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Bothe T, Fietz AK, Mielke N, Freitag J, Ebert N, Schaeffner E. The Lack of a Standardized Definition of Chronic Dialysis Treatment in German Statutory Health Insurance Claims Data. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:148-154. [PMID: 38381660 DOI: 10.3238/arztebl.m2024.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Chronic kidney failure (CKF) is often treated with dialysis, which is invasive and costly and carries major medical risks. The existing studies of patients with CKF requiring dialysis that are based on claims data from German statutory health insurance (SHI) carriers employ varying definitions of this entity, with unclear consequences for the resulting statistical estimates. METHODS We carried out a cohort study on four random samples, each consisting of 62 200 persons aged 70 or above, from among the insurees of the SHI AOK Nordost, with one sample for each of the years 2012, 2014, 2016, and 2018. The prevalence, incidence, mortality, and direct health care costs of CKF requiring dialysis were estimated and compared on the basis of four different definitions from literature and a new definition developed by the authors in reference to billing data. RESULTS The different definitions led to variation in 12-month prevalences (range: 0.33-0.61%) and 6-month incidences (0.058-0.100%). The percentage of patients with prior acute kidney injury (AKI) ranged from 27.6% to 61.8%. Among incident patients, three-month survival ranged from 70.2% to 88.1%, and six-month survival from 60.5% to 81.3%. In CKF patients without prior AKI, the survival curves differed less across definitions (80.2-91.8% at three months, 70.7-84.4% at six months). The monthly health care costs ranged from €6010 to €9606, with marked variability across definitions in the costs of inpatient and outpatient care. CONCLUSION The lack of a standardized definition of CKF requiring dialysis in German SHI claims data leads to variability in the estimated case numbers, mortality, and health care costs. These differences are most probably in part due to the variable inclusion of inpatients who received short-term dialysis after AKI.
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Affiliation(s)
- Tim Bothe
- Institute for Public Health, Charité - Universitätsmedizin Berlin, Germany; Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Germany; AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
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Reiland K, Haastert B, Arend W, Klüppelholz B, Windolf J, Icks A, Thelen S, Andrich S. Epidemiology of distal radius fractures in Germany - incidence rates and trends based on inpatient and outpatient data. Osteoporos Int 2024; 35:317-326. [PMID: 37819401 PMCID: PMC10837268 DOI: 10.1007/s00198-023-06904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023]
Abstract
We examined incidence rates (IR) for all distal radius fracture (DRF) events based on inpatient and outpatient data from a large statutory health insurance in Germany. Of all DRF, 56% were treated as inpatients, and thus, 44% treated as outpatients. IR were higher in women than in men. PURPOSE Although a distal radius fracture (DRF) is one of the most common fractures in the elderly population, epidemiological data are limited. Many studies examine only hospitalized patients, do not analyze time trends, or include only small populations. In this retrospective population-based observational study, routine data on inpatient and outpatient care of persons aged ≥ 60 years insured by a large statutory health insurance in Germany were analyzed from 2014 to 2018. METHODS DRF were identified by ICD-10 codes. All DRF events of an individual were considered with a corresponding individual washout period. Incidence rates (IR) and time trends were estimated assuming a Poisson distribution per 100,000 person-years, with 95% confidence intervals [95% CI] and age-sex standardization to the German population in 2018. Associations of calendar year, age, sex, and comorbidity with IR were examined using Poisson regression estimating incidence rate ratios (IRR) with CI. RESULTS The study population consists of 974,332 insured individuals, with 16,557 experiencing one or more DRF events during the observation period. A total of 17,705 DRF events occurred, of which 9961 (56.3%) were hospitalized. Standardized IR were 439 [424-453] (inpatient: 240 [230-251], outpatient: 199 [189-209]) in 2014 and 438 [423-452] (inpatient: 238 [227-249], outpatient: 200 [190-210]) in 2018. Female sex, older age, and comorbidity were associated with higher IR and adjusted Poisson regression showed no significant time trend (IRR overall 0.994 [0.983-1.006]). CONCLUSION A relevant proportion of DRF were treated in outpatient settings, so both inpatient and outpatient data are necessary for a valid estimate.
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Affiliation(s)
- Kevin Reiland
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Burkhard Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
- mediStatistica, Wuppertal, Germany
| | - Werner Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Birgit Klüppelholz
- AOK Rheinland/Hamburg, Statutory Health Insurance, Nordrhein-Westfalen, Germany
| | - Joachim Windolf
- Department of Orthopaedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz-Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Simon Thelen
- Department of Orthopaedics and Trauma Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz-Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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Rolle U, Bechstein WO, Fahlenbrach C, Heller G, Meyer HJ, Schuler E, Stier A, Waibel B, Jeschke E, Günster C, Maneck M. The Outcome of Laparoscopic Versus Open Appendectomy in Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:39-44. [PMID: 37967286 PMCID: PMC10979443 DOI: 10.3238/arztebl.m2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Appendectomy in children is performed either lapa - roscopically (LA) or by open surgery (OA). We studied whether, and how, the outcome is affected by the technique used and by the intraoperative conversion of LA to OA. METHODS We analyzed routine data from children and adolescents in three age groups (1-5 years, 6-12 years, and 13-17 years) who were insured by the AOK statutory health insurance carrier in Germany and who underwent appendectomy in the period 2017-2019. General surgical complications and reoperations within 90 days were assessed with relevant indicators. Associations between the surgical technique and these indicators were studied with logistic regression. RESULTS Of the 21 541 patients included in the study, general surgical complications were observed in 2.1% and reoperations in 1.8% overall. Broken down by age group, the corresponding figures were 5.4% and 4.4% (age 1 to 5), 2.5% and 1.8% (age 6 to 12), and 1.5% and 1.6% (age 13 to 17). The main risk factors for complications and reoperations were acute complicated appendicitis and conversion from LA to OA. Regression analysis revealed similar outcomes with OA compared to LA in the 1-to-5 age group, (odds ratios and 95% confidence intervals: 1.1 [0.6; 2.1] for general surgical complications and 1.5 [0.8; 2.7] for reoperations), but worse outcomes with OA in the other two age groups (age 6 to 12: 1.9 [1.2; 2.9] and 2.1 [1.5; 2.9]; age 13 to 17: 1.7 [1.0; 2.9] and 2.2 [1.4; 3.6]). When conversions were assigned to the LA group, the odds ratio (OA compared to LA) for reoperation across all age groups was 3.5 [2.8; 4.4] in patients with acute uncomplicated appendicitis and 4.2 [3.4; 5.3] in patients with complicated appendicitis. Complicated appendicitis also increased the rate of general surgical complications and the length of stay in hospital. CONCLUSION Among children in the two older age groups, LA was followed by fewer general surgical complications and reoperations than OA. These differences were less pronounced when conversions were counted as belonging to the LA group. Children aged 1-5 appear to benefit the least from the lapa - roscopic technique.
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Affiliation(s)
- Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplantation and Thoracic Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | | | - Günther Heller
- Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany
| | | | - Ekkehard Schuler
- Helios Kliniken, Division of Quality Management, Berlin, Germany
| | - Albrecht Stier
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Beate Waibel
- Medical Service of the Health Insurance Fund Baden-Württemberg, Freiburg, Germany
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Hagenström K, Müller K, Garbe C, Augustin M. Prevalence of psoriasis and psoriatic arthritis in Germany - analysis of claims data. J Dtsch Dermatol Ges 2024; 22:45-54. [PMID: 38128108 DOI: 10.1111/ddg.15269] [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: 01/04/2023] [Accepted: 09/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies are available on the epidemiology of psoriasis and psoriatic arthritis in Germany. The aim of this study was to estimate this prevalence based on different case definitions. METHODS Statutory health insurance (SHI) data were examined (2017 to 2019). Prevalence was analyzed and validated using three different case definitions: (1) At least one inpatient or outpatient diagnosis within one year, (2) additionally at least two outpatient diagnoses within one year, (3) additionally within three years. RESULTS The administrative prevalence of psoriasis including psoriatic arthritis ranged from 1.90% to 2.51%. For all case definitions, the prevalence increased with age, decreasing from the age of 70 with psoriasis and from the age of 65 with psoriatic arthritis. Males were more likely to be affected at an older age (p <0.0001), while in the under-20 age group, more girls were affected (p = 0.04). CONCLUSIONS Psoriasis is a common skin disease in Germany. The internal diagnoses validation showed that in future studies with claims data, the narrow and broad criteria should be used to identify patients with psoriasis, depending on the research question.
