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Willms AG, Schaaf S, Schwab R. Analysis of surgical quality indicators after certification as a Hernia Center. Updates Surg 2024; 76:255-264. [PMID: 36811182 PMCID: PMC10805962 DOI: 10.1007/s13304-023-01449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Certifications are an increasingly used tool of quality management in the health care system. The primary goal is to improve the quality of treatment due to implemented measures based on a defined catalog of criteria and standardization of the treatment processes. However, the extent to which this affects medical and health-economic indicators is unknown. Therefore, the study aims to examine the possible effects of the certification as a Reference Center for Hernia Surgery on the treatment quality and reimbursement dimensions. The observation and recording periods were defined as 3 years before (2013-2015) and 3 years after certification as a "Reference Center for Hernia Surgery" (2016-2018). Possible changes due to the certification were examined based on multidimensional data collection and analysis. In addition, the aspects of structure, process and result quality, and the reimbursement situation were reported. One thousand three hundred and nineteen cases before and one thousand four hundred and three cases after certification were included. After the certification, the patients were older (58.1 ± 16.1 vs. 64.0 ± 16.1 years, p < 0.01), had a higher CMI (1.01 vs. 1.06), and a higher ASA score (< III 86.9 vs. 85.5%, p < 0.01). The interventions became more complex (e.g., recurrent incisional hernias 0.5% vs. 1.9%, p < 0.01). The mean length of hospital stay was significantly reduced for incisional hernias (8.8 ± 5.8 vs. 6.7 ± 4.1 days, p < 0.001). The reoperation rate for incisional hernias also decreased significantly from 8.24 to 3.66% (p = 0.04). The postoperative complication rate for inguinal hernias was significantly reduced (3.1 vs. 1.1%, p = 0.002). The reimbursement of the hernia center increased by 27.6%. There were positive changes in process and outcome quality and reimbursement after the certification, which supports the effectivity of certifications in hernia surgery.
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Affiliation(s)
- Arnulf Gregor Willms
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
- Department of General and Visceral Surgery, German Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
| | - Sebastian Schaaf
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Robert Schwab
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
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Schulmeyer CE, Koch MC, Dietl AK, Stuebs FA, Behrens A, Renner SK, Mehlhorn G, Geppert CC, Hartmann A, Beckmann MW, Gass P. Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program. Geburtshilfe Frauenheilkd 2023; 83:1031-1042. [PMID: 37588259 PMCID: PMC10427204 DOI: 10.1055/a-1934-1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/25/2022] [Indexed: 08/18/2023] Open
Abstract
Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.
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Affiliation(s)
- Carla E. Schulmeyer
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, ANregiomed Klinikum Ansbach, Ansbach, Germany
| | - Anna K. Dietl
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Frederik A. Stuebs
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Annika Behrens
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Simone K. Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | - Grit Mehlhorn
- Frauenarztpraxis, DKG und AGCPC zertifizierte Dysplasiesprechstunde, Frauenarztpraxis Erlangen, Erlangen, Germany
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Carol C. Geppert
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W. Beckmann
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
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Ben-Aharon O, Iskrov G, Sagy I, Greenberg D. Willingness to pay for cancer prevention, screening, diagnosis, and treatment: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:281-295. [PMID: 36635646 DOI: 10.1080/14737167.2023.2167713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Willingness to pay (WTP) studies examine the maximum amount of money an individual is willing to pay for a specified health intervention, and can be used to inform coverage and reimbursement decisions. Our objectives were to assess how people value cancer-related interventions, identify differences in the methodologies used, and review the trends in studies' publication. AREAS COVERED We extracted PubMed and EconLit articles published in 1997-2020 that reported WTP for cancer-related interventions, characterized the methodological differences and summarized each intervention's mean and median WTP values. We reviewed 1,331 abstracts and identified 103 relevant WTP studies, of which 37 (36%) focused on treatment followed by screening (26), prevention (21), diagnosis (7) and other interventions (12). The methods used to determine WTP values were primarily discrete-choice questions (n = 54, 52%), bidding games (15), payment cards (12) and open-ended questions (12). We found a wide variation in WTP reported values ranged from below $100 to over $20,000. EXPERT OPINION The WTP literature on oncology interventions has grown rapidly. There is considerable heterogeneity with respect to the type of interventions and diseases assessed, the respondents' characteristics, and the study methodologies. This points to the need to establish international guidelines for best practices in this field.
