account, the tool had a good internal consistency (Cronbach's α=0.81). The QUALIFY structural matrix comprises three components, one of which reflected six from eight original quality criteria of the scientific category. The other two components represent the semiotic structure of the QIs. CONCLUSION QUALIFY is an internally inconsistent instrument, which may be useful to assess mental health care QIs. The information about the structure of QUALIFY can be applied for the purposes of research planning as well as the interpretation and development of QIs.
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Affiliation(s)
- Yuriy Ignatyev
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland; Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland.
| | - Juri Habicht
- Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland
| | - Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Anne Neumann
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie der Philipps-Universität Marburg, Marburg, Deutschland
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland
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16
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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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17
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Geraedts M, de Cruppé W. [Effects of statutory quality assurance in acute inpatient care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:285-292. [PMID: 35122107 PMCID: PMC8888375 DOI: 10.1007/s00103-022-03489-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Statutory quality assurance (QA) serves to ensure and further develop the quality of service provision. Particularly prominent in Germany's acute inpatient care are mandatory quality reports (QRs) and participation in external quality assessments (eQAs). Their effects have not yet been comprehensively evaluated. OBJECTIVES What are the effects of eQAs and QRs on the quality of care? MATERIALS AND METHODS Based on a selective literature review, international evidence on the effects of QA was compiled. This was supplemented by analyses of the quality reports of the Federal Office for Quality Assurance (BQS), the Institute for Applied Quality Improvement and Research in Health Care (AQUA), and the Institute for Quality Assurance and Transparency in Healthcare (IQTIG), which have been responsible for eQAs since 2001. RESULTS According to international literature, at most weak effects of these measures can be expected, especially on process quality. Studies from Germany mostly observe only uncontrolled temporal trends and partly show improved quality indicators. Only one controlled study each was able to show weak positive effects on outcome and process quality for eQAs and QRs, respectively. CONCLUSIONS There are no convincing evaluation results for either the QRs or the eQAs. Deficiencies in the addressee-oriented design of the QRs and the reported indicator results in terms of their validity, risk adjustment, and temporal availability can be cited as potential causes. Statutory QA should be revised by paying more attention to the prerequisites for successful performance feedback and by again creating room for an intrinsically motivated assessment of one's own quality of care.
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Affiliation(s)
- Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Deutschland.
| | - Werner de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Deutschland
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18
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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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19
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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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20
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Ebbeler D, Schneider M, Busse O, Berger K, Dröge P, Günster C, Kaps M, Misselwitz B, Timmesfeld N, Geraedts M. Spezialisierung der Schlaganfallversorgung in Deutschland:
Strukturveränderungen im Zeitraum von 2006–2017. Gesundheitswesen 2021; 85:242-249. [PMID: 34942663 DOI: 10.1055/a-1690-6786] [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: 11/07/2022]
Abstract
Zusammenfassung
Hintergrund Um die Schlaganfallversorgung zu optimieren, wurden in
Deutschland in den letzten Jahren verschiedene
qualitätsfördernde Maßnahmen (qfM) in regional
unterschiedlichem Maß eingeführt. Ob sich diese
Maßnahmen über die Jahre flächendeckend etabliert
haben, ist unklar.
Methode Für die strukturbezogenen Analysen der Schlaganfallversorgung
in Deutschland wurden alle relevanten dokumentierten Schlaganfälle
(ICD-10) aus den Qualitätsberichten (QB) deutscher
Krankenhäuser und eine repräsentative Stichprobe von
Krankenversicherungsdaten (AOK) im Zeitraum von 2006 (QB)/2007 (AOK)
bis 2017 verwendet. Diese Informationen wurden u. a. durch Angaben
zu zertifizierten Stroke Units der Deutschen Schlaganfall-Gesellschaft (DSG)
und Daten zur Führung von regionalen Schlaganfall-Registern der
Arbeitsgemeinschaft Deutschsprachiger Schlaganfall-Register (ADSR)
ergänzt. Zur Verfolgung der Veränderungen des
Versor-gungsgeschehens im deutschen Bundesgebiet wurden die Daten mit
geografischen Daten (Bundesamt für Kartographie und
Geodäsie) verknüpft. Es erfolgten univariate Analysen der
Daten und eine Trend-Analyse der verschiedenen qfM im Jahresverlauf
(Konkordanzkoeffizient nach Kendall).
Ergebnisse Die QB Analysen zeigten einen Anstieg kodierter
Schlaganfälle in Krankenhäusern mit qfM um
14–20%. In 2006 wurden 80% der Schlaganfälle
(QB) in einem Krankenhaus mit min. einer qfM kodiert, in 2017 95%.
Diese Entwicklungen spiegelten sich auch in den AOK-Routinedaten wider,
wobei in 2007 89% und in 2017 97% der Patient:innen unter
mindestens einer qfM behandelt wurden. Dabei waren in 2007 bei 55%
der behandelnden Krankenhäuser qfM vorhanden, in 2017 bei
72%.
Schlussfolgerung Patient:innen werden inzwischen signifikant häufiger
in Krankenhäusern mit Spezialisierung auf die Schlaganfallversorgung
behandelt. Auch die verschiedenen qfM haben sich im Laufe der Jahre im
gesamten Bundesgebet verbreitet, jedoch existieren noch
Versorgungslücken, die geschlossen werden sollten, damit in Zukunft
alle Patient:innen qualitativ hochwertig behandelt werden
können.