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Affiliation(s)
- Kristina Hagenström
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Müller
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Garbe
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Holtz AV, Fink A, Tamgüney G, Doblhammer G. Colonoscopy and Subsequent Risk of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:747-760. [PMID: 38669559 PMCID: PMC11191466 DOI: 10.3233/jpd-240017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Background Parkinson's disease (PD) is caused by the misfolding and aggregation of α-synuclein in neurons into toxic oligomers and fibrils that have prion-like properties allowing them to infect healthy neurons and to be transmitted to animal models of PD by injection or oral exposure. Given α-synuclein fibrils' potential transmission on the gut-brain axis, α-synuclein may be transmitted through colonoscopy procedures. Objective This study examines a possible association between colonoscopy and PD. Methods Longitudinal health insurance data of 250,000 individuals aged 50+ from 2004-2019 was analyzed. Cox proportional hazard and competing risk models with death as a competing event were estimated to calculate the risk of PD. Colonoscopy was categorized as never receiving colonoscopy, colorectal cancer (CRC) screening without or with biopsy, destruction or excision (BDE), and diagnostic colonoscopy without or with BDE. Results We identified 6,422 new cases of PD among 221,582 individuals. The Cox model revealed a significantly increased risk of PD for patients who ever had a diagnostic colonoscopy without or with BDE (HR = 1.31; 95% CI: [1.23-1.40]; HR = 1.32 [1.22-1.42]) after adjustment for age and sex. After controlling for covariates and death, persons who ever underwent CRC screening had a 40% reduced risk of PD (CRHR = 0.60 [0.54-0.67]), while persons who underwent diagnostic colonoscopy had a 20% reduced risk of PD (CRHR = 0.81 [0.75-0.88]). Conclusions Colonoscopy does not increase the risk of PD, after adjusting for death and covariates. Individuals who underwent only CRC screening had the lowest risk of PD, which may be a result of a more health-conscious lifestyle.
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Affiliation(s)
- Anna-Victoria Holtz
- German Center for Neurodegenerative Diseases(DZNE), Demographic Studies, Bonn, Germany
- University of Rostock, Institute for Sociology and Demography, Rostock, Germany
| | - Anne Fink
- German Center for Neurodegenerative Diseases(DZNE), Demographic Studies, Bonn, Germany
| | - Gültekin Tamgüney
- Forschungszentrum Jülich, Institute of Biological Information Processing – Structural Biochemistry (IBI-7), Jülich, Germany
- Mathematisch-Naturwissenschaftliche Fakultät, Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Gabriele Doblhammer
- German Center for Neurodegenerative Diseases(DZNE), Demographic Studies, Bonn, Germany
- University of Rostock, Institute for Sociology and Demography, Rostock, Germany
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Hagenström K, Müller K, Garbe C, Augustin M. Prävalenz der Psoriasis und Psoriasis-Arthritis in Deutschland - Analyse von Routinedaten der gesetzlichen Krankenversicherung: Prevalence of psoriasis and psoriatic arthritis in Germany - analysis of claims data. J Dtsch Dermatol Ges 2024; 22:45-55. [PMID: 38212930 DOI: 10.1111/ddg.15269_g] [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: 01/04/2023] [Accepted: 09/08/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungHintergrund und ZielsetzungEs gibt nur wenige Studien zur Epidemiologie der Psoriasis und Psoriasis‐Arthritis in Deutschland. Ziel dieser Studie war es, diese Prävalenz anhand verschiedener Falldefinitionen zu schätzen.MethodenEs wurden Daten der Gesetzlichen Krankenversicherung (GKV) untersucht (2017 bis 2019). Die Prävalenz wurde anhand von drei verschiedenen Falldefinitionen analysiert und validiert: (1) mindestens eine stationäre oder ambulante Diagnose innerhalb eines Jahres (2) mindestens zwei ambulante Diagnosen innerhalb eines Jahres (3) zusätzlich innerhalb von drei Jahren.ErgebnisseDie administrative Prävalenz der Psoriasis inklusive Psoriasis‐Arthritis lag zwischen 1,90% und 2,51%. Bei allen Falldefinitionen nahm die Prävalenz mit dem Alter zu, wobei sie bei der Psoriasis ab einem Alter von 70 Jahren und bei der Psoriasis‐Arthritis ab einem Alter von 65 Jahren sank. Männer waren im höheren Alter häufiger betroffen (p <0,0001), während in der Altersgruppe der unter 20‐Jährigen mehr Mädchen betroffen waren (p = 0,04).SchlussfolgerungDie Psoriasis ist eine häufige Hauterkrankung in Deutschland. Die interne Diagnosenvalidierung hat gezeigt, dass in zukünftigen Studien mit GKV‐Routinedaten, je nach Fragestellung, die engen oder weiten Kriterien zur Identifizierung von Patienten mit Psoriasis verwendet werden sollten.
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Affiliation(s)
- Kristina Hagenström
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Katharina Müller
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Claudia Garbe
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Matthias Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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Dröge P, Ruhnke T, Fischer-Rosinsky A, Henschke C, Keil T, Möckel M, Günster C, Slagman A. Patients pathways before and after treatments in emergency departments: A retrospective analysis of secondary data in Germany. Health Policy 2023; 138:104944. [PMID: 38016261 DOI: 10.1016/j.healthpol.2023.104944] [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: 05/30/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Increasing emergency department (ED) utilization induces considerable pressure on ED staff and organization in Germany. Reasons for certain ED attendances are seen partly in insufficient continuity of care outside of hospitals. To explore the health care patterns before and after an ED attendance in Germany, we used claims data from nine statutory health insurance funds, covering around 25 % of statutory health insurees (1). We descriptively analyzed ED attendances for adult patients in 2016 according to their sociodemographic characteristics and diagnoses (2). Based on the ED attendance as initial event, we investigated health care provider utilization 180 days before and after the respective ED treatment and are presented by means of Sankey diagrams. In total, 4,757,536 ED cases of 3,164,343 insured individuals were analyzed. Back pain was the most frequent diagnosis in outpatient ED cases (5.0 %), and 80.2 % of the patients visited primary care physicians or specialists 180 days before and 78.8 % 180 days after ED treatment. Among inpatient cases, heart failure (4.6 %) was the leading diagnosis and 74.6 % used primary care physicians or specialists 180 days before and 65.1 % 180 days after ED treatment. The ED re-attendance slightly increased for back pain (4.9 % to 7.9 %) and decreased for heart failure (13.4 % to 12.6 %).
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Affiliation(s)
| | | | - Antje Fischer-Rosinsky
- Charité - Universitätsmedizin Berlin, Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
| | - Cornelia Henschke
- Dept. Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
| | | | - Anna Slagman
- Charité - Universitätsmedizin Berlin, Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
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Ihle P, Schneider U, Vogt V. [Five Key Questions for Health Services Research: are SHI Claims Data Suitable for Your Research Project?]. DAS GESUNDHEITSWESEN 2023. [PMID: 37863050 DOI: 10.1055/a-2098-3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Health services research examines the structures and processes of health care under everyday conditions. Routine data of the statutory health insurance (SHI) - the so-called routine practice data - represent real health care and are therefore an important data source for health services research. This paper presents 5 key questions that researchers and data-holding institutions can use to assess the suitability of this data source for answering their health services research question. The aim of these guiding questions is to generate a common understanding between researchers and data-holding institutions of the research project, the research objective, and the feasibility of implementation in health services research. The five guiding questions cover the formulation of the research question, the planned method, the target population, the relevant study periods, and the required information from SHI data. These methodologically oriented guiding questions are supplemented by the question of how the results of the research project could improve care. Thus, for researchers, the five guiding questions provide an initial structuring for data requests; for data-holding institutions, they provide a framework for considering possible involvement in or support of a research idea in health services research.
