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Levinson RT, Paul C, Meid AD, Schultz JH, Wild B. Identifying Predictors of Heart Failure Readmission in Patients From a Statutory Health Insurance Database: Retrospective Machine Learning Study. JMIR Cardio 2024; 8:e54994. [PMID: 39042456 DOI: 10.2196/54994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Patients with heart failure (HF) are the most commonly readmitted group of adult patients in Germany. Most patients with HF are readmitted for noncardiovascular reasons. Understanding the relevance of HF management outside the hospital setting is critical to understanding HF and factors that lead to readmission. Application of machine learning (ML) on data from statutory health insurance (SHI) allows the evaluation of large longitudinal data sets representative of the general population to support clinical decision-making. OBJECTIVE This study aims to evaluate the ability of ML methods to predict 1-year all-cause and HF-specific readmission after initial HF-related admission of patients with HF in outpatient SHI data and identify important predictors. METHODS We identified individuals with HF using outpatient data from 2012 to 2018 from the AOK Baden-Württemberg SHI in Germany. We then trained and applied regression and ML algorithms to predict the first all-cause and HF-specific readmission in the year after the first admission for HF. We fitted a random forest, an elastic net, a stepwise regression, and a logistic regression to predict readmission by using diagnosis codes, drug exposures, demographics (age, sex, nationality, and type of coverage within SHI), degree of rurality for residence, and participation in disease management programs for common chronic conditions (diabetes mellitus type 1 and 2, breast cancer, chronic obstructive pulmonary disease, and coronary heart disease). We then evaluated the predictors of HF readmission according to their importance and direction to predict readmission. RESULTS Our final data set consisted of 97,529 individuals with HF, and 78,044 (80%) were readmitted within the observation period. Of the tested modeling approaches, the random forest approach best predicted 1-year all-cause and HF-specific readmission with a C-statistic of 0.68 and 0.69, respectively. Important predictors for 1-year all-cause readmission included prescription of pantoprazole, chronic obstructive pulmonary disease, atherosclerosis, sex, rurality, and participation in disease management programs for type 2 diabetes mellitus and coronary heart disease. Relevant features for HF-specific readmission included a large number of canonical HF comorbidities. CONCLUSIONS While many of the predictors we identified were known to be relevant comorbidities for HF, we also uncovered several novel associations. Disease management programs have widely been shown to be effective at managing chronic disease; however, our results indicate that in the short term they may be useful for targeting patients with HF with comorbidity at increased risk of readmission. Our results also show that living in a more rural location increases the risk of readmission. Overall, factors beyond comorbid disease were relevant for risk of HF readmission. This finding may impact how outpatient physicians identify and monitor patients at risk of HF readmission.
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Affiliation(s)
- Rebecca T Levinson
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Cinara Paul
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Andreas D Meid
- Medical Faculty of Heidelberg, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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Zhang W, Su M, Li D, Yang F, Li Z. The association between family doctor contract services and the health of middle-aged and older people in China: an instrumental variables analysis. Sci Rep 2024; 14:16229. [PMID: 39004624 PMCID: PMC11247085 DOI: 10.1038/s41598-024-65621-0] [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: 01/05/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Previous research on the association between Family Doctor Contract Services (FDCS) and health has only considered a single indicator of health and has not considered the endogeneity of independent variables. This study aimed to evaluate the association from a multidimensional perspective of the health of middle-aged and older people using the instrumental variables method and determine the underlying mechanisms. Using data from the 2018 China Health and Retirement Longitudinal Study surveys, a total of 19,438 sample was obtained. Health was measured by health related-quality of life (HR-QoL), subjective well-being, and cognitive function. The instrumental variables method was used to estimate the association. Mediation analysis was employed to analyze the underlying mechanisms. The results of the instrumental variables method showed a correlation between FDCS and health, such as HR-QoL (η = 33.714, p < 0.01), subjective well-being (η = 1.106, p < 0.05), and cognitive function (η = 4.133, p < 0.05). However, we found no evidence that FDCS improved physical health. We also identified reduced utilization of healthcare services and increased social activities as mediators of the effect of FDCS on health. The Chinese government should improve incentive-based initiatives to improve the quality of FDCS. Moreover, more attention needs to be paid to the multidimensional health of middle-aged and older people, especially vulnerable groups, such as older individuals and those in rural areas.