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Affiliation(s)
- Omer Ben-Aharon
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Georgi Iskrov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Bulgaria
| | - Iftach Sagy
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Soroka Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Burghaus S, Hildebrandt T, Fahlbusch C, Heusinger K, Antoniadis S, Lermann J, Hackl J, Häberle L, Renner SP, Fasching PA, Beckmann MW, Blum S. Standards Used by a Clinical and Scientific Endometriosis Center for the Diagnosis and Therapy of Patients with Endometriosis. Geburtshilfe Frauenheilkd 2019; 79:487-497. [PMID: 31148849 PMCID: PMC6529229 DOI: 10.1055/a-0813-4411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/30/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
Endometriosis is one of the most common benign gynecological diseases. The extremely heterogeneous complex of symptoms complicates the diagnosis and treatment of this disease. In most patients, there is a latency period of several years between the first occurrence of symptoms and the definitive diagnosis. This paper aims (1) to evaluate standards for the diagnosis and treatment of patients with (symptoms suspicious for) endometriosis in terms of feasibility, and (2) to assess the potential use of data collected by a certified clinical and scientific endometriosis center to answer scientific questions. Standards for outpatient consultations were developed for a special endometriosis outpatient clinic. Between January 2014 and December 2017, a total of 1715 outpatients with a suspicion of endometriosis presented to this special endometriosis outpatient clinic; the diagnosis and treatment of patients was carried out in accordance with the developed standards. Data of this patient cohort obtained from patient records created during outpatient consultations and from a questionnaire recorded in an Oracle-based database was analyzed. The patient cohort was also compared with another patient cohort who had attended different outpatient clinics and had been diagnosed intraoperatively with endometriosis. 41.8% of patients examined during special outpatient consultations had surgery for suspicion or recurrence of endometriosis. Endometriosis was confirmed in 81.5% of cases. Pain symptoms were the main indication for surgery in 70.1% of cases compared to 45.1% of cases in the comparison group. The structured approach used in the special endometriosis outpatient clinic is a key aspect of the care provided by the certified clinical and scientific endometriosis center. It ensures that patients are diagnosed and treated in accordance with guideline recommendations, that diagnosis and treatment comply with certification requirements, and that the collected data can be used to answer scientific questions.
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Affiliation(s)
- Stefanie Burghaus
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Thomas Hildebrandt
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Christine Fahlbusch
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Katharina Heusinger
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Sophia Antoniadis
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Johannes Lermann
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Janina Hackl
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Lothar Häberle
- Abteilung für Biostatistik, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan P Renner
- Frauenklinik, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | - Peter A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
| | - Simon Blum
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Erlangen, Germany
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Formago M, Schrauder MG, Rauh C, Hack CC, Jud SM, Hildebrandt T, Schulz-Wendtland R, Frentz S, Graubert S, Beckmann MW, Lux MP. Should Breast Cancer Surgery Be Done in an Outpatient Setting?: Health Economics From the Perspective of Service Providers. Geburtshilfe Frauenheilkd 2017; 77:879-886. [PMID: 28845052 DOI: 10.1055/s-0043-114427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The care of patients with breast cancer is extremely complex and requires interdisciplinary care in certified facilities. These specialized facilities provide numerous services without being correspondingly remunerated. The question whether breast cancer surgery should be performed in an outpatient setting to reduce costs is increasingly being debated. This study compares inpatient surgical treatment with a model of the same surgery performed on an outpatient basis to examine the potential financial impact. MATERIAL AND METHODS A theoretical model was developed and the DRG fees for surgical interventions to treat primary breast cancer were calculated. A theoretical 1-day DRG was then calculated to permit comparisons with outpatient procedures. The costs of outpatient surgery were calculated based on the remuneration rates of the AOP (Outpatient Surgery) Contract and the EBM (Uniform Assessment Scale) and compared to the costs of the 1-day DRG. RESULTS The DRG fee for both breast-conserving surgery and mastectomy is higher than the fee paid in the context of the EBM system, although the same procedures were carried out in both systems. If a hospital were to carry out breast-conserving surgery as an outpatient procedure, the fee would be € 1313.81; depending on the type of surgery, the hospital would therefore only receive between 39.20% and 52.82% of the DRG fee. This was the case even for a 1-day treatment. Compared to the real DRG fees the difference would be even more striking. CONCLUSION Carrying out breast cancer surgery as an outpatient procedure would result in a significant shortfall of revenues. Additional services from certified centers, such as the interdisciplinary planning of treatment, psycho-oncological and social-medical care with the involvement of relatives, detailed documentation, etc., which are currently provided without surcharge or adequate remuneration, could no longer be maintained. The quality of processes and excellent results which have been achieved and ultimately the care given by certified facilities would be significantly at risk.