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Affiliation(s)
- Dijana Ebbeler
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
| | - Michael Schneider
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
| | - Otto Busse
- Deutsche Schlaganfall-Gesellschaft e.V., Berlin,
Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin,
Westfälische Wilhelms- Universität Münster, Medizinische
Fakultät, Münster, Deutschland
| | - Patrik Dröge
- Wissenschaftliches Institut der AOK (WIdO), AOK-Bundesverband, Berlin,
Deutschland
| | - Christian Günster
- Wissenschaftliches Institut der AOK (WIdO), AOK-Bundesverband, Berlin,
Deutschland
| | - Manfred Kaps
- Neurologische Klinik, Universitätsklinikum
Gießen/Marburg, Justus-Liebig-Universität
Gießen, Gießen, Deutschland
| | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH),
Hessische Krankenhausgesellschaft e. V. Eschborn,
Deutschland
| | - Nina Timmesfeld
- Abteilung für Medizinische Informatik, Biometrie und
Epidemiologie, Ruhr-Universität Bochum, Medizinische Fakultät,
Bochum, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
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21
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Geraedts M, Ebbeler D, Timmesfeld N, Kaps M, Berger K, Misselwitz B, Günster C, Dröge P, Schneider M. Quality Assurance Measures and Mortality After Stroke. Dtsch Arztebl Int 2021; 118:857-863. [PMID: 34730084 PMCID: PMC8948340 DOI: 10.3238/arztebl.m2021.0339] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality assurance for acute in-hospital care in Germany is based on compulsory comparisons between institutions, so-called external quality assurance (EQA). The effectiveness of EQA has not yet been adequately studied. The purpose of the QUASCH project, which is supported by the Innovation Fund of the Federal Joint Committee, is to investigate the association between EQA and health care outcomes, specifically with respect to stroke. METHODS The analyses were based on data from 379 825 patients insured by the AOK health insurance fund who were acutely admitted to a hospital because of stroke over the period 2007-2017. Data on 47 659 patients were derived from EQA documentation in the state of Hesse, in which stroke EQA had already been introduced in 2003; data on the remaining 332 166 patients were from other federal states, where 117 734 of these patients had been treated under EQA conditions. The association of EQA with mortality over the period of observation was analyzed by multivariate Cox regression, with the following covariates: age, sex, comorbidities, time period of occurrence, nursing care level, type of stroke, socio-economic deprivation in the region of origin, and treatment in a stroke unit. RESULTS Compared to treatment without EQA, mortality risk under EQA in the state of Hesse was significantly lower (hazard ratio [HR]: 0.93; 95% confidence interval: [0.92; 0.95]). The reduction in mortality risk with EQA was somewhat lower in the other federal states (HR: 0.96 [0.95; 0.97]). Treatment in a stroke unit was associated with a mortality risk that was lower still (HR: 0.86 [0.85; 0.87]). Mortality risk rose with age, comorbidities, and need for nursing care; it was lower in women and in persons whose stroke occurred in a later period. CONCLUSION Quality assurance measures are associated with lower mortality risk after stroke. The concentration of care in specially qualified institutions is associated with stronger effects than EQA alone.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
| | - Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr University Bochum
| | - Manfred Kaps
- Department of Neurology, University Hospital of Giessen/Marburg, Justus Liebig University of Giessen
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Medical Faculty, Westphalian Wilhelms University of Münster
| | | | - Christian Günster
- Research Institute of the AOK [German public health insurance company], AOK Federal Association
| | - Patrik Dröge
- Research Institute of the AOK [German public health insurance company], AOK Federal Association
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
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22
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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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23
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de Cruppé W, Kummer MC, Geraedts M. [How do internal medicine patients choose their hospital? A cross-sectional study]. Dtsch Med Wochenschr 2021; 147:e23-e31. [PMID: 34861698 PMCID: PMC8841205 DOI: 10.1055/a-1653-6717] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Einleitung
Die freie Krankenhauswahl durch Patienten wird gesundheitspolitisch gefördert und soll durch die Qualitätsberichte der Krankenhäuser unterstützt werden. Doch wie entscheiden sich Patienten für ein Krankenhaus? Wie viele können selber entscheiden, wo informieren sie sich und was sind in der konkreten Situation ihre Entscheidungskriterien? Dies soll für stationäre Patienten der Inneren Medizin im Vergleich zu denen anderer Fachgebiete beantwortet werden.
Methoden
Die Daten entstammen einer Beobachtungsstudie. Die nach Fachgebieten und Krankenhausversorgungsstufen geschichtete Zufallsstichprobe wurde in 46 Fachabteilungen von 17 Krankenhäusern aus 15 Städten und Gemeinden Nordrhein-Westfalens erhoben. Die gewichtete Stichprobe wertet 758 Patienten der Inneren Medizin und 1168 Patienten anderer Fachgebiete deskriptiv und inferenzstatistisch aus.
Ergebnisse
Internistische Patienten sind älter, häufiger Männer, ohne Migrationshintergrund und chronisch krank, zudem öfter stationär vorbehandelt. Etwa die Hälfte entscheidet selbst über das Krankenhaus, wobei die eigene Kenntnis des Krankenhauses durch einen Voraufenthalt die wichtigste Informationsquelle darstellt und wichtige Entscheidungskriterien die eigene Vorerfahrung, der Ruf des Krankenhauses und die Empfehlung der ambulanten Behandler sind. Der kleine Anteil Patienten mit mehr Zeit vor der Aufnahme wählt das Krankenhaus aktiver.
Diskussion
In der Inneren Medizin können weniger Patienten selbst über das Krankenhaus bestimmen. Diese entscheiden dann überwiegend aufgrund ihrer Vorerfahrung mit dem Krankenhaus und setzen die erneute Behandlung im ihnen bekannten Krankenhaus, in dem auch sie bekannt sind, fort. Ein kleiner Anteil jüngerer, gebildeterer und weniger krankenhauserfahrener Patienten informiert sich aktiver vor elektiven Eingriffen. Die Behandlungserfahrungen der Patienten sind zentral bei der eigenen Krankenhauswahl und über den sozialen Austausch auch bei der ihrer Angehörigen.
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Affiliation(s)
- W de Cruppé
- Philipps Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
| | - M-C Kummer
- Philipps Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
| | - M Geraedts
- Philipps Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
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24
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Tischlik V, Mehl C, Ewald D, Heinzel-Gutenbrunner M, Geraedts M, Bachmann CJ. Assessment of the quality of routine ambulatory healthcare for common disorders in children and adolescents in Germany: study protocol for a retrospective medical record review (QualiPäd). BMJ Open 2021; 11:e048782. [PMID: 34815275 PMCID: PMC8611448 DOI: 10.1136/bmjopen-2021-048782] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The quality of healthcare in childhood and adolescence is of key importance, in order to foster a healthy development and to avoid chronic health problems. Yet, data for Germany regarding the quality of healthcare for this patient group are lacking. The QualiPäd research project aims to estimate the quality of outpatient healthcare for children and adolescents in Germany, focusing on common psychiatric and physical disorders. METHODS AND ANALYSIS Quality indicators for seven common physical and mental childhood and adolescent clinical conditions (attention deficit/hyperactivity disorder, asthma, atopic dermatitis, depression, otitis media, conduct disorder/oppositional defiant disorder, tonsillitis) will be developed and ratified by experts, using the RAND/UCLA Appropriateness Method.Initially, 1400 medical records of children and adolescents with one of the aforementioned clinical conditions will then be randomly drawn from 40 outpatient practices in the German federal state of Hessen. The records will then be assessed regarding their adherence to the respective quality indicators. Based on this, the percentage of appropriate and inappropriate (eg, wasteful) healthcare of all clinical conditions (primary endpoint) will be estimated. Additionally, possible factors influencing the quality of care (eg, patient characteristics, type of condition, type of practice) will be identified using generalised estimation equation models. ETHICS AND DISSEMINATION This study will show for which of the studied clinical conditions and/or patients improvement of quality of care is necessary within the German health system. Also, the quality indicators designed for the study can afterwards be implemented in regular care and thus enable regular reporting of the outpatient care of this target group. The authors plan to disseminate their findings through international, peer-reviewed scientific publications, and through presentations at national and international paediatric and child psychiatric conferences. TRIAL REGISTRATION NUMBER DRKS00022408.