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Affiliation(s)
- Weile Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, 010070, Inner Mongolia, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, 010070, Inner Mongolia, China.
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, 010070, Inner Mongolia, China
| | - Fan Yang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, 010070, Inner Mongolia, China
| | - Zhengrong Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, 010070, Inner Mongolia, China
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3
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Yao L, Liu H, Pan Q, Tian X. The association between symptomatic remission and social support in community-dwelling schizophrenia patients during COVID-19. Front Psychiatry 2024; 15:1404059. [PMID: 39077625 PMCID: PMC11284603 DOI: 10.3389/fpsyt.2024.1404059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/03/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Schizophrenia is a severe and enduring psychiatric disorder, characterized by substantial challenges in achieving symptomatic remission. Up to now, there have been limited studies examining the association between remission status and social support in patients with schizophrenia during COVID-19. This study aimed to investigate the remission status of community-dwelling schizophrenia patients during the pandemic and explore whether symptomatic remission is significantly associated with social support in a cross-sectional study. Methods 727 schizophrenia patients were recruited using a cluster random sampling method in the local community. Face-to-face interviews were used to gather data on participants' clinical characteristics, sociodemographic, social support, and symptomatic remission criteria. Logistic regression models were deployed to identify potential relationships between symptomatic remission and social support. Results Among the 727 patients in our study, a substantial proportion of 522 (71.80%) achieved symptomatic remission, while 205 (28.2%) did not. Remarkably, those who achieved symptomatic remission exhibited a higher level of social support (28.32 ± 6.82) compared to those who did not. The proportion of patients achieving symptomatic remission in the low (19.4%), medium (46.2%), and high (34.3%) social support groups was 56.7%, 66.1%, and 88.0%, respectively. Moreover, the crude odds ratio for the association between social support and symptomatic remission was 3.20 (95% CI: 2.45-4.18). After controlling for all confounding factors, the adjusted odds ratio remained significant at 3.02 (95% CI: 2.30-3.97). Discussion This consistent association underscores the critical role of social support in influencing symptomatic remission among community-dwelling schizophrenia patients, especially during the COVID-19 pandemic. Reinforcing the utilization of social support for fostering symptomatic remission among individuals with schizophrenia who reside in the community during such crises is recommended.
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Affiliation(s)
- Lansicheng Yao
- Foreign Affairs Office, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hongying Liu
- Department of Psychiatric Rehabilitation, Nanchong Psychosomatic Hospital Affiliated to North Sichuan Medical College, Nanchong, Sichuan, China
| | - Qiuyu Pan
- Teaching and Research Office of Social Medicine and Health Management, School of Public Health, North Sichuan Medical College, Nanchong, Sichuan, China
- School of Medicine, Tibet University, Lhasa, Tibet, China
| | - Xiaobing Tian
- Department of Epidemiology and Health Statistics, School of Public Health, North Sichuan Medical College, Nanchong, Sichuan, China
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4
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Wangler J, Jansky M. [Ensuring primary care in Germany-findings from a quantitative survey of general practitioners]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03896-4. [PMID: 38862728 DOI: 10.1007/s00103-024-03896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Given the risk of a shortage of general practitioners in private practice, the question arises as to which concepts can make an effective contribution. To date, there is a lack of studies that comprehensively shed light on how general practitioners, based on their professional experience, view different approaches to ensuring primary care in the long term. OBJECTIVES The aim of the study was to determine the positions, attitudes, and experiences of general practitioners with regard to ensuring primary care. METHODS Using an online survey, a total of 4176 general practitioners were surveyed between February and June 2023. In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups. RESULTS Of those surveyed, 42% reported a noticeable decline of general medical practices in their area. In addition, 53% saw a declining attractiveness of primary care for young doctors, which is attributed to three problem areas: 1) the position of primary care in the healthcare system, 2) requirements for training and further education, and 3) working conditions. In order to secure primary care, those surveyed were primarily in favor of the following approaches: establishing a primary care physician system (85%), increasing the promotion of interest and points of contact in training and further education (80%), strengthening multi-professional outpatient care centers (64%), restructuring curricula (56%) and admission criteria for medical studies (50%), and reforming general medical training (53%). CONCLUSIONS As the results show, general practitioners have their own suggestions and preferences that complement existing expert assessments. General practitioners should be more consistently involved in the planning, implementation, and evaluation of measures to stabilize primary care.