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Affiliation(s)
- Margaret Formago
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Michael G Schrauder
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Claudia Rauh
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Carolin C Hack
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Sebastian M Jud
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Thomas Hildebrandt
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Radiology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Frentz
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Commercial Directorate, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Graubert
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Commercial Directorate, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Matthias W Beckmann
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Michael P Lux
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Is there evidence for better health care for cancer patients in certified centers? A systematic review. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0728-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Lux M, Hildebrandt T, Beyer-Finkler E, Bani M, Loehberg C, Jud S, Rauh C, Schrauder M, Fasching P, Beckmann M. Relevance of health economics in breast cancer treatment - the view of certified breast centres and their patients. ACTA ACUST UNITED AC 2014; 8:15-21. [PMID: 24715838 DOI: 10.1159/000347098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast cancer centres - certified in accordance with the criteria of the German Cancer Association and the German Mastology Association - are established throughout Germany. Although the setting up of centres and the subsequent need for certification are associated with a marked increase in costs, initial data show positive effects on quality. Certified centres are cost-effective from the point of view of health economics - they lead to improved quality in processes and results without creating any increase in costs for the funding bodies. However, the organization of the necessary structures, with interdisciplinary treatment, documentation and quality-assurance measures, requires considerable resources. Increasing consolidation of inpatient services is also involved, while shortening of the patients' hospitalization periods is leading to reduced remuneration from the funding bodies. The current cost deficits, which have resulted from the increased resources required, need to be recouped through additional charges. It will only be possible to maintain the high quality achieved if additional charges become available to cover the centres' added costs. Good data are increasingly becoming available as a basis for negotiations on charges - e.g., with regard to the quality of results and the National Cancer Plan - as well as clear support from patients.
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Affiliation(s)
- Michael Lux
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Thomas Hildebrandt
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | | | - Mayada Bani
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Christian Loehberg
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Sebastian Jud
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Claudia Rauh
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Michael Schrauder
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Peter Fasching
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias Beckmann
- University Breast Centre for Franconia, Department of Gynaecology, Erlangen University Hospital, Erlangen, Germany
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Jacobs VR, Bogner G, Schausberger CE, Reitsamer R, Fischer T. Relevance of health economics in breast cancer treatment: integration of economics in the management of breast cancer at the clinic level. ACTA ACUST UNITED AC 2014; 8:7-14. [PMID: 24715837 DOI: 10.1159/000348370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Since the introduction of the diagnosis-related groups (DRG) system with cost-related and entity-specific flat-rate reimbursements for all in-patients in 2004 in Germany, economics have become an important focus in medical care, including breast centers. Since then, physicians and hospitals have had to gradually take on more and more financial responsibilities for their medical care to avoid losses for their institutions. Due to financial limitations of resources, most medical services have to be adjusted to correlating revenues, which results in the development of a variety of active measures to understand, steer, and optimize costs, resources and related processes for breast cancer treatment. In this review, the challenging task to implement microeconomic management at the clinic level for breast cancer treatment is analyzed from breast cancer-specific publications. The newly developed economic management perspective is identified for different stakeholders in the healthcare system, and successful microeconomic projects and future aspects are described.