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Affiliation(s)
- Peter Ihle
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
| | - Udo Schneider
- Versorgungsmanagement, Techniker Krankenkasse, Hamburg, Germany
| | - Verena Vogt
- Health Care Management, Technische Universität Berlin, Berlin, Germany
- Institut für Allgemeinmedizin Universitätsklinikum Jena, Germany
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Flemming R, Sundmacher L. Organization and quality of care in patient-sharing networks. Health Policy 2023; 136:104891. [PMID: 37651969 DOI: 10.1016/j.healthpol.2023.104891] [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: 07/24/2020] [Revised: 04/11/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
Healthcare systems seek to provide continuous and coordinated care of high quality. However, patient pathways in the ambulatory sector may differ and result in various provider units. Our aim was to analyze whether health outcomes and the quality of care differ between different types of patient-sharing physician networks. We analyzed administrative data on patients with diagnosed heart failure in Germany. We investigated distinct networks of ambulatory physicians by using a modular-based optimization algorithm and characterized each network as having either a key physician at its center or some other kind of configuration. We subsequently conducted multilevel regression analyses to estimate the impact a network's configuration has on hospitalization rates and guideline-based process indicators. We identified 1,847 networks, of which 27% had a key physician at their center. Compared to physician networks with other configurations, networks that had a key physician at their center were associated in our regression analysis with (a) somewhat lower hospitalization rates, and (b) heart failure treatment that was more frequently in concordance with the German national treatment guideline. Organizing healthcare for people with chronic disease into units that have a key physician at their center and include the relevant specialists may foster treatment that is effective and of higher quality.
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Affiliation(s)
- Ronja Flemming
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60, 80992, Munich, Germany.
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60, 80992, Munich, Germany
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Czwikla J, Rothgang H, Schwendicke F, Hoffmann F. Dental care utilization among home care recipients, nursing home residents, and older adults not in need of long-term care: An observational study based on German insurance claims data. J Dent 2023; 136:104627. [PMID: 37473830 DOI: 10.1016/j.jdent.2023.104627] [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: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES To describe and compare dental care utilization (DCU) among home care recipients, nursing home residents, and older adults not in need of long-term care (LTC). METHODS Using nationwide claims data of 8 German statutory health and LTC insurance funds, proportions of home care recipients (n = 68,137), nursing home residents (n = 21,167), and non-LTC dependents (n = 632,205) aged 65+ years with DCU in 2017 were determined and compared. Associations between DCU and individual characteristics and setting were investigated via multivariable logistic regression. The proportions of individuals with DCU one year before and after transition to (a) home care (n = 23,590) and (b) nursing home care (n = 6,583) were compared. RESULTS Proportions of home care recipients and nursing home residents with DCU were lower compared to non-LTC dependents (51.9, 53.1, and 73.2%, respectively). Adjusted odds ratios for DCU for home care recipients vs. non-LTC dependents ranged from 0.55 (LTC grades 1/2; 95% confidence interval 0.54-0.56) to 0.38 (LTC grades 4/5; 0.36-0.40). For nursing home residents vs. non-LTC dependents they ranged from 0.69 (3; 0.65-0.72) to 0.67 (4/5; 0.63-0.71). Women, older individuals, those with 0-1 diseases of the Elixhauser comorbidity index, dementia, and those from West Germany were also less likely to utilize dental care than their counterparts. Utilization decreased after transition to home care (60.0 vs. 55.6%) and increased after transition to nursing homes (46.1 vs. 53.5%). CONCLUSIONS Nursing home residents and especially home care recipients utilized dental care less frequently than older non-LTC dependents. Organizational barriers for dental care utilization and ways to remove them should be investigated. CLINICAL SIGNIFICANCE Dental care utilization among LTC dependents is low and should be improved in both the home care and nursing home setting.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany; Department of Health, Long-term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany.
| | - Heinz Rothgang
- Department of Health, Long-term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health, Health Services Research, Charité - Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
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Burgio NM, Jennessen S. [PraeKids: diagnosis prevalence of life-threatening and life-limiting diseases in children and adolescents in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03704-5. [PMID: 37284862 DOI: 10.1007/s00103-023-03704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/17/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In Germany, a prevalence of approximately 50,000 children and adolescents living with life-threatening and life-limiting diseases is currently assumed. This number, which is communicated in the supply landscape, is based on a simple transfer of empirical data from England. METHODS In cooperation with the German National Association of Health Insurance Funds (GKV-SV) and the Institute for Applied Health Research Berlin GmbH (InGef), the billing data of the specific treatment diagnoses documented by statutory health insurance funds for the years 2014-2019 were analyzed and - for the first time - prevalence data of affected 0‑ to 19-year-olds were collected. In addition, the data from InGef was used to calculate the prevalence by diagnosis grouping, the Together for Short Lives (TfSL) groups 1-4, and based on the (updated) coding lists from the English prevalence studies. RESULTS The data analysis determined a prevalence range of 319,948 (InGef - adapted Fraser list) to 402,058 (GKV-SV), with consideration of the TfSL groups. The TfSL‑1 group represents the largest group with 190,865 patients. DISCUSSION AND CONCLUSION This study is the first to provide the prevalence of 0‑ to 19-year-olds living with life-threatening or life-limiting diseases in Germany. Since the case definitions and the included care settings (outpatient/inpatient) differ in the research design, the prevalence values collected from the GKV-SV and InGef are also different. Due to the very heterogeneous course of the diseases, chances of survival, and mortality rates, no direct conclusions can be drawn for palliative and hospice care structures.
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Affiliation(s)
- Nadja Melina Burgio
- Abteilung Pädagogik bei Beeinträchtigungen der körperlich-motorischen Entwicklung, Institut für Rehabilitationswissenschaften, Kultur‑, Sozial- und Bildungswissenschaftliche Fakultät, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland.
| | - Sven Jennessen
- Abteilung Pädagogik bei Beeinträchtigungen der körperlich-motorischen Entwicklung, Institut für Rehabilitationswissenschaften, Kultur‑, Sozial- und Bildungswissenschaftliche Fakultät, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland
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Epidemiology of cardiac amyloidosis in Germany: a retrospective analysis from 2009 to 2018. Clin Res Cardiol 2023; 112:401-408. [PMID: 36241897 PMCID: PMC9998316 DOI: 10.1007/s00392-022-02114-y] [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: 06/15/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Improved imaging modalities contributed to increasing awareness of cardiac amyloidosis. Contemporary data on frequency trends in Germany are lacking. METHODS In a retrospective study using health claims data of a German statutory health insurance, patients with diagnostic codes of amyloidosis and concomitant heart failure between 2009 and 2018 were identified. RESULTS Prevalence increased from 15.5 to 47.6 per 100,000 person-years, and incidence increased from 4.8 to 11.6 per 100,000 person-years, with a continuous steepening in the slope of incidence trend. In patients with amyloidosis and heart failure age and proportion of men significantly increased, whereas the frequency of myeloma and nephrotic syndrome significantly decreased over time. Median (IQR) survival time after first diagnosis was 2.5 years (0.5-6 years), with a 9% (95% CI 2-15%, p = 0.008) reduced risk of death in the second compared to the first 5 years of observation. In the 2 years prior and 1 year after diagnosis, mean total health care costs were 6568 €, 11,872 € and 21,955 € per person and year. CONCLUSION The rise in cardiac amyloidosis has continuously accelerated in the last decade. Considering the adverse outcome and high health care burden, further effort should be put on early detection of the disease to implement available treatment.