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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Chen Y, Gue Y, Banach M, Mikhailidis D, Toth PP, Gierlotka M, Osadnik T, Golawski M, Tomasik T, Windak A, Jozwiak J, Lip GYH. Phenotypes of Polish primary care patients using hierarchical clustering: Exploring the risk of mortality in the LIPIDOGEN2015 study cohort. Eur J Clin Invest 2024:e14261. [PMID: 38850064 DOI: 10.1111/eci.14261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Comorbidities in primary care do not occur in isolation but tend to cluster together causing various clinically complex phenotypes. This study aimed to distinguish phenotype clusters and identify the risks of all-cause mortality in primary care. METHODS The baseline cohort of the LIPIDOGEN2015 sub-study involved 1779 patients recruited by 438 primary care physicians. To identify different phenotype clusters, we used hierarchical clustering and investigated differences between clinical characteristics and mortality between clusters. We then performed causal analyses using causal mediation analysis to explore potential mediators between different clusters and all-cause mortality. RESULTS A total of 1756 patients were included (mean age 51.2, SD 13.0; 60.3% female), with a median follow-up of 5.7 years. Three clusters were identified: Cluster 1 (n = 543) was characterised by overweight/obesity (body mass index ≥ 25 kg/m2), older (age ≥ 65 years), more comorbidities; Cluster 2 (n = 459) was characterised by non-overweight/obesity, younger, fewer comorbidities; Cluster 3 (n = 754) was characterised by overweight/obesity, younger, fewer comorbidities. Adjusted Cox regression showed that compared with Cluster 2, Cluster 1 had a significantly higher risk of all-cause mortality (HR 3.87, 95% CI: 1.24-15.91), whereas this was insignificantly different for Cluster 3. Causal mediation analyses showed that decreased protein thiol groups mediated the hazard effect of all-cause mortality in Cluster 1 compared with Cluster 2, but not between Clusters 1 and 3. CONCLUSION Overweight/obesity older patients with more comorbidities had the highest risk of long-term all-cause mortality, and in the young group population overweight/obesity insignificantly increased the risk in the long-term follow-up, providing a basis for stratified phenotypic risk management.
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Affiliation(s)
- Yang Chen
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ying Gue
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Maciej Banach
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Dimitri Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA
| | - Marek Gierlotka
- Department of Cardiology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Tadeusz Osadnik
- Faculty of Medical Sciences in Zabrze, Department of Pharmacology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Golawski
- Faculty of Medical Sciences in Zabrze, Department of Pharmacology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Jozwiak
- Department of Family Medicine and Public Health, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Simmons C, Pot M, Lorenz-Dant K, Leichsenring K. Disentangling the impact of alternative payment models and associated service delivery models on quality of chronic care: A scoping review. Health Policy 2024; 143:105034. [PMID: 38508061 DOI: 10.1016/j.healthpol.2024.105034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
Payment reforms are frequently implemented alongside service delivery reforms, thus rendering it difficult to disentangle their impact. This scoping review aims to link alternative payment arrangements within their context of service delivery, to assess their impact on quality of chronic care, and to disentangle, where possible, the impact of payment reforms from changes to service delivery. A search of literature published between 2013 and 2022 resulted in 34 relevant articles across five types of payment models: capitation/global budget (n = 13), pay-for-coordination (n = 10), shared savings/shared risk (n = 6), blended capitation (n = 3), and bundled payments (n = 1). The certainty of evidence was generally low due to biases associated with voluntary participation in reforms. This scoping review finds that population-based payment reforms are better suited for collaborative, person-centred approaches of service delivery spanning settings and providers, but also highlights the need for a wider evidence base of studies disentangling the impact of financing from service delivery reforms. Limited evidence disentangling the two suggests that transforming service delivery to a team-based model of care alongside a purchasing reform shifting to blended capitation was more impactful in improving quality of chronic care, than the individual components of payment and service delivery. Further comparative studies employing causal inference methods, accounting for biases and quantifying aspects of service delivery, are needed to better disentangle the mechanisms impacting quality of care.