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Affiliation(s)
- Volker R Jacobs
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Gerhard Bogner
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Christiane E Schausberger
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Roland Reitsamer
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
| | - Thorsten Fischer
- Frauenklinik (OB/GYN) of Salzburger Landeskrankenanstalten (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria
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Seidel RP, Lux MP, Hoellthaler J, Beckmann MW, Voigt W. Economic constraints - the growing challenge for Western breast cancer centers. Breast Care (Basel) 2013; 8:41-7. [PMID: 24715842 PMCID: PMC3971806 DOI: 10.1159/000348356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Breast cancer care in Western countries has reached a considerable level of quality and standardization, which has contributed to the decline in breast cancer mortality. Certified Breast Cancer Centers (BCC) represent an important element of this development. Related to changes in reimbursement and growing costs, BCC face economic constraints which ultimately could endanger the achievements of the past. Thus, BCC have to optimize their care strategies from an economic perspective, particularly by increasing efficiency but also by adapting their service portfolio. This could result in competitive advantages and additional revenue by increasing case numbers and extra charges to patients. Furthermore, an intensification of collaboration with the outpatient sector resulting in an integrated and managed 'trans-sectoral' care approach which could allow to shift unprofitable procedures to the outpatient sector - in the sense of a win-win situation for both sectors and without loss of care quality - seems reasonable. Structured and specialized consulting approaches can further be a lever to fulfill economic requirements in order to avoid cuts in medical care quality for the sake of a balanced budget. In this review, economic constraints of BCC with a focus on the German healthcare system and potential approaches to ameliorate these financial burdens are being discussed.
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Affiliation(s)
- Rene P. Seidel
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Michael P. Lux
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Josef Hoellthaler
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Centre Franconia, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Wieland Voigt
- Siemens AG, Healthcare Sector, Customer Solutions Division, H CX CRM-VA HCC ONC, Friedrich Alexander University, Erlangen, Germany
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Soejima A, Matsuzawa N, Hayashi T, Kimura R, Ootsuka T, Fukuoka K, Yamada A, Nagasawa T, Era S. Alteration of redox state of human serum albumin before and after hemodialysis. Blood Purif 2004; 22:525-9. [PMID: 15583477 DOI: 10.1159/000082524] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Persistent hypoalbuminemia is a predictor of death in long-term maintenance hemodialysis patients, although cardiovascular diseases remain the leading cause of death. A decreased serum antioxidant activity in maintenance hemodialysis patients may contribute to increased oxidative damage, and may be associated with accelerated atherosclerotic changes. METHODS The aim of this study was to examine the redox state of human serum albumin in maintenance hemodialysis patients by high-performance liquid chromatography (HPLC) using a fluorescence detector. RESULTS HPLC of human serum albumin on a Shodex-Asahipak ES-502N column at pH 4.85 showed a clear resolution of human mercaptalbumin (HMA) and nonmercaptalbumin (HNA), which are the reduced and oxidized forms of human serum albumin, respectively. The mean +/- SD percentage of the HMA fraction of human serum albumin was significantly lower in maintenance hemodialysis patients than in age-matched normal subjects. The percentage of HMA increased 3-5 h after starting the hemodialysis and then decreased to subnormal levels. CONCLUSION This suggests that serum albumin may be a major extracellular antioxidant in maintenance hemodialysis patients, and that hemodialysis may rescue serum albumin reduction by inducing intermolecular sulfhydryl-disulfide exchange reaction.
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Affiliation(s)
- Akinori Soejima
- First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
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