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Makowski L, Feld J, Engelbertz C, Köppe J, Kühnemund L, Fischer A, Lange SA, Dröge P, Ruhnke T, Günster C, Malyar N, Gerß J, Freisinger E, Reinecke H. [Sex Disparities in Treatment and Outcome of Patients with Lower Extremity Arterial Disease: A Secondary Data Analysis]. DAS GESUNDHEITSWESEN 2023; 85:S127-S134. [PMID: 36170865 DOI: 10.1055/a-1916-9717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIM OF THE STUDY The aim of our study was to analyse sex-specific differences in diagnosis and treatment of patients with lower extremity artery disease (LEAD) at Rutherford stage (RF) 1-3, based on secondary data. Furthermore, we focussed on the influence of the biological sex on short- and long-term outcome. METHODS The GenderVasc project is carried out in cooperation with the AOK Research Institute (WIdO). As data basis, anonymized routine data from all insured patients of the AOK were used. All patients hospitalized due to a main diagnosis of LEAD at RF 1-3 were included and in addition to the multisectoral cross-sectional analysis, longitudinal analysis (follow-up of up to 10 years) of the health claims data was performed and evaluated. RESULTS Our secondary data analysis of 42,197 patients with intermittent claudication (IC, LEAD at RF 1-3) showed that male patients were more often hospitalized due to LEAD, while women were older at time-point of index hospitalisation (female: 72.6 vs. male: 66.4 years). Fewer vascular procedures (diagnostic angiography and revascularisation) were carried out in females. Moreover, the prescription of guideline-recommended medications (statins and antithrombotic therapy) was lower in women compared to men. Multivariable Cox regression showed, after adjusting for age, cardiovascular risk profile and performed vascular procedure, that female sex was protective with respect to overall survival and progression of LEAD (progress to chronic limb-threatening ischemia or ischemic amputation). CONCLUSION In Germany, female LEAD patients were older and less likely to receive guideline-recommended therapy, while female sex is protective in terms of overall survival and progression of LEAD. The extent to which increased age or the presence of other comorbidities influence the decision for or against a vascular procedure can only be assumed from a secondary data analysis. Furthermore, the prescription of drugs in multimorbid patients is challenging and the compliance of the patients with prescribed medication intake is not part of our analysis. Nevertheless, targeted analysis, as in the GenderVasc project, are urgently needed to identify and describe differences in the medical care between the sexes.
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Affiliation(s)
- Lena Makowski
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Jannik Feld
- Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Christiane Engelbertz
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Jeanette Köppe
- Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Leonie Kühnemund
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Alicia Fischer
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Germany
| | - Stefan A Lange
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Patrik Dröge
- Qualitäts- und Versorgungsforschung, Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Thomas Ruhnke
- Qualitäts- und Versorgungsforschung, Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Christian Günster
- Qualitäts- und Versorgungsforschung, Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Nasser Malyar
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Joachim Gerß
- Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Eva Freisinger
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Holger Reinecke
- Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
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Albrecht K, Regierer AC, Strangfeld A, Marschall U, Callhoff J. High burden of polypharmacy and comorbidity in persons with psoriatic arthritis: an analysis of claims data, stratified by age and sex. RMD Open 2023; 9:rmdopen-2022-002960. [PMID: 36894195 PMCID: PMC10008426 DOI: 10.1136/rmdopen-2022-002960] [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: 12/23/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To assess polypharmacy in women and men with psoriatic arthritis (PsA). METHODS From the German BARMER health insurance database, 11 984 persons with PsA and disease-modifying antirheumatic drug therapy in 2021 were included and compared with sex-matched and age-matched controls without inflammatory arthritis. Medications were analysed by Anatomical Therapeutic Chemical (ATC) groups. Polypharmacy (≥5 concomitant drugs) was compared by sex, age and comorbidity using the Rheumatic Disease Comorbidity Index (RDCI) and the Elixhauser Score. The mean difference in the number of medications between persons with PsA and controls was estimated using a linear regression model. RESULTS Compared with controls, all ATC drug classes were significantly more frequent in persons with PsA, most commonly musculoskeletal (81% vs 30%), immunomodulatory (56% vs 2.6%), cardiovascular (62% vs 48%), alimentary tract/metabolic (57% vs 31%) and nervous system (50% vs 31%) drugs. Polypharmacy was significantly higher in PsA (49%) compared with controls (17%), more frequent in women (52%) compared with men (45%) and strongly increased with age and comorbidity. For each unit increase of the RDCI, the age-adjusted number of medications increased by 0.98 (95% CI 0.95 to 1.01) units in men and 0.93 (95% CI 0.90 to 0.96) units in women. Compared with controls, the number of medications in PsA (mean 4.9 (SD 2.8)) was 2.4 (95%CI 2.34; 2.43) units higher in women and 2.3 (95% CI 2.21 to 2.35) units higher in men. CONCLUSIONS Polypharmacy is common in PsA and is composed of PsA-specific medication as well as frequent medications for comorbidities, equally affecting women and men.
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Affiliation(s)
- Katinka Albrecht
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Anne Constanze Regierer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ursula Marschall
- Department Medicine and Health Services Research, BARMER Institute for Health System Research, Wuppertal, Germany
| | - Johanna Callhoff
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Achstetter K, Köppen J, Hengel P, Nimptsch U, Blümel M. [Methodological Challenges and Lessons Learned in the Scientific Use of Data from a Private Health Insurance Company within the IPHA Project]. DAS GESUNDHEITSWESEN 2023; 85:S135-S144. [PMID: 34798661 DOI: 10.1055/a-1658-0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The 11% of people with private health insurance (PHI) in Germany have so far been underrepresented in health services research. The scientific use of PHI data is rare. The aim of this research was to examine the scientific usability of PHI data and to highlight challenges and lessons learned in the process of data preparation and analysis using a linked dataset (n=3,109) of survey and claims data of one PHI company. Challenges were identified in the terminology of the PHI insurance, in the processing and validity of the data, and regarding insured persons without submitted billing receipts. With thorough preparation of the data and presentation of the limitations, PHI data can be used for health services research.
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Affiliation(s)
- Katharina Achstetter
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
- Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
| | - Julia Köppen
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
- Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
| | - Philipp Hengel
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Ulrike Nimptsch
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Miriam Blümel
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
- Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
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Reitzle L, Ihle P, Heidemann C, Paprott R, Köster I, Schmidt C. [Algorithm for the Classification of Type 1 and Type 2 Diabetes Mellitus for the Analysis of Routine Data]. DAS GESUNDHEITSWESEN 2023; 85:S119-S126. [PMID: 35654399 DOI: 10.1055/a-1791-0918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diabetes mellitus is a disease of high public health relevance. To estimate the temporal development of prevalence, routine data of statutory health insurances (SHI) are being increasingly used. However, these data are primarily collected for billing purposes and the case definition of specific diseases remains challenging. In this study, we present an algorithm for differentiation of diabetes types analyzing SHI routine data. METHODS The basis for the analysis was an age and sex-stratified random sample of persons of the Barmer SHI with a continuous insurance duration from 2010 to 2018 in the magnitude of 1% of the German population. Diabetes was defined in the reporting year 2018, as documentation of (1) a "confirmed" ICD diagnosis E10.- to E14.- in at least two quarters, (2) a "confirmed" ICD diagnosis E10.- to E14.- in one quarter with an additional prescription of an antidiabetic drug (ATC codes A10), or (3) an ICD diagnosis E10.- to E14.- in the inpatient sector, outpatient surgery, or work disability. Individuals were assigned to a diabetes type based on the specific ICD diagnosis E10.- to E14.- and prescribed medications, differentiated by insulin and other antidiabetics. Still unclear or conflicting constellations were assigned on the basis of the persons' age or the frequency and observation of the diagnosis documentation over more than one year. The participation in a disease management program was considered in a sensitivity analysis. RESULTS The prevalence of documented diabetes in the Barmer sample was 8.8% in 2018. Applying the algorithm, 98.5% of individuals with diabetes could be classified as having type 1 diabetes (5.5%), type 2 diabetes (92.6%), or another specific form of diabetes (0.43%). Thus, the prevalence was 0.48% for type 1 diabetes and 8.1% for type 2 diabetes in 2018. CONCLUSION The vast majority of people with diabetes can be classified by their diabetes type on the basis of just a few characteristics, such as diagnoses, drug prescription, and age. Further studies should assess the external validity by comparing the results with primary data. The algorithm enables the analysis of important epidemiological indicators and the frequency of comorbidities based on routine data differentiated by type 1 and type 2 diabetes, which should be considered in the surveillance of diabetes in the future.