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Affiliation(s)
- Viktor Tischlik
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
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25
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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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26
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Seufert S, de Cruppé W, Assheuer M, Leinert J, Geraedts M. How do patients respond to safety problems in ambulatory care? Results of a retrospective cross-sectional telephone survey. BMJ Open 2021; 11:e052973. [PMID: 34753764 PMCID: PMC8578976 DOI: 10.1136/bmjopen-2021-052973] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/18/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patients in German ambulatory care frequently report patient safety problems (PSP). It is unclear whether patients report PSP back to their general practitioner (GP) or specialist in charge. This study reports on how patients respond to experienced PSP. DESIGN Retrospective cross-sectional study. SETTING Computer-assisted telephone interviews (CATI) with randomly recruited citizens aged ≥40 years in Germany. PARTICIPANTS 10 037 citizens ≥40 years. About 52% of the interviewees were female, 38% were between 60 and 79 years old and about 47% reported that they were chronically ill. A total of 2589 PSPs was reported. PRIMARY AND SECONDARY MEASURES/RESULTS According to the respondents (n=1422, 77%, 95% CI: 74.7 to 79.1), 72% (95% CI: 70.2 to 73.7) of PSP were reported back to the GP in charge or to another GP/specialist. Further reactions were taken by 65% (95% CI: 62.5 to 67.5) of the interviewees: around 63% (95% CI: 62.5 to 66.2) of the reported PSP led to a loss of faith in the physician or to complaints. χ2 and binary logistic regression analyses show significant associations between the (a) reporting and (b) reaction behaviour and determinants like 'medical treatment area' ((a) χ2=17.13, p=0.009/(b) χ2=97.58, p=0.000), 'PSP with/without harm' ((a) χ2=111.84, p=0.000/(b) χ2=265.39, p=0.000) and sociodemographic characteristics when respondents are aged between 40 and 59 years ((a) OR 2.57/(b) OR 2.60) or have chronic illnesses ((a) OR 2.16/(b) OR 2.14). CONCLUSION The data suggest that PSPs are frequently reported back to the GP or specialist in charge and have a significant serious impact on the physician-patient relationship. Much could be learnt from the patient reporting and reacting behaviour to prevent PSPs in ambulatory care.
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Affiliation(s)
- Svenja Seufert
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Werner de Cruppé
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Michaela Assheuer
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Johannes Leinert
- infas Institut fur angewandte Sozialwissenschaft GmbH, Bonn, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
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27
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de Cruppé W, Geraedts M. Inanspruchnahme und Wahl eines Krankenhauses in Deutschland – unterscheiden sich Patienten mit und ohne Migrationshintergrund? Änderungen übernehmenAbbrechen. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732040] [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: 10/20/2022]
Affiliation(s)
- W de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps Universität Marburg
| | - M Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps Universität Marburg
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28
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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 PMCID: PMC8456442 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] [MESH Headings] [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
- *These two authors share first authorship
- PMV research group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, Faculty of Medicine and University Hospital Cologne
| | - Dominikus Stelzer
- *These two authors share first authorship
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
| | - Achim Siegel
- Institute for Occupational and Social Medicine and Health Services Research, University of Tübingen
| | - Ingrid Köster
- PMV research group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, Faculty of Medicine and University Hospital Cologne
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology (IVE), Philipps-Universität Marburg
| | - Peter Ihle
- PMV research group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, Faculty of Medicine and University Hospital Cologne
| | | | | | | | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research (SEVERA), Faculty of Medicine and Medical Center, University of Freiburg
| | - Erika Graf
- *These two authors share last authorship
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
| | - Max Geraedts
- *These two authors share last authorship
- Institute for Health Services Research and Clinical Epidemiology (IVE), Philipps-Universität Marburg
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29
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Heytens H, Walther F, Keßler L, Bremer D, Frenz E, Härter M, Geraedts M, Bierbaum T, Apfelbacher C, Schmitt J. [Characteristics of Innovation Fund-supported Intervention Studies: Review and Document Analysis of Study Protocols, Publications and Final Reports]. Gesundheitswesen 2021; 83:e20-e37. [PMID: 34015857 DOI: 10.1055/a-1448-2412] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This prospectively registered review characterizes 50 intervention studies from the 1st wave of the Innovation Fund based on study protocols or original articles, among other sources. The mainly (randomized) controlled intervention studies included predominantly adults/seniors in ambulatory care without a regional focus and analyzed treatment processes, clinical and patient outcomes as outcomes. The substantial lack of study protocols and methodological details (e. g., sample size planning) reveals (avoidable) methodological problems regarding the scientific quality of the funded studies.
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Affiliation(s)
- Heike Heytens
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Felix Walther
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität, Dresden.,Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus Dresden, Dresden
| | - Laura Keßler
- Deutsches Netzwerk Versorgungsforschung e. V., Berlin
| | - Daniel Bremer
- Institut und Poliklinik für Medizinische Psychologie, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Elisa Frenz
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität, Dresden
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg
| | | | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität, Dresden
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30
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Wellkamp R, de Cruppé W, Schwalen S, Geraedts M. [Health Care Use by Intellectually Disabled People: A Cross-Sectional Study in three Sheltered Workshops]. Gesundheitswesen 2021; 84:457-465. [PMID: 33890264 DOI: 10.1055/a-1330-8081] [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: 10/21/2022]
Abstract
STUDY OBJECTIVE People with intellectual disabilities have a lower life expectancy and more frequent comorbidities than the general population and have unmet health needs. Insufficient medical care is suspected to be one reason, for which little data is available in Germany. The study therefore focuses on the question of how people with intellectual disabilities make use of medical care, including screening and preventive measures. METHOD In a cross-sectional study in 3 workshops for people with intellectual disabilities, the use of health care was surveyed by means of questionnaires from their relatives. The evaluation was carried out descriptively and by means of inferential statistics comparing participants with the general population as well as within the group of participants for socio-demographic differences. RESULTS Almost all 181 participants (participation rate 19.3%) had a family doctor. In comparison to the general population, the participants made more frequent use of the services of general practitioners and the care provided by numerous other specialist areas. They made less frequent use of screening for colon, breast, cervix and prostate and more frequent use for skin cancer and general check-up. Dental check-ups and preventive measures showed no difference. Participants living in institutional settings made more use of the regular services than those living with relatives or alone. Participants with a migration background were less aware of care services. CONCLUSIONS The results do not show any indications of a general undersupply of health care. Participation in cancer screening with more complex examinations should be encouraged, especially for people with mental disabilities living alone or with relatives. Those with a migration background and their families should be specifically informed.