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Affiliation(s)
- Cassandra Simmons
- European Centre for Social Welfare Policy & Research, Vienna, Austria.
| | - Mirjam Pot
- European Centre for Social Welfare Policy & Research, Vienna, Austria
| | - Klara Lorenz-Dant
- General Practice, Institute of General Practice, University Hospital of Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Kai Leichsenring
- European Centre for Social Welfare Policy & Research, Vienna, Austria
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Jasilionis D, van Raalte AA, Klüsener S, Grigoriev P. The underwhelming German life expectancy. Eur J Epidemiol 2023; 38:839-850. [PMID: 37185793 PMCID: PMC10129301 DOI: 10.1007/s10654-023-00995-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/15/2023] [Indexed: 05/17/2023]
Abstract
This article contributes to the discussion on the determinants of diverging life expectancy in high-income countries, with a focus on Germany. To date, much of this discourse has centered around the social determinants of health, issues of healthcare equity, poverty and income inequality, and new epidemics of opioids and violence. Yet despite doing well on all of these metrics and having numerous advantages such as comparatively strong economic performance, generous social security, and an equitable and well-resourced health care system, Germany has been a long-time life expectancy laggard among the high-income countries. Using aggregated population-level mortality data for Germany and selected six high-income countries (Switzerland, France, Japan, Spain, the United Kingdom, and the United States) from the Human Mortality Database and WHO Mortality Database, we find that the German longevity shortfall is mainly explained by a longstanding disadvantage in survival among older adults and adults nearing statutory retirement age, which mainly stems from sustained excess cardiovascular disease mortality, even when compared to other laggard countries such as the US and the UK. Patchy contextual data suggests that the unfavorable pattern of cardiovascular mortality may be driven by underperforming primary care and disease prevention. More systematic and representative data on risk factors are needed to strengthen the evidence base on the determinants of the controversial and long-standing health gap between more successful countries and Germany. The German example calls for broader narratives of population health that embed the variety of epidemiological challenges populations face around the globe.
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Affiliation(s)
- Domantas Jasilionis
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad Zuse str. 1, Rostock, DE-18057, Germany.
| | - Alyson A van Raalte
- Independent Research Group of Lifespan Inequalities, Max Planck Institute for Demographic Research, Konrad Zuse str. 1, Rostock, DE-18057, Germany
| | - Sebastian Klüsener
- Research Area of Demographic Change and Longevity, Federal Institute for Population Research (BIB), Friedrich- Ebert-Allee 4, Wiesbaden, DE-65185, Germany
| | - Pavel Grigoriev
- Research Group Mortality, Federal Institute for Population Research (BIB), Friedrich-Ebert-Allee 4, Wiesbaden, DE-65185, Germany
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Ee C. The Role of the Primary Care Physician in the Assessment and Management of Polycystic Ovary Syndrome. Semin Reprod Med 2023; 41:20-25. [PMID: 37913787 DOI: 10.1055/s-0043-1776419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a complex and heterogeneous female endocrine disorder with manifestations that span the hormonal, reproductive, metabolic, and psychological. Primary care physicians (PCPs), also known as family physicians or general practitioners, play a key role in the diagnosis, assessment, and management of PCOS. This article outlines the role of the PCP in the timely and accurate diagnosis, provision of information and education, lifestyle and weight management, and management of key features such as hyperandrogenism, irregular cycles, infertility, emotional well-being, and cardiometabolic risk. PCPs play an essential role as the point of first contact for women and adolescents with or at high risk of PCOS, providers of whole-person care and continuity of care, and coordinators of care within a multidisciplinary team. Optimal management of PCOS requires equitable access to primary care. There is a need for systemic approaches to addressing barriers to provision of quality primary care, such as poor remuneration of longer consultations and low awareness of evidence-based guidelines, to women and adolescents with PCOS.