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Affiliation(s)
- Lukas Reitzle
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
| | - Peter Ihle
- PMV forschungsgruppe an der Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
| | - Christin Heidemann
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
| | - Rebecca Paprott
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
| | - Ingrid Köster
- PMV forschungsgruppe an der Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
| | - Christian Schmidt
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
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Routine practice data of three cancer entities: Comparison among cancer registry and health insurance data. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:65-72. [PMID: 36804770 DOI: 10.1016/j.zefq.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/12/2022] [Accepted: 01/07/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Claims data and cancer registry data are valuable secondary data sources for addressing health service research questions. This study provides a thorough insight into the comparability of data from health insurance companies and cancer registries in Germany regarding breast, prostate, and lung cancer patients and their treatment. METHODS For this study claims data of the InGef database and data of the Cancer Registry of Rhineland-Palatinate were used to identify patients living in Rhineland-Palatinate with an incident breast, prostate, or lung cancer diagnosis between Jan. 1, 2018 and Dec. 31, 2019. Both datasets were compared for patient and tumour characteristics as well as treatment strategy. For the descriptive analysis of tumour localisation and treatment all patients were followed up for a maximum of two years. RESULTS A total of 1,470 incident cancer cases were identified in the InGef database and 1,694 in the Cancer Registry. Data on sex, age, and tumour localisation matched well for all cancer entities in the cohorts. Data for early UICC stages I+II varied between the cohorts for prostate cancer (84% InGef, 66% Cancer Registry) and lung cancer (29% InGef, 20% Cancer Registry). Larger deviations were found for antihormonal treatment (breast 54% vs. 44%, prostate 32% vs. 18%). Significant differences were found for surgery (breast and lung) and radiation (breast and prostate), respectively. DISCUSSION Age at diagnosis, tumour localisation, and treatment for breast cancer was well documented in both databases. Tumour-specific deviations were observed for tumour localisations (lung cancer), UICC stage (prostate and lung cancer) and treatment options. CONCLUSION Both databases show very good completeness across cancer entities, but at the same time have minor limitations where they could readily complement each other. Individual linkage of claims and registry data could be an important step to improve oncological studies with routine practice data and to overcome the limitations identified.
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Achstetter K, Köppen J, Haltaufderheide M, Hengel P, Blümel M, Busse R. Health Literacy of People with Substitutive Private Health Insurance in Germany and Their Assessment of the Health System Performance According to Health Literacy Levels: Results from a Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16711. [PMID: 36554592 PMCID: PMC9778886 DOI: 10.3390/ijerph192416711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous research has shown that low HL is more prevalent among, e.g., people with lower social status, lower educational level, and among the elderly. In Germany, people with substitutive private health insurance (PHI) account for 11% of the population and tend to have a higher level of education and social status, but in-detail assessments of their HL are missing so far. Therefore, this study aimed to investigate the HL of PHI insureds in Germany, and to analyze their assessment of the health system according to their HL level. In 2018, 20,000 PHI insureds were invited to participate in a survey, which contained the HLS-EU-Q16, and items covering patient characteristics and the World Health Organization health systems framework goals (e.g., access, quality, safety, responsiveness). Low HL was found for 46.2% of respondents and was more prevalent, e.g., among men and insureds with a low subjective social status. The health system performance was perceived poorer by respondents with low HL. Future initiatives to strengthen health systems should focus on promoting HL.
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Affiliation(s)
- Katharina Achstetter
- Department of Health Care Management and Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
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Schnakenberg R, Fassmer AM, Allers K, Hoffmann F. Characteristics and place of death in home care recipients in Germany - an analysis of nationwide health insurance claims data. BMC Palliat Care 2022; 21:172. [PMID: 36203168 PMCID: PMC9535886 DOI: 10.1186/s12904-022-01060-w] [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] [Received: 04/08/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Most care-dependent people live at home, where they also would prefer to die. Unfortunately, this wish is often not fulfilled. This study aims to investigate place of death of home care recipients, taking characteristics and changes in care settings into account. Methods We retrospectively analysed a cohort of all home-care receiving people of a German statutory health insurance who were at least 65 years and who deceased between January 2016 and June 2019. Next to the care need, duration of care, age, sex, and disease, care setting at death and place of death were considered. We examined the characteristics by place of care, the proportion of dying in hospital by care setting and characterised the deceased cohort stratified by their actual place of death. Results Of 46,207 care-dependent people initially receiving home care, 57.5% died within 3.5 years (n = 26,590; mean age: 86.8; 66.6% female). More than half of those moved to another care setting before death with long-term nursing home care (32.3%) and short-term nursing home care (11.7%) being the most frequent transitions, while 48.1% were still cared for at home. Overall, 36.9% died in hospital and in-hospital deaths were found most often in those still receiving home care (44.7%) as well as care in semi-residential arrangements (43.9%) at the time of death. People who died in hospital were younger (mean age: 85.5 years) and with lower care dependency (low care need: 28.2%) as in all other analysed care settings. Conclusion In Germany, changes in care settings before death occur often. The proportion of in-hospital death is particularly high in the home setting and in semi-residential arrangements. These settings should be considered in interventions aiming to decrease the number of unwished care transitions and hospitalisations at the end of life.
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Affiliation(s)
- Rieke Schnakenberg
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | - Alexander Maximilian Fassmer
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Antithrombotic Treatment Patterns of Patients with Symptomatic Peripheral Arterial Occlusive Disease in Germany: Evidence from Health Insurance Claims Data. J Clin Med 2022; 11:jcm11185455. [PMID: 36143102 PMCID: PMC9501602 DOI: 10.3390/jcm11185455] [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] [Received: 08/15/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Patients with peripheral arterial occlusive disease (PAOD) are at risk of worsening limb symptoms, major adverse cardiovascular events and exhibit an impaired life expectancy. There is a lack of evidence on the extent of pharmacological secondary prevention in PAOD patients. This study assesses treatment patterns of antithrombotic agents in symptomatic PAOD patients. Methods: This is a retrospective cohort study using data from the second largest insurance fund in Germany, BARMER. We included symptomatic PAOD patients undergoing in-hospital treatment with an index admission between 1 January 2010 and 31 December 2017. Outcomes were proportions of single antiplatelets (SAPT), dual antiplatelets (DAPT), vitamin-K antagonists (VKA), or direct oral anticoagulants (DOAC) in the 12 months prior and 6 months after the index hospitalization. Non-parametric cumulative incidence for competing risks was estimated to account for censoring and death after discharge from hospital stay. Patient flows were visualised by alluvial diagrams. All analyses were stratified by intermittent claudication (IC) and chronic limb-threatening ischaemia (CLTI). The protocol was registered to ClinicalTrials.gov (NCT03909022). Results: A total of 80,426 unique patient encounters were identified. Mean age was 72.7 (46.3% female). Amongst all patients, 25.6% were on SAPT, 4.1% on DAPT, 9.1% on VKA, 3.9% on DOAC, 3.9% on both antiplatelets and oral anticoagulation, and 53.3% without any antithrombotic therapy during the 12 months before index stay. The estimated cumulative incidence was 37.9% SAPT, 14.8% DAPT, 7.5% VKA, 4.3% DOAC, 7.4% both, and 28.1% without any antithrombotic therapy during the 6 months after index stay. The considerable increases in antiplatelet therapy were mainly driven by the group of patients without antithrombotics before index stay. As compared with IC, patients who suffered from CLTI received less often antiplatelets but more often anticoagulants both before and after index stay. Conclusions: Utilisation rates of antithrombotic therapy increased considerably after in-hospital treatment for PAOD. Yet, remarkably high rates of symptomatic patients without any blood-thinning therapy constitute a major concern with respect to adequate secondary prevention of PAOD patients.