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Affiliation(s)
- Randi Wellkamp
- Institut für Gesundheitssystemforschung, Universität Witten/Herdecke, Witten, Deutschland
| | - Werner de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Marburg, Philipps-Universität Marburg, Deutschland
| | | | - Max Geraedts
- Institut für Gesundheitssystemforschung, Universität Witten/Herdecke, Witten, Deutschland.,Institut für Versorgungsforschung und Klinische Epidemiologie, Marburg, Philipps-Universität Marburg, Deutschland
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Abstract
BACKGROUND The Hospital sector in Germany is undergoing uncoordinated structural changes for financial reasons. At the same time, quality-oriented control measures are used to ensure and improve the quality of treatment. It is unclear whether the right structures, namely those that guarantee positive results, will be maintained. OBJECTIVE Investigation of the association between different structural hospital characteristics with quality of care. METHODS In a secondary data analysis, the association of quality of care and the structural characteristics of hospital size, type of ownership, region, teaching status and case mix index (CMI) were compared based on hospital quality reports. Quality indices were calculated for each hospital using selected quality indicators of external quality assurance (eQA). First, the associations were examined univariately using the Mann-Whitney U test or Kruskal-Wallis test and then using multiple linear regression analysis, taking into account the interaction effects of the independent variables. FINDINGS About 90% of the indices examined showed significant associations between structural hospital characteristics and the quality of care. Positive associations with the quality of care were found in the structural characteristics of hospital size of less than 100 beds, private ownership, no teaching hospital and a low CMI. Negative associations were observed in the structural variables hospital size more than 500 beds, public ownership, teaching-status and higher CMI. CONCLUSION According to the results of this study, small hospitals seem to provide the best quality of care. This counterintuitive result suggests that the examined eQA quality indicators used in the index calculation may not be sufficiently risk-adjusted or scientifically evaluated, and their use as quality management tools is not recommended.
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Affiliation(s)
- Lisa Vorbeck
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin, Marburg, Deutschland
| | - Dijana Naumoska
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin, Marburg, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin, Marburg, Deutschland
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Deckert S, Arnold K, Becker M, Geraedts M, Brombach M, Breuing J, Bolster M, Assion C, Birkner N, Buchholz E, Carl EG, Diel F, Döbler K, Follmann M, Harfst T, Klinkhammer-Schalke M, Kopp I, Lebert B, Lühmann D, Meiling C, Niehues T, Petzold T, Schorr S, Tholen R, Wesselmann S, Voigt K, Willms G, Neugebauer E, Pieper D, Nothacker M, Schmitt J. [Methodological Standard for the Development of Quality Indicators within Clinical Practice Guidelines - Results of a structured consensus process]. Z Evid Fortbild Qual Gesundhwes 2021; 160:21-33. [PMID: 33483285 DOI: 10.1016/j.zefq.2020.11.008] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/11/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recommendations of evidence- and formally consensus-based clinical practice guidelines (CPGs) represent a valuable source of quality indicators (QIs). Nevertheless, a standardized methodological procedure for developing QIs in the context of CPGs does not yet exist in Germany for all CPGs. For this reason, a methodological standard for the guideline-based development of QIs (QI Standard) was developed based on a structured consensus process involving multiple key stakeholders. METHODS The proposed content of the QI Standard was derived from evidence, drawing upon results of reviews and qualitative studies, and considered German manuals for guideline-based QI development of two guideline programs. A multi-perspective consensus panel, broadly representing key stakeholders from the German healthcare system with expertise in CPGs and/or quality management, was nominated to vote on recommendations for guideline-based development of QIs. The iterative, structured consensus process included a two-stage online survey based on the Delphi method ("preliminary voting") and a moderated final stakeholder conference where all those recommendations were definitely included in the QI Standard that received approval of more than 75 % (consensus criterion) of the consensus panel. RESULTS Based on the agreed QI Standard, the QI development process starts with a criteria-based selection of "potential" QIs which - in case of adoption - are published in CPGs as "preliminary" QIs and can achieve the status "final" after successful testing. The QI Standard is composed of a total of 30 recommendations, which are allocated to six areas: A) preparatory work steps for the guideline-based recommendation of QIs, B) QI development group and cooperation with the CPG group, C) development of potential QIs, D) critical appraisal of potential QIs, E) formal adoption and publication as well as F) piloting/testing of preliminary QIs and conversion into final QIs. DISCUSSION Before the QI Standard can be recommended for implementation in future CPGs, it should have been successfully tested in selected German CPG projects. In addition to methodological requirements for the QI development, it must be ensured that guideline groups have adequate resources for the implementation of the QI Standard. CONCLUSION By using the QI Standard, scientifically sound and healthcare-relevant QIs can be expected.
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Affiliation(s)
- Stefanie Deckert
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.
| | - Katrin Arnold
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Monika Becker
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | - Marie Brombach
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Jessica Breuing
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland
| | - Marie Bolster
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps-Universität, Marburg, Deutschland
| | - Cornelia Assion
- Bundesministerium für Gesundheit (BMG), Referat 214 - Qualitätssicherung, Evidenzbasierte Medizin, Berlin, Deutschland
| | - Norbert Birkner
- BQS Institut für Qualität & Patientensicherheit, Hamburg, Deutschland
| | - Eva Buchholz
- Interessenvertretung Selbstbestimmt Leben in Deutschland e.V. (ISL), Berlin, Deutschland; Zentrum für Versorgungsforschung Brandenburg (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane, c/o Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | | | - Franziska Diel
- Kassenärztliche Bundesvereinigung (KBV), Dezernat Versorgungsqualität, Berlin, Deutschland
| | - Klaus Döbler
- Kompetenzzentrum Qualitätssicherung / Qualitätsmanagement (KCQ), MDK Baden-Württemberg, Stuttgart, Deutschland
| | - Markus Follmann
- Deutsche Krebsgesellschaft e.V., Leitlinienprogramm Onkologie, Berlin, Deutschland
| | - Timo Harfst
- Bundespsychotherapeutenkammer, Berlin, Deutschland
| | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps-Universität, Marburg, Deutschland
| | - Burkhard Lebert
- Frauenselbsthilfe Krebs - Bundesverband e.V., Bonn, Deutschland
| | - Dagmar Lühmann
- Institut und Poliklinik für Allgemeinmedizin, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Claudia Meiling
- Deutscher Verband der Ergotherapeuten e.V., Referat Standards und Qualität, Karlsbad, Deutschland
| | - Tim Niehues
- Helios Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Krefeld, Deutschland
| | - Thomas Petzold
- Gesellschaft für Qualitätsmanagement in der Gesundheitsversorgung e.V. (GQMG), Köln, Deutschland
| | - Susanne Schorr
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Reina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e.V., Köln, Deutschland
| | - Simone Wesselmann
- Deutsche Krebsgesellschaft e.V., Zertifizierung, Berlin, Deutschland
| | - Karen Voigt
- Bereich Allgemeinmedizin/MK3, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland; Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM), Berlin, Deutschland
| | - Gerald Willms
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, Göttingen, Deutschland
| | - Edmund Neugebauer
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland; Medizinische Hochschule Brandenburg - Theodor Fontane, Neuruppin, Deutschland
| | - Dawid Pieper
- IFOM - Institut für Forschung in der Operativen Medizin, Department für Humanmedizin Universität Witten/Herdecke, Köln, Deutschland
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), c/o Philipps-Universität, Marburg, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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de Cruppé W, Ortwein A, Kraska RA, Geraedts M. Impact of suspending minimum volume requirements for knee arthroplasty on hospitals in Germany: an uncontrolled before-after study. BMC Health Serv Res 2020; 20:1109. [PMID: 33261615 PMCID: PMC7709412 DOI: 10.1186/s12913-020-05957-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Since then, MVRQs were implemented for seven hospital procedures. This study evaluates the effect of a system-wide intermission of MVRQ for total knee arthroplasty (TKA), demanding 50 annual cases per hospital. Methods An uncontrolled before–after study based on federal-level data including the number of hospitals performing TKA, and TKA cases from the external hospital quality assurance programme in Germany (2004–2017). Bi- and multivariate analyses based on hospital-level secondary data of TKA cases and TKA quality indicators extracted from hospital quality reports in Germany (2006–2014). Results The number of TKAs performed in Germany decreased by 11% after suspending the TKA-MVRQ in 2011, and rose by 13% after its reintroduction in 2015. The number of hospitals with less than 50 cases rose from 10 to 25% and their case share from 2 to 5.5% during suspension. Change in hospital volume after the suspension of TKA-MVRQ was not associated with hospital size, ownership, or region. All four evaluable quality indicators increased significantly in the year after their first public reporting. Compared to hospitals meeting the TKA-MVRQ, three indicators show slight but statistically significant better quality in hospitals below the TKA-MVRQ. Conclusions In Germany, TKA-MVRQs seem to induce in-hospital caseload adjustments rather than foster regional inter-hospital case transfers as intended.