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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The effects of hospital and dialysis unit characteristics on hospitalizations for access-related complications among children on maintenance dialysis: a European, multicenter, observational, cross-sectional study. Pediatr Nephrol 2023:10.1007/s00467-022-05842-5. [PMID: 36595069 DOI: 10.1007/s00467-022-05842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies investigating hospitalizations in dialysis patients have focused primarily on patient-centered factors. We analyzed the impact of hospital and dialysis unit characteristics on pediatric dialysis patients' hospitalizations for access-related complications (ARCs). METHODS This cross-sectional study involved 102 hemodialysis (HD) and 163 peritoneal dialysis (PD) patients. Data between July 2017 and July 2018 were analyzed. RESULTS Children's hospitals (CHs) had more pediatric nephrologists and longer PD experience (years) than general hospitals (GHs) (p = 0.026 and p = 0.023, respectively). A total of 53% of automated PD (APD) and 6% of continuous ambulatory PD (CAPD) patients were in CHs (p < 0.001). Ninety-three percent of APD and 69% of CAPD patients were treated in pediatric-specific PD units (p = 0.001). CHs had a higher prevalence in providing hemodiafiltration (HDF) than GHs (83% vs. 30%). Ninety-seven percent of HDF vs. 66% for conventional HD (cHD) patients, and 94% of patients with arteriovenous fistula (AVF) vs. 70% of those with central venous catheters (CVC), were dialyzed in pediatric-specific HD units (p = 0.001 and p = 0.016, respectively). Eighty patients (51 PD and 29 HD) had 135 (84 PD, 51 HD) hospitalizations. CAPD was an independent risk factor for hospitalizations for infectious ARCs (I-ARCs) (p = 0.009), and a health center's PD experience negatively correlated with CAPD patient hospitalizations for I-ARCs (p = 0.041). cHD and dialyzing in combined HD units significantly increased hospitalization risk for non-infectious (NI-)ARCs (p = 0.044 and p = 0.017, respectively). CONCLUSIONS CHs and pediatric-specific dialysis units have higher prevalence of APD and HDF use. Hospitalizations for I-ARCs in CAPD are lower in centers with longer PD experience, and pediatric HD units are associated with fewer hospitalizations due to NI-ARCs. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Hospital Admission and Discharge: Lessons Learned from a Large Programme in Southwest Germany. Int J Integr Care 2023; 23:4. [PMID: 36741970 PMCID: PMC9881439 DOI: 10.5334/ijic.6534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction In the context of a GP-based care programme, we implemented an admission, discharge and follow-up programme. Description The VESPEERA programme consists of three sets of components: pre-admission interventions, in-hospital interventions and post-discharge interventions. It was aimed at all patients with a hospital stay participating in the GP-based care programme and was implemented in 7 hospitals and 72 general practices in southwest Germany using a range of strategies. Its' effectiveness was evaluated using readmissions within 90 days after discharge as primary outcome. Questionnaires with staff were used to explore the implementation process. Discussion A statistically significant effect was not found, but the effect size was similar to other interventions. Intervention fidelity was low and contextual factors affecting the implementation, amongst others, were available resources, external requirements such as legal regulations and networking between care providers. Lessons learned were derived that can aid to inform future political or scientific initiatives. Conclusion Structured information transfer at hospital admission and discharge makes sense but the added value in the context of a GP-based programme seems modest. Primary care teams should be involved in pre- and post-hospital care.
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Arnold C, Hennrich P, Wensing M. Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study. BMC PRIMARY CARE 2022; 23:56. [PMID: 35346050 PMCID: PMC8958478 DOI: 10.1186/s12875-022-01649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Coordination of care requires information exchange between health workers. The structure of their information exchange networks may influence the quality and efficiency of healthcare delivery. The aim of this study was to explore and classify information exchange networks in primary care for patients with chronic diseases in Germany.
Methods
A cross-sectional study was carried out between 2019 and 2021. As part of a larger project on coordination of care, this study focused on information exchange in practice teams regarding patients with type 2 diabetes (DM), coronary heart disease (CHD) and chronic heart failure (CHF). Social network analysis was applied to determine the number of connections, density and centralization for each of the health conditions for each of the practices. On the basis of the descriptive findings, we developed typologies of information exchange networks in primary care practices.