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Pot M. Epistemic solidarity in medicine and healthcare. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:681-692. [PMID: 36045178 PMCID: PMC9430002 DOI: 10.1007/s11019-022-10112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022]
Abstract
In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, on solidarity’s relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions.
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Affiliation(s)
- Mirjam Pot
- Department of Political Science, University of Vienna, Vienna, Austria
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Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up. Trials 2022; 23:560. [PMID: 35804423 PMCID: PMC9264743 DOI: 10.1186/s13063-022-06470-y] [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] [Received: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data. Methods Seven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables. Results At baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found. Conclusions For half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings. Trial registration German Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06470-y.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany. .,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany. .,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Alexandra Herzberg
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Sonja Kapp
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.,Competence Center for Clinical Trials, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Ina Nitschke
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, University Medical Center, Liebigstraße 10-14, 04103, Leipzig, Germany.,Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstraße 11, CH-8032, Zurich, Switzerland
| | - Cornelius Haffner
- Special Care- and Geriatric Dentistry, Städtisches Klinikum Harlaching München, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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Cognitive disorders in childhood epilepsy: a comparative longitudinal study using administrative healthcare data. J Neurol 2022; 269:3789-3799. [PMID: 35166927 PMCID: PMC9217877 DOI: 10.1007/s00415-022-11008-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The study aimed to assess the risk of cognitive impairment in patients with epilepsy, the impact of age of epilepsy onset on cognition and the temporal relationship of epilepsy onset and intellectual impairment. METHODS This longitudinal study analyzed birth cohorts and followed-up children born 2005-2007 up to the age of ten using administrative healthcare data of about 8.9 million members insured by the statutory health insurance "BARMER" in Germany. We compared prevalence of cognitive impairment (ICD-code F7*) in children with epilepsy (ICD-code G40) to controls, and calculated relative risks by age groups at onset of epilepsy and assessed differences in relation to the temporal sequence of the diagnoses. RESULTS Of the 142,563 pre-pubertal children included in the analysis, 2728 (1.9%) had an epilepsy diagnosis within the first 10 years of life. 17.4% (475/2728) of children with epilepsy had a diagnosis of cognitive impairment compared to 1.7% (2309/139835) in controls. The relative risk for cognitive impairment compared to age-matched controls was 10.5 (95% CI 9.6, 11.6) and was highest in epilepsy cases with seizure manifestation within the first 2 years of life compared to older children. The prevalence of cognitive impairment before epilepsy diagnosis was slightly increased compared to controls, while it was increased by a factor of nine in children diagnosed with cognitive impairment in the year of onset of epilepsy or afterwards. CONCLUSIONS Pre-pubertal children with epilepsy have a ten-fold higher risk for intellectual impairment compared to age-matched controls. This risk inversely correlates with the age of epilepsy manifestation. Cognitive impairment was diagnosed after epilepsy manifestation in the majority of patients.
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Domhoff D, Seibert K, Stiefler S, Wolf-Ostermann K, Peschke D. Data linkage of German statutory health insurance claims data and care needs assessments preceding a population-based cohort study on nursing home admission. BMJ Open 2022; 12:e063475. [PMID: 35772817 PMCID: PMC9247689 DOI: 10.1136/bmjopen-2022-063475] [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] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We perform and evaluate record linkage of German Care Needs Assessment (CNA) data to Statutory Health Insurance (SHI) claims data. The resulting dataset should enable the identification of factors in healthcare predicting the time between the onset of long-term care dependency and the admission to a nursing home in Germany in subsequent analyses. DESIGN A deterministic record linkage was conducted using the key variables region, sex, date of birth and care level. In further steps, the underlying cause of care dependency (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10)) was added for a higher level of distinction. Before linkage, the suitability of the two datasets for these procedures was assessed. After linkage, the results of each stage were analysed and the resulting dataset was evaluated cross-sectionally with respect to bias generated through this process. SETTING The study comprises data from the German SHI and Statutory Long-Term Care Insurance. PARTICIPANTS The study cohort comprised 158 069 individuals who became care dependent in 2006. We obtained CNA data for the year 2006 including 188 935 individuals. RESULTS We could link CNAs to 66 310 individuals of the original study cohort, corresponding to 42.0%. Records from two federal states could not be matched due to missing data. Linkage rates were lower where more people shared the same attributes. The resulting dataset showed minor differences regarding age, sex and care level compared to the original cohort. CONCLUSIONS Data linkage between German SHI claims data and CNA data is feasible. Failure to link was mostly attributable to a lack of distinction between individuals using available identifiers. The resulting dataset contains relevant information from both health services provision and functional status of care dependent people and is suitable for further analyses with critical reflection of representativity.
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Affiliation(s)
- Dominik Domhoff
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Kathrin Seibert
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Susanne Stiefler
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Karin Wolf-Ostermann
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dirk Peschke
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
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25
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Frick J, Gebert P, Grittner U, Letsch A, Schindel D, Schenk L. Identifying and handling unbalanced baseline characteristics in a non-randomized, controlled, multicenter social care nurse intervention study for patients in advanced stages of cancer. BMC Cancer 2022; 22:560. [PMID: 35585571 PMCID: PMC9118792 DOI: 10.1186/s12885-022-09646-6] [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] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Given the psychosocial burdens patients in advanced stages of cancer face, innovative care concepts are needed. At the same time, such vulnerable patient groups are difficult to reach for participation in intervention studies and randomized patient inclusion may not be feasible. This article aims to identify systematic biases respectively selection effects occurring during the recruitment phase and to discuss their potential causes based on a non-randomized, multicenter intervention study with patients in advanced stages of cancer. Methods Patients diagnosed with at least one of 16 predefined cancers were recruited at four hospitals in three German cities. The effect of social care nurses’ continuous involvement in acute oncology wards was measured by health-related quality of life (EORTC QLQ-C30), information and participation preferences, decisional conflicts, doctor-patient communication, health literacy and symptom perception. Absolute standardized mean difference was calculated as a standardized effect size to test baseline characteristics balance between the intervention and control groups. Results The study enrolled 362 patients, 150 in the intervention and 212 in the control group. Except for gender, both groups differed in relevant socio-demographic characteristics, e.g. regarding age and educational background. With respect to the distribution of diagnoses, the intervention group showed a higher symptom burden than the control group. Moreover, the control group reported better quality of life at baseline compared to the intervention group (52.6 points (SD 21.7); 47.8 points (SD 22.0), ASMD = 0.218, p = 0.044). Conclusion Overall, the intervention group showed more social and health vulnerability than the control group. Among other factors, the wide range of diagnoses included and structural variation between the recruiting clinics increased the risk for bias. We recommend a close, continuous monitoring of relevant social and health-related characteristics during the recruitment phase as well as the use of appropriate statistical analysis strategies for adjustment, such as propensity score methods. Trial registration: German Clinical Trials Register (DRKS-ID: DRKS00013640); registered on 29th December 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09646-6.