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Affiliation(s)
- Werner de Cruppé
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany.
| | - Annette Ortwein
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany
| | - Rike Antje Kraska
- Institute for Health Systems Research, School of Medicin, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany
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Assheuer M, Beine K, Mehl C, Kellner M, Agelink M, Sieberer M, de Cruppé W, Geraedts M. Umsetzung von Behandlungskontinuität im Versorgungsalltag – ein Vergleich zwischen zwei psychiatrischen Kliniken
1. Psychiatr Prax 2020; 48:143-148. [DOI: 10.1055/a-1274-3792] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Ziel der Studie Die starre Trennung von ambulanter und stationärer Versorgung im deutschen Gesundheitssystem verhindert eine Behandlungskontinuität, obwohl sie sich für psychiatrische Patienten als sehr wichtig erwiesen hat. Die vorliegende Studie analysiert die Behandlungskontinuität einer Modellklinik mit einem Gesamtbudget nach § 64b SGB V und konstantem Behandlungspersonal über alle Settings hinweg im Vergleich zu einer Kontrollklinik mit Regelfinanzierung ohne ein solches Team.
Methodik In einer prospektiven Kohortenstudie mit einem Beobachtungszeitraum von 20 Monaten wurden Daten zur Behandlungskontinuität von 220 Patienten der Modellklinik und 215 Patienten der Kontrollklinik erhoben.
Ergebnisse Die Modellklinik erreichte eine signifikant höhere Behandlungskontinuität als die Kontrollklinik, sowohl während der stationären Behandlung zum Zeitpunkt der Rekrutierung als auch in allen Settings während des Beobachtungszeitraums.
Schlussfolgerung Ein Gesamtbudget kann die notwendigen Voraussetzungen für eine flexiblere psychiatrische Versorgung und eine bessere Umsetzung der Behandlungskontinuität schaffen.
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Affiliation(s)
- Michaela Assheuer
- Private Universität Witten/Herdecke, Institut für Gesundheitssystemforschung
- Philipps-Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
| | - Karl Beine
- Private Universität Witten/Herdecke, Lehrstuhl für Psychiatrie und Psychotherapie
- St. Marien-Hospital Hamm, Klinik für Psychiatrie, Psychotherapie und Psychosomatik
| | - Claudia Mehl
- Philipps-Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
| | - Michael Kellner
- Klinikum Herford, Klinik für Psychiatrie, Psychotherapie und Psychosomatik
| | - Marcus Agelink
- Klinikum Herford, Klinik für Psychiatrie, Psychotherapie und Psychosomatik
- LWL Universitätsklinikum für Psychiatrie, Psychotherapie und Präventivmedizin der Ruhruniversität Bochum
| | - Marcel Sieberer
- Private Universität Witten/Herdecke, Lehrstuhl für Psychiatrie und Psychotherapie
- St. Marien-Hospital Hamm, Klinik für Psychiatrie, Psychotherapie und Psychosomatik
| | - Werner de Cruppé
- Philipps-Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
| | - Max Geraedts
- Private Universität Witten/Herdecke, Institut für Gesundheitssystemforschung
- Philipps-Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie
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Schmitt J, Geraedts M, Maier B, Schwarzkopf D, Schoffer O, Härter M, Neugebauer E, Apfelbacher C, Bierbaum T, Dreinhöfer K, Hoffmann W, Klinkhammer-Schalke M. Zum Status quo und der vorgesehenen Weiterentwicklung des Innovationsfonds
(Version 3, 4.2.2020). Gesundheitswesen 2020. [DOI: 10.1055/a-1119-3984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aus Sicht des Deutschen Netzwerks Versorgungsforschung (DNVF) bietet der
Innovationsfonds eine für unser Gesundheitssystem einmalige Chance
für eine zukunftsfähige, evidenzgeleitete Weiterentwicklung der
Gesundheitsversorgung in Deutschland. Aus diesem Grund hat sich das DNVF seit der
Ankündigung des Innovationsfonds im Gesetz zur Stärkung der
Versorgung in der gesetzlichen Krankenversicherung
(GKV-Versorgungsstärkungsgesetz) im Jahr 2015 kontinuierlich engagiert, um
einen möglichst effektiven, effizienten, gerechten, transparenten und
nachhaltigen Einsatz der Mittel des Innovationsfonds zu unterstützen.