Results
We included 153 health workers from 40 practices, of which 25 practices were included in the social network analysis. Four types of information exchange structures were identified for the three chronic diseases: highly connected networks with low hierarchy, medium connected networks with medium hierarchy, medium connected networks with low hierarchy and lowly connected networks. Highly connected networks with low hierarchy were identified most frequently (18 networks for DM, 17 for CHD and 14 for CHF). Of the three chronic conditions, information sharing about patients with DM involved the most team members. Information exchange outside the family practice took place mainly with nurses and pharmacists.
Conclusions
This study identified four types of information exchange structures, which provides a practical tool for management and improvement in primary care. Some practices had few information transfer connections and could hardly be considered a network.
Trial registration
We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de) under ID no. DRKS00019219.
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Mueller A, Sawicki OA, Günther MP, Glushan A, Witte C, Klaaßen-Mielke R, Gerlach FM, Beyer M, Karimova K. General practitioner-centred paediatric primary care reduces risk of hospitalisation for mental disorders in children and adolescents with ADHD: findings from a retrospective cohort study. Eur J Gen Pract 2022; 28:150-156. [PMID: 35712903 PMCID: PMC9225782 DOI: 10.1080/13814788.2022.2082409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background General practitioners (GPs) play an essential role in the sustainable management of attention-deficit/hyperactivity disorder (ADHD). To our knowledge, the healthcare programme described here is the first integrated care programme for paediatric ambulatory care embedded in GP-centred-healthcare in Germany. Objectives To compare the health-service-utilisation of patients with ADHD enrolled in a GP-centred-paediatric-primary-care-programme with usual care in terms of disease-related hospitalisation, pharmacotherapy and psychotherapy. Methods In 2018, we conducted a retrospective cohort study of 3- to 18-year-old patients with ADHD in Baden-Wuerttemberg, southern Germany. The intervention group (IG) comprised patients enrolled in a GP-centred-paediatric-primary-healthcare-programme and consulted a participating GP for ADHD at least once. GP-centred-paediatric-primary-care provides high continuity of care, facilitated access to specialist care, extended routine examinations and enhanced transition to adult healthcare. Patients in the control group (CG) received usual care, meaning they consulted a non-participating GP for ADHD at least once. Main outcomes were disease-related hospitalisation, pharmacotherapy and psychotherapy. Multivariable logistic regression was performed to compare groups. Results A total of 2317 patients were included in IG and 4177 patients in CG. Mean age was 8.9 ± 4.4. The risk of mental-disorder-related hospitalisations was lower in IG than CG (odds ratio (OR): 0.666, 95% confidence interval (CI): 0.509–0.871). The prescription rate for stimulants was lower in IG (OR: 0.817; 95% CI: 0.732–0.912). There was no statistically significant difference in the participation rate of patients in cognitive behavioural therapy between groups (OR: 0.752; 95% CI: 0.523–1.080). Conclusion Children and adolescents with ADHD enrolled in GP-centred-paediatric-primary-care are at lower risk of mental-disorder-related hospitalisation and less likely to receive stimulants.
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Affiliation(s)
- Angelina Mueller
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Olga A Sawicki
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Claudia Witte
- aQua, Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University, Bochum, Germany
| | | | - Martin Beyer
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Frankfurt, Germany
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Müller A, Amberger OA, Glushan A, Klaaßen-Mielke R, Witte C, van den Akker M, Brünn R, Gerlach FM, Beyer M, Karimova K. Differences in opioid prescription rates between patients with musculoskeletal disorders enrolled in coordinated ambulatory healthcare and patients receiving usual care: a retrospective observational cohort study. BMJ Open 2022; 12:e062657. [PMID: 35940832 PMCID: PMC9364404 DOI: 10.1136/bmjopen-2022-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare opioid prescription rates between patients enrolled in coordinated ambulatory care and patients receiving usual care. DESIGN In this retrospective cohort study, we analysed claims data for insured patients with non-specific/specific back pain or osteoarthritis of hip or knee from 2014 to 2017. SETTING The study was based on administrative data provided by the statutory health insurance fund 'Allgemeine Ortskrankenkasse', in the state of Baden-Wurttemberg, Germany. PARTICIPANTS The intervention group consisted of patients enrolled in a coordinated ambulatory healthcare model; the control group included patients receiving usual care. Outcomes were overall strong and weak opioid prescriptions. Generalised linear regression models were used to analyse the effect of the intervention. RESULTS Overall, 46 001 (non-specific 18 787/specific 27 214) patients with back pain and 19 366 patients with osteoarthritis belonged to the intervention group, and 7038 (2803/4235) and 963 patients to the control group, respectively. No significant difference in opioid prescriptions existed between the groups. However, the chance of being prescribed strong opioids was significantly lower in the intervention group (non-specific back pain: Odds Ratio (OR) 0.735, 95% Confidential Interval (CI) 0.563 to 0.960; specific back pain: OR 0.702, 95% CI 0.577 to 0.852; osteoarthritis: OR 0.644, 95% CI 0.464 to 0.892). The chance of being prescribed weak opioids was significantly higher in patients with specific back pain (OR 1.243, 95% CI 1.032 to 1.497) and osteoarthritis (OR 1.493, 95% CI 1.037 to 2.149) in the intervention group. CONCLUSION Coordinated ambulatory healthcare appears to be associated with a lower prescription rate for strong opioids in patients with chronic musculoskeletal disorders. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00017548).