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Affiliation(s)
- Johann Frick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Schindel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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26
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Ludwig M, Enders D, Basedow F, Walker J, Jacob J. Sampling strategy, characteristics and representativeness of the InGef research database. Public Health 2022; 206:57-62. [DOI: 10.1016/j.puhe.2022.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
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Kern KU, Vogelmann T, Tölle TR. [Tapentadol versus classical WHO-III opioids for chronic back pain. Health services research study based on representative data from health insurance funds]. MMW Fortschr Med 2022; 164:19-27. [PMID: 35449488 DOI: 10.1007/s15006-022-0876-1] [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] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVE In clinical trials, tapentadol prolonged release (PR) showed a more favourable gastrointestinal tolerability profile compared to other strong opioids in the treatment of pain. The present analysis compared tapentadol PR and classical WHO-III PR opioids in routine clinical practice. METHOD Retrospective cohort study (matched pair approach) using anonymised health insurance data of patients with chronic low back pain who were prescribed strong opioids following pretreatment with WHO-I/II analgesics. Data were analysed from the date of first prescription in 2015 over a maximum period of two years. The primary analysis parameter was the prescription of laxatives. RESULTS Data of 227 patients per cohort could be included in the analysis. Significantly fewer tapentadol PR than WHO-III PR patients were prescribed laxatives (20.3% vs. 37%; p < 0.0001). In addition, laxative dosages were significantly lower in the tapentadol PR cohort (26.4 vs. 82.5 defined daily doses; p < 0.0001). A significant difference in laxative prescription was also observed under long-term treatment (tapentadol PR patients 27.7% vs. WHO-III PR patients 50%; p = 0.0029). CONCLUSION Routine clinical practice indirectly confirmed the more favourable gastrointestinal tolerability of tapentadol PR in the treatment of chronic pain which had previously been demonstrated in clinical trials and non-interventional studies.
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Affiliation(s)
- Kai-Uwe Kern
- Schmerzpraxis Wiesbaden, Institut für Schmerzmedizin, Sonnenberger Str. 68, 65193, Wiesbaden, Germany.
| | | | - Thomas R Tölle
- Neurologische Klinik u. Poliklinik, Klinikum rechts d. Isar d. TU München, München, Germany
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28
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Schofer N, Jeschke E, Kröger J, Baberg H, Falk V, Gummert JF, Hamm CW, Möckel M, Goßling A, Malzahn J, Günster C, Blankenberg S. Risk-related short-term clinical outcomes after transcatheter aortic valve implantation and their impact on early mortality: an analysis of claims-based data from Germany. Clin Res Cardiol 2022; 111:934-943. [PMID: 35325270 PMCID: PMC9334430 DOI: 10.1007/s00392-022-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
Objectives We aimed to define and assess risk-specific adverse outcomes after transcatheter aortic valve implantation (TAVI) in an all-comers patient population based on German administrative claims data. Methods Administrative claims data of patients undergoing transvascular TAVI between 2017 and 2019 derived from the largest provider of statutory health-care insurance in Germany were used. Patients’ risk profile was assessed using the established Hospital Frailty Risk (HFR) score and 30-day adverse events were evaluated. Multivariable logistic regression models were applied to investigate the relation of patients’ risk factors to clinical outcomes and, subsequently, of clinical outcomes to mortality. Results A total of 21,430 patients were included in the analysis. Of those, 51% were categorized as low-, 37% as intermediate-, and 12% as high-risk TAVI patients according to HFR score. Whereas low-risk TAVI patients showed low rates of periprocedural adverse events, TAVI patients at intermediate or high risk suffered from worse outcomes. An increase in HFR score was associated with an increased risk for all adverse outcome measures. The strongest association of patients’ risk profile and outcome was present for cerebrovascular events and acute renal failure after TAVI. Independent of patients’ risk, the latter showed the strongest relation with early mortality after TAVI. Conclusions Differentiated outcomes after TAVI can be assessed using claims-based data and are highly dependent on patients’ risk profile. The present study might be of use to define risk-adjusted outcome margins for TAVI patients in Germany on the basis of health-insurance data. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02009-y.
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Affiliation(s)
- Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany. .,German Centre for Cardiovascular Research, DZHK, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
| | - Elke Jeschke
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | - Janine Kröger
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | - Henning Baberg
- Department of Cardiology and Nephrology, Helios Klinikum, Berlin-Buch, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, DZHK, Partner Site Berlin, Berlin, Germany.,Department of Health Science and Technology, ETH Zurich, Zürich, Switzerland
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christian W Hamm
- Medical Clinic I, University of Giessen and Campus Kerckhoff, Giessen/Bad Nauheim, Germany
| | - Martin Möckel
- Division of Emergency Medicine and Chest Pain Units, Department of Cardiology, Campus Virchow-Klinikum and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alina Goßling
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jürgen Malzahn
- Federal Association of the Local Health Care Funds (AOK), Baden-Württemberg, Germany
| | | | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,German Centre for Cardiovascular Research, DZHK, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Albrecht K, Marschall U, Zink A, Callhoff J. [Prescription frequency of physical therapy for inflammatory rheumatic diseases]. Z Rheumatol 2022; 81:360-368. [PMID: 35316384 PMCID: PMC9156497 DOI: 10.1007/s00393-022-01180-x] [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] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
Zielsetzung Es erfolgte die Untersuchung der Verordnungshäufigkeit von ambulanter physikalischer Therapie (PT) bei Versicherten mit der Diagnose einer rheumatoiden Arthritis (RA), axialen Spondyloarthritis (axSpA), Psoriasisarthritis (PsA) oder eines systemischen Lupus erythematodes (SLE) in den Jahren 2005 bis 2020. Methodik Eingeschlossen wurden erwachsene Versicherte der BARMER Krankenversicherung mit Diagnose einer RA (ICD-10: M05, M06), axSpA (M45), PsA (M07.0-3) oder SLE (M32.1,8,9). PT wurden über das bundeseinheitliche Positionsnummernverzeichnis für Heilmittelleistungen identifiziert. Berichtet wird der Anteil an Personen mit mindestens einer Verordnung von PT in den Jahren 2005 bis 2020 nach Alters- und Geschlechtergruppen. Außerdem wurden die Anzahl und die Dauer der Verschreibungen verglichen, und es wurde analysiert, ob Versicherte mit fachärztlichem Kontakt häufiger PT erhalten. Ergebnisse Im Jahr 2020 erhielten 43 % (SLE), 46 % (RA, PsA) und 49 % (axSpA) der Versicherten mindestens eine PT-Verordnung. Am häufigsten wurde Krankengymnastik rezeptiert (37 %), gefolgt von manueller Therapie (14 %) und Thermotherapie (10 %). Seit 2005 hat sich der Anteil der Versicherten, die Krankengymnastik erhalten, nicht verändert. Manuelle Therapie wird zunehmend verordnet (+7 %), während Massagen (−10 %), Thermotherapie (−7 %) und Elektrotherapie (3 % in 2005, 2 % in 2020) rückläufig sind (Zahlen zu RA). Auch die Anzahl der Verschreibungen hat sich seit 2010 nicht wesentlich verändert. Versicherte in orthopädischer Betreuung erhalten häufiger PT als Versicherte in hausärztlicher oder internistisch-rheumatologischer Betreuung; 61- bis 80-jährige Patientinnen werden am häufigsten mit PT behandelt. Schlussfolgerung Etwas weniger als die Hälfte aller Versicherten mit RA-, axSpA-, PsA- oder SLE-Diagnose erhalten eine ambulante Verordnung von PT. Dieser Anteil hat sich in den letzten 15 Jahren kaum verändert. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00393-022-01180-x) enthält die Tabellen S1–S3 und die Abbildungen S1–S2.
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Affiliation(s)
- Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Ursula Marschall
- Abteilung Medizin und Versorgungsforschung, Barmer, Wuppertal, Deutschland
| | - Angela Zink
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Johanna Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.,Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Hradetzky E, Ohlmeier C, Brinkmann C, Schild M, Galetzka W, Schmedt N, John T, Kaleth D, Gothe H. Epidemiology and routine care treatment of patients with hip or knee osteoarthritis and chronic lower back pain: real-world evidence from Germany. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Aim
Musculoskeletal disorders are a major public health problem in most developed countries. As a main cause of chronic pain, they have resulted in an increasing prescription of opioids worldwide. With regard to the situation in Germany, this study aimed at estimating the prevalence of musculoskeletal diseases such as chronic low back pain (CLBP) and hip/knee osteoarthritis (OA) and at depicting the applied treatment patterns.