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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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Geraedts M, Krause S, Schneider M, Ortwein A, Leinert J, de Cruppé W. Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey. BMJ Open 2020; 10:e034617. [PMID: 32066609 PMCID: PMC7044884 DOI: 10.1136/bmjopen-2019-034617] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Data on patient safety problems (PSPs) in ambulatory care are scarce. The aim of the study was to record the frequency, type, severity and point of origin of PSPs in ambulatory care in Germany. DESIGN Retrospective cross-sectional study. SETTING Computer-assisted telephone interviews with randomly recruited citizens aged ≥40 years in Germany who were asked about their experiences with PSPs in ambulatory care. PARTICIPANTS 10 037 citizens ≥40 years. MEASURES A new questionnaire was developed to record patient experiences with PSPs in ambulatory care. The study reported here targets patient experiences in the last 12 months. The questionnaire focuses on PSPs in seven areas of medical treatment: anamnesis/diagnostic procedures; medication; vaccination, injection, infusion; aftercare; outpatient surgery; office administration; other areas. For each PSP reported, detailed questions were asked about the specialist group concerned, and, on the most serious harm, the severity of the harm and its consequences. The target parameters are presented as proportions with 95% CIs. RESULTS 1422 of the respondents (14%) reported 2589 PSPs. The areas most frequently affected by PSPs were anamnesis/diagnostic procedures (61%) and medication (15%). General practitioners accounted for 44% of PSPs, orthopaedists for 15% and internists for 10%. 75% of PSPs were associated with harm, especially unnecessarily prolonged pain or deterioration of health; 35% of PSPs led to permanent harm. 804 PSPs (32%) prompted patients to see another doctor for additional treatment; 255 PSPs (10%) required inpatient treatment. CONCLUSION PSPs experienced by patients are widespread in ambulatory care in Germany. The study reveals in which areas of medical treatment efforts to prevent PSPs could make the greatest contribution to improving patient safety. It also demonstrates the valuable contribution of patient reports to the analysis of PSPs.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Svenja Krause
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Annette Ortwein
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Johannes Leinert
- infas Institut fur angewandte Sozialwissenschaft GmbH, Bonn, Germany
| | - Werner de Cruppé
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
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Geraedts M, Krause S, Schneider M, Leinert J, de Cruppé W. Patient safety incidents in ambulatory care in Germany. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.620] [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: 11/14/2022] Open
Abstract
Abstract
Background
In contrast to the inpatient sector, reliable data on the epidemiology and public health impact of patient safety incidents (PSI) are hardly found in the outpatient sector. Thus, this study focusses on the incidence of PSI; the distribution among the various specialist groups; the harmful consequences; the causes and how affected patients deal with PSI in Germany.
Methods
We conducted a cross-sectional study using a newly developed computer-assisted-telephone-interview survey tool. Based on random telephone numbers, citizens >39 years were asked to report whether they had experienced a PSI in the last year or since their 40th birthday; whereby the PSI happened, what consequences the PSI had for them and if they reported the PSI back to their physician. We performed descriptive and multivariate analyses and extrapolated the results to the total population >39 years in Germany.
Results
10037 citizens were surveyed (response rate 13%): 8841 had an outpatient visit last year, of whom 1570 (18%) had experienced at least one PSI. In total, 2832 PSI were reported. General practitioners caused 43% of PSI. Among specialists (54%), most PSI were found among orthopedists (15%) and internists (9%) and arose in connection with anamnesis and clinical examination (61%) as well as drug prescriptions (15%). 72% of the PSI caused health related harm. The most frequent harm was a deterioration in health (23%) and persistent pain (22%). 54% of those affected described the harm as severe or very severe. 27% considered doctors’ stress and lack of time or poor communication (18%) as causes for PSI. 32% of PSI were reported back to the treating physician.
Discussion
Extrapolated to the total population >39 years in Germany (47.2 million), an incidence of 12 million PSI per year must be expected with around 6.6 million affected outpatients. Thus, PSI in the outpatient sector are of immense public health importance in Germany.
Key messages
Patient safety incidents (PSI) often happen in the German outpatient sector. Outpatient PSI can also be accompanied by severe harm for patients.
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Affiliation(s)
- M Geraedts
- Institute for Health Services Research and Clinical Epidemio, Philipps-Universitaet Marburg, Marburg, Germany
| | - S Krause
- Institute for Health Services Research and Clinical Epidemio, Philipps-Universitaet Marburg, Marburg, Germany
| | - M Schneider
- Institute for Health Services Research and Clinical Epidemio, Philipps-Universitaet Marburg, Marburg, Germany
| | - J Leinert
- Infas Institut fuer Angewandte Sozialwissenschaft GmbH, Bonn, Germany
| | - W de Cruppé
- Institute for Health Services Research and Clinical Epidemio, Philipps-Universitaet Marburg, Marburg, Germany
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Döbler K, Schrappe M, Kuske S, Schmitt J, Sens B, Boywitt D, Misselwitz B, Nothacker M, Geraedts M. Eignung von Qualitätsindikatorensets in der Gesundheitsversorgung für verschiedene Einsatzgebiete – Forschungs- und Handlungsbedarf. Gesundheitswesen 2019; 81:781-787. [PMID: 31574557 DOI: 10.1055/a-1007-0811] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pollmanns J, Drösler SE, Geraedts M, Weyermann M. Predictors of hospitalizations for diabetes in Germany: an ecological study on a small-area scale. Public Health 2019; 177:112-119. [PMID: 31561049 DOI: 10.1016/j.puhe.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/27/2018] [Revised: 06/26/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Our objective was to evaluate the role of potential predictors in explaining spatial variation among diabetes hospitalization rates in Germany. STUDY DESIGN This was an ecological analysis using hospital routine data. METHODS County-level hospitalization rates (n = 402) in 2015 were calculated based on the German Diagnosis Related Groups database. We used a funnel plot to identify counties with high hospitalization rates. To examine the impact of predictors such as socio-economic status or structure of primary care, we performed linear and logistic regression analyses. RESULTS The crude hospitalization rate was 262 admissions per 100,000 population. In multivariable logistic models, we found the percentage of employees with academic degree (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.56-0.91), high hospital bed rate (4th quartile vs 1st quartile; OR: 2.73, CI: 1.03-7.24), and diabetes prevalence (OR: 1.49, CI: 1.17-1.90) to be significant predictors for high hospitalization rates. In multivariable linear models, the percentage of unemployed (regression coefficient b: 4.79, CI: 0.81-8.78) and rurality (b: 0.52, CI: 0.19-0.85) explained the variation in addition to predictors from logistic regression. Primary care structure was not a significant predictor in multivariable models. CONCLUSIONS The non-significant impact of primary care in adjusted models casts the use of diabetes hospitalizations as indicators for access and quality of primary care into doubt. Diabetes hospitalizations may rather reflect demand for care.
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Affiliation(s)
- J Pollmanns
- Niederrhein University of Applied Sciences, Faculty of Health Care, Reinarzstrasse 49, 47805 Krefeld, Germany; Universität Witten/Herdecke, Fakultät für Gesundheit, Institut für Gesundheitssystemforschung, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
| | - S E Drösler
- Niederrhein University of Applied Sciences, Faculty of Health Care, Reinarzstrasse 49, 47805 Krefeld, Germany.
| | - M Geraedts
- Philipps-Universität Marburg, Department of Medicine, Karl-von-Frisch-Strasse 4, 35043 Marburg, Germany; Universität Witten/Herdecke, Fakultät für Gesundheit, Institut für Gesundheitssystemforschung, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
| | - M Weyermann
- Niederrhein University of Applied Sciences, Faculty of Health Care, Reinarzstrasse 49, 47805 Krefeld, Germany.