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Affiliation(s)
- Angelina Müller
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | | | - Anastasiya Glushan
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-Universitat Bochum, Bochum, Germany
| | - Claudia Witte
- Institute for Applied Quality Improvement and Research in Health Care, AQUA, Gottingen, Germany
| | | | - Robin Brünn
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
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Müller A, Amberger OA, Glushan A, Witte C, Klaaßen-Mielke R, Lembeck B, Beyer M, Gerlach FM, Karimova K. Evaluation of a collaborative ambulatory orthopedic care program for patients with hip and knee osteoarthritis: a comparative observational cohort study. BMC Musculoskelet Disord 2022; 23:740. [PMID: 35922853 PMCID: PMC9347081 DOI: 10.1186/s12891-022-05697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/26/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2014, the novel orthopedic care program was established by the AOK health insurance fund in southern Germany to improve ambulatory care for patients with musculoskeletal disorders. The program offers extended consultation times, structured collaboration between general practitioners and specialists, as well as a renewed focus on guideline-recommended therapies and patient empowerment. The aim of this study was to assess the impact of the program on health service utilization in patients with hip and knee osteoarthritis (OA). METHODS This retrospective cohort study, which is based on claims data, evaluated health service utilization in patients with hip and knee OA from 2014 to 2017. The intervention group comprised OA patients enrolled in collaborative ambulatory orthopedic care, and the control group received usual care. The outcomes were participation in exercise interventions, prescription of physical therapy, OA-related hospitalization, and endoprosthetic surgery rates. Generalized linear regression models were used to analyze the effect of the intervention. RESULTS Claims data for 24,170 patients were analyzed. Data for the 23,042 patients in the intervention group were compared with data for the 1,128 patients in the control group. Participation in exercise interventions (Odds Ratio (OR): 1.781; 95% Confidence Interval (CI): 1.230-2.577; p = 0.0022), and overall prescriptions of physical therapy (Rate Ratio (RR): 1.126; 95% CI: 1.025-1.236; p = 0.0128) were significantly higher in the intervention group. The intervention group had a significantly lower risk of OA -related hospitalization (OR: 0.375; 95% CI: 0.290-0.485; p < 0.0001). Endoprosthetic surgery of the knee was performed in 53.8% of hospitalized patients in the intervention group vs. 57.5% in the control group; 27.7% of hospitalized patients underwent endoprosthetic surgery of the hip in the intervention group versus 37.0% in the control group. CONCLUSIONS In patients with hip and knee OA, collaborative ambulatory orthopedic care is associated with a lower risk of OA-related hospitalization, higher participation in exercise interventions, and more frequently prescribed physical therapy.
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Affiliation(s)
- Angelina Müller
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Olga A Amberger
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Anastasiya Glushan
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Claudia Witte
- aQua, Institute for Applied Quality Improvement and Research in Health Care, 37073, Goettingen, Germany
| | - Renate Klaaßen-Mielke
- Institute of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44789, Bochum, Germany
| | - Burkhard Lembeck
- Joint Practice for Orthopaedic and Trauma, Hindenburgstr. 7/1, 73730, Ostfildern, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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