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Pollmanns J, Weyermann M, Geraedts M, Drösler SE. [Hospitalizations and amputations for diabetes mellitus-trends and small-area variation in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1462-1471. [PMID: 30191270 DOI: 10.1007/s00103-018-2812-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators. OBJECTIVES The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations. MATERIALS AND METHODS Based on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005-2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates. RESULTS Crude hospitalization rates were 310 admissions per 100,000 inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000 inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2 cases per 100,000 inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5 cases per 100,000 inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high. CONCLUSIONS A decrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.
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Affiliation(s)
- Johannes Pollmanns
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland.
| | - Maria Weyermann
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Saskia E Drösler
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland
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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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de Cruppé W, Geraedts M. Krankenhauswahl in Deutschland – hängt die Möglichkeit über das Krankenhaus selber zu entscheiden von soziodemografischen oder medizinischen Merkmalen ab? Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667811] [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)
- W de Cruppé
- Philipps Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie, Marburg, Deutschland
| | - M Geraedts
- Philipps Universität Marburg, Institut für Versorgungsforschung und Klinische Epidemiologie, Marburg, Deutschland
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Schmelz HA, Geraedts M. [Correction: Cost and Revenue Relationship in Orthopaedic and Trauma Surgery Patients in Relation to Body Mass Index]. Z Orthop Unfall 2018; 156:e3. [PMID: 30016824 DOI: 10.1055/a-0653-9153] [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: 10/28/2022]
Affiliation(s)
- Helmut A Schmelz
- Geschäftsbereich Technik, Bau & IT, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin
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Schmelz HA, Geraedts M. [Cost and Revenue Relationship in Orthopaedic and Trauma Surgery Patients in Relation to Body Mass Index]. Z Orthop Unfall 2018; 156:561-566. [PMID: 29902832 DOI: 10.1055/a-0608-5343] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Growing numbers of patients in orthopaedic and trauma surgery are obese. The risks involved are e.g. surgical complications, higher costs for longer hospital stays or special operating tables. It is a moot point whether revenues in the German DRG system cover the individual costs in relation to patients' body mass index (BMI) and in which area of hospital care potentially higher costs occur. MATERIAL AND METHODS Data related to BMI, individual costs and revenues were extracted from the hospital information system for 13,833 patients of a large hospital who were operated in 2007 to 2010 on their upper or lower extremities. We analysed differences in cost revenue relations dependent on patients' BMI and surgical site, and differences in the distribution of hospital cost areas in relation to patients' BMI by t and U tests. RESULTS Individual costs of morbidly obese (BMI ≥ 40) and underweight patients (BMI < 18.5) significantly (p < 0.05) exceeded individual DRG revenues. Significantly higher cost revenue relations were detected for all operations on the lower and upper extremities except for ankle joint surgeries in which arthroscopical procedures predominate. Most of the incremental costs resulted from higher spending for nursing care, medication and special appliances. Costs for doctors and medical ancillary staff did not increase in relation to patients' BMI. CONCLUSION To avoid BMI related patient discrimination, supplementary fees to cover extra costs for morbidly obese or underweight patients with upper or lower extremities operations should raise DRG revenues. Moreover, hospitals should be organisationally prepared for these patients.
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Affiliation(s)
- Helmut A Schmelz
- Geschäftsbereich Technik, Bau & IT, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin
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de Cruppé W, Geraedts M. [Falling Short of Minimum Volume Standards, Exemptions and Their Consequences from 2018 Onwards. Complex Procedures on Oesophagus and Pancreas in German Hospitals from 2006 to 2014]. Zentralbl Chir 2018; 143:250-258. [PMID: 29548062 DOI: 10.1055/a-0573-2625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
STUDY AIM The minimum volume standards for hospitals in Germany, in force since 2004, provide four exemptions for non-complying hospitals. This study investigates the extent and importance of these exemptions for complex procedures on the oesophagus and pancreas for all non-complying hospitals and for the revised minimum volume regulations in force since the beginning of 2018. METHOD Longitudinal, descriptive analyses of data on minimum volume standards and their exemptions for complex procedures on the oesophagus and pancreas, as presented by the hospital quality report cards of the reporting years from 2006 to 2014. RESULTS For each year and both procedures, about 120 hospitals with some 500 cases report non-compliance with the minimum volume standards. Of these a third report no exemptions (with 180 procedures), a third state emergencies (110), and another third report exemptions due to internal hospital restructuring (210). Ensuring geographical access to care as an exemption is of no importance. After the three year exemption period for installation of a new service line, 20% of the hospitals with procedures on the oesophagus and 30% on the pancreas complied with the minimum volume standards. After the two-year period for staff realignment, the figures were 40 and 50%, respectively. CONCLUSION Exemptions do not entirely explain all procedures performed by hospitals not complying with the minimum volume standards. The revised minimum volume regulations' restructuring of exemptions to "emergencies" and "new or renewed service lines" with a two year exemption period, are concordant with the empirical findings of this study.
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Affiliation(s)
- Werner de Cruppé
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Fachbereich Medizin, Deutschland
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Konrad R, Geraedts M. Case-oriented selection of investigation methods in direct access: A comparison between physiotherapy trainees at professional colleges and in bachelor's study courses. GMS J Med Educ 2018; 35:Doc10. [PMID: 29497695 PMCID: PMC5827191 DOI: 10.3205/zma001157] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 06/08/2023]
Abstract
Objective: Direct access to physiotherapy services is currently discussed in Germany. Its introduction would mean that initial diagnoses must be made in physiotherapy practices as well. However, it was not yet investigated whether the current training in physiotherapy is sufficient for this, and whether there are differences between the training systems. This study aims to answer the question of whether trainees at the end of Bachelor's studies (BS) are more reliably able to assess the case-related suitability of examination methods than professional college students (FS). Methodology: Questionnaires were developed to assess the suitability of examination methods for diagnostic inquiries. All professional colleges and bachelor's study courses listed with the German Physiotherapy Association were asked to present the questionnaires to their final classes. Results: In 216 addressed professional colleges and 24 bachelor's study courses, the return rate was 9.26% for professional colleges and 33.33% for study courses. One hundred thirty-eight questionnaires from students in 8 study courses and 368 questionnaires from students at 20 professional colleges were evaluated. The mean of correct decisions in total (of max. 54) was 19.01 (BS) or 15.73 (FS); in structure-related and function-related examination methods (of max. 42), it was 17.22 (BS) and 14.8 (FS); in activity-related methods (of max. 12), it was 1.97 (BS) and 0.89 (FS). Out of a max. of 49 examination methods, 23.45 (BS) and 26.72 (FS) were stated as unknown. Conclusion: The university students made correct decisions on the suitability of examination methods significantly more frequently than the professional college students. However, the determined group difference is low. Overall, the results do not appear sufficient for direct access. Training would have to be adapted for this purpose.
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Affiliation(s)
- Ralf Konrad
- Private Universität Witten/Herdecke, Fakultät für Gesundheit, Institut für Gesundheitssystemforschung, Witten, Germany
| | - Max Geraedts
- Philipps-Universität Marburg, Fachbereich Medizin, Institut für Versorgungsforschung und Klinische Epidemiologie, Marburg, Germany
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Doebler K, Geraedts M. [Assessing the balance of quality indicator sets of external quality assurance according to SGB V section 136]. Z Evid Fortbild Qual Gesundhwes 2017; 134:9-17. [PMID: 29274920 DOI: 10.1016/j.zefq.2017.11.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The value and usefulness of the results of indicator-based performance measurement in healthcare for different purposes do not only depend on the methodological quality of the individual indicators but also on the composition of the indicator sets. So far, the balance of the currently used indicator sets of the German mandatory national performance measurement system for hospitals has not been systematically analyzed. MATERIAL AND METHODS Due to the lack of a methodological gold standard for the assessment of balance and orientation of indicator sets we adapted the OECD concept of quality dimensions and defined four categories: 1) "Achieving primary goals of treatment", 2) "Avoiding adverse events", 3) "Indication" and 4) "Patient-centeredness". We defined rules for the assignment to the categories and analyzed the distribution of the 239 indicators from 29 medical areas in relation to these categories. RESULTS 63 indicators (26.4 %) were assigned to the category "Achieving primary goals of treatment", 153 (64.0 %) to the category "Avoiding adverse events", 18 (7.5 %) to the category "Indication", one indicator (0.4 %) to the category "Patient-centeredness". Four indicators (1.7 %) addressed documentation quality. 12 of the 29 indicator sets only covered one OECD quality dimension by at least one indicator. CONCLUSIONS The current indicator sets seem to be unbalanced with a strong focus on the category "Avoiding adverse events". As regards the goal of monitoring compliance with minimal safety standards and performing improvement interventions, the direction of the indicator sets seems to be appropriate. With respect to other goals, such as for example the identification of "excellence", further development efforts are required. One relevant reason for the dominant focus on the category "Avoiding adverse events" seems to be that data sources for a follow-up and for the inclusion of the patient perspective have not been available until recently. There is a strong demand for the consequent use of these data sources to optimize the interpretability and value of the current performance measurement. The methodological approach presented may offer useful information to assess the value of indicator sets for different purposes although further development and research is necessary.
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Affiliation(s)
- Klaus Doebler
- Kompetenzzentrum Qualitätssicherung und Qualitätsmanagement (KCQ), MDK Baden-Württemberg, Stuttgart, Deutschland.
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
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de Cruppé W, Geraedts M. Hospital choice in Germany from the patient's perspective: a cross-sectional study. BMC Health Serv Res 2017; 17:720. [PMID: 29132430 PMCID: PMC5683328 DOI: 10.1186/s12913-017-2712-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/07/2017] [Indexed: 11/11/2022] Open
Abstract
Background In many countries health policy encourages patients to choose their hospital, preferably by considering information of performance reports. Previous studies on hospital choice mainly have focused on patients undergoing elective surgery. This study examined a representative sample of hospital inpatients across disciplines and treatment interventions in Germany. Its research questions were: How many patients decide where to go for hospital treatment? How much time do patients have before admission? Which sources of information do they use, and which criteria are relevant to their decision? Methods Cross-sectional observational study covering 1925 inpatients of 46 departments at 17 hospitals in 2012. The stratified survey comprised 11 medical disciplines (internal medicine, gynaecology, obstetrics, paediatrics, psychiatry, orthopaedics, neurology, urology, ENT and geriatrics) on 3 hospital care levels representing 91.9% of all hospital admissions to inpatient care in Germany in 2012. The statistical analysis calculated the frequency distributions and 95% confidence intervals of characteristics related to the hospital choice. Results 63.0% [60.9–65.2] of patients in Germany chose the hospital themselves, but only 21.1% [19.3–22.9] had more than one week to decide prior to admission. Major sources of information were personal knowledge of hospitals, relatives, outpatient health professionals and the Internet. Main criteria for the decision were personal experience with a hospital, recommendations from relatives and providers of outpatient services, a hospital’s reputation and distance from home. Specific quality information as provided by performance reports were of secondary importance. Conclusions A majority of patients in the German health system choose their hospital freely. Providers of outpatient health care can have an important “agent” function in the quality-oriented hospital choice especially for patients with little time prior to admission and those who do not decide themselves. Hospitals have an impact on patients’ future hospital choices by the treatment experience they provide to patients. Electronic supplementary material The online version of this article (10.1186/s12913-017-2712-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Werner de Cruppé
- Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany
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Geraedts M, Drösler S, Döbler K, Eberlein-Gonska M, Heller G, Kuske S, Manser T, Sens B, Stausberg J, Schrappe M. DNVF-Memorandum III „Methoden für die Versorgungsforschung“, Teil 3: Methoden der Qualitäts- und Patientensicherheitsforschung. Gesundheitswesen 2017; 79:e95-e124. [DOI: 10.1055/s-0043-112431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas Deutsche Netzwerk Versorgungsforschung e.V. (DNVF) fördert seit Jahren die methodische Qualität von Versorgungsforschungsstudien auf der Basis von Memoranden und anderen Initiativen. Die Qualitäts- und Patientensicherheitsforschung (QPSF) gilt als Kerngebiet der Gesundheitsversorgungsforschung. Das vorliegende Memorandum erläutert wesentliche etablierte Fragestellungen und Methoden der QPSF. Vor dem Hintergrund der besonderen gesundheitspolitischen Bedeutung des Themas werden Methoden der Messgrößenentwicklung und -prüfung, die Risikoadjustierung, Methoden zur Erhebung von Patientensicherheitsdaten, Instrumente zur Analyse sicherheitsrelevanter Ereignisse und Methoden zur Evaluation der meist multiplen und komplexen QPSF-Interventionen behandelt. Zudem werden vordringliche Forschungsthemen benannt.
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Affiliation(s)
| | - Saskia Drösler
- Kompetenzzentrum Routinedaten im Gesundheitswesen, Hochschule Niederrhein, Krefeld
| | - Klaus Döbler
- Kompetenzzentrum Qualitätssicherung und Qualitätsmanagement, MDK Baden-Württemberg, Stuttgart
| | - Maria Eberlein-Gonska
- Zentralbereich Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
| | | | | | - Tanja Manser
- Institut für Patientensicherheit, Rheinische Friedrich-Wilhelms-Universität Bonn
| | - Brigitte Sens
- Zentrum für Qualität und Management im Gesundheitswesen (ZQ) der Ärztekammer Niedersachsen, Hannover
| | | | - Matthias Schrappe
- Institut für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln
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