Subject and methods
German claims data from the InGef Research Database were analyzed over a 6-year period (2011–2016). The dataset contains over 4 million people, enrolled in German statutory health insurances. Inpatient and outpatient diagnoses were considered for case identification of hip/knee OA and CLBP. The World Health Organization (WHO) analgesic ladder was applied to categorize patients according to their pain management interventions. Information on demographics, comorbidities, and adjuvant medication was collected.
Results
In 2016, n = 2,693,481 individuals (50.5% female, 49.5% male) were assigned to the study population; 62.5% of them were aged 18–60 years. In 2016, n = 146,443 patients (5.4%) with CLBP and n = 307,256 patients (11.4%) with hip/knee OA were identified. Of those with pre-specified pain management interventions (CLBP: 66.3%; hip/knee OA: 65.1%), most patients received WHO I class drugs (CLBP: 73.6%; hip/knee OA: 68.7%) as the highest level.
Conclusion
This study provides indications that CLBP and hip/knee OA are common chronic pain conditions in Germany, which are often subjected to pharmacological pain management. Compared to non-opioid analgesic prescriptions of the WHO I class, the dispensation of WHO class II and III opioids was markedly lower, though present to a considerable extent.
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Schindel D, Mandl L, Schilling R, Meisel A, Schenk L. Guideline adherence in speech and language therapy in stroke aftercare. A health insurance claims data analysis. PLoS One 2022; 17:e0263397. [PMID: 35113968 PMCID: PMC8812973 DOI: 10.1371/journal.pone.0263397] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background Impairments to comprehension and production of speech (aphasia, dysarthria) and swallowing disorders (dysphagia) are common sequelae of stroke, reducing patients’ quality of life and social participation. Treatment oriented on evidence-based guidelines seems likely to improve outcomes. Currently, little is known about guideline adherence in stroke aftercare for the above-mentioned sequelae. This study aims to analyse guideline adherence in the treatment of aphasia, dysarthria and dysphagia after stroke, based on suitable test parameters, and to determine factors that influence the implementation of recommended therapies. Methods Six test parameters were defined, based on systematic study of guidelines for the treatment of speech impairments and swallowing disorders (e.g. comprehensive diagnostics, early initiation and continuity). Guideline adherence in treatment was tested using claims data from four statutory health insurance companies. Multivariate logistic and linear regression analyses were performed in order to test the outcomes. Results 4,486 stroke patients who were diagnosed with specific disorders or received speech therapy were included in the study. The median age was 78 years; the proportion of women was 55.9%. Within the first year after the stroke, 90.3% of patients were diagnosed with speech impairments and swallowing disorders. Overall, 44.1% of patients received outpatient speech and language therapy aftercare. Women were less frequently diagnosed with specific disorders (OR 0.70 [95%CI:0.55/0.88], p = 0.003) and less frequently received longer therapy sessions (OR 0.64 [95%CI:0.43/0.94], p = 0.022). Older age and longer hospitalization duration increased the likelihood of guideline recommendations being implemented and of earlier initiation of stroke aftercare measures. Conclusions Our observations indicate deficits in the implementation of guideline recommendations in stroke aftercare. At the same time, they underscore the need for regular monitoring of implementation measures in stroke aftercare to address group-based disparities in care.
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Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail:
| | - Lena Mandl
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralph Schilling
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Meisel
- Center for Stroke Research Berlin, NeuroCure Clinical Research Center and Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Jeschke E, Citak M, Halder AM, Heller KD, Niethard FU, Schräder P, Zacher J, Leicht H, Malzahn J, Günster C, Gehrke T. Blood transfusion and venous thromboembolism trends and risk factors in primary and aseptic revision total hip and knee arthroplasties: A nationwide investigation of 736,061 cases. Orthop Traumatol Surg Res 2022; 108:102987. [PMID: 34144253 DOI: 10.1016/j.otsr.2021.102987] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Over the last years, new transfusion guidelines and pharmaceuticals have been introduced in primary and revision total hip and knee arthroplasty (P-THA, P-TKA, R-THA, R-TKA). In the US, a substantial decrease in transfusions has been observed in recent years. Little data exists on the subject in Europe. In this context we aimed to analyze: (1) Is there also a significant decrease in blood transfusion for these procedures in Germany? (2) Which patient and hospital related factors are associated with the risk of blood transfusion? (3) Is there a trend in complications, especially venous thromboembolism and stroke events that can be linked to tranexamic acid use? HYPOTHESIS There is a significant trend in decreasing blood transfusions in hip and knee arthroplasty. METHODS Using nationwide healthcare insurance data for inpatient hospital treatment, 736,061 cases treated between January 2011 and December 2017 were included (318,997 P-THAs, 43,780 R-THAs, 338,641 P-TKAs, 34,643 R-TKAs). Multivariable logistic regression was used to model the odds of transfusion as a function of the year of surgery. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS In each cohort the odds of transfusion decreased over time (2017 vs. 2011 (reference): P-THA: OR 0.42 (95%CI: 0.39-0.45), P-TKA: OR 0.41 (95%CI: 0.37-0.46), R-THA: OR 0.52 (95%CI: 0.47-0.58), R-TKA: OR 0.53 (95%CI: 0.46-0.61). Patient-related risk factors for blood transfusion included older age, female gender, lower Body Mass Index, comorbidities such as renal failure, cardiac arrhythmia, congestive heart failure, valvular disease, coagulopathy, depression, and antithrombotic medication prior to surgery. Venous thromboembolism or stroke events did not increase over the study period. DISCUSSION The incidence of blood transfusions in primary and revision TKA and THA decreased over the study period. This may be due to new transfusion guidelines and the introduction of novel pharmaceuticals such as tranexamic acid. A further improved patient blood management and a focus on vulnerable patient groups might lead to a further future reduction of transfusions, especially in R-THA. LEVEL OF EVIDENCE III; comparative observational study.
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Affiliation(s)
- Elke Jeschke
- Research Institute of the Local Health Care Funds, Rosenthaler Straße 31, 10178 Berlin, Germany.
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767 Hamburg, Germany
| | - Andreas M Halder
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstraße 44, 16766 Sommerfeld/Kremmen, Germany
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124 Braunschweig, Germany
| | - Fritz U Niethard
- German Society of Orthopedics and Orthopedic Surgery, Straße des 17. Juni 106-108, 10623 Berlin, Germany
| | - Peter Schräder
- Department of Orthopaedic Surgery, Kreisklinik Jugenheim, Hauptstraße 30, 64342 Seeheim-Jugenheim, Germany
| | - Josef Zacher
- Department of Orthopaedic Surgery, Kreisklinik Jugenheim, Hauptstraße 30, 64342 Seeheim-Jugenheim, Germany
| | - Hanna Leicht
- Helios Kliniken GmbH, Friedrichstrasse 136, 10117 Berlin, Germany
| | - Jürgen Malzahn
- Federal Association of the Local Health Care Funds, Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Christian Günster
- Research Institute of the Local Health Care Funds, Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767 Hamburg, Germany
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Bruns N, Sorg AL, Felderhoff-Müser U, Dohna-Schwake C, Stang A. Administrative data in pediatric critical care research-Potential, challenges, and future directions. Front Pediatr 2022; 10:1014094. [PMID: 36245724 PMCID: PMC9554413 DOI: 10.3389/fped.2022.1014094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Heterogenous patient populations with small case numbers constitute a relevant barrier to research in pediatric critical care. Prospective studies bring along logistic barriers and-if interventional-ethical concerns. Therefore, retrospective observational investigations, mainly multicenter studies or analyses of registry data, prevail in the field of pediatric critical care research. Administrative health care data represent a possible alternative to overcome small case numbers and logistic barriers. However, their current use is limited by a lack of knowledge among clinicians about the availability and characteristics of these data sets, along with required expertise in the handling of large data sets. Specifically in the field of critical care research, difficulties to assess the severity of the acute disease and estimate organ dysfunction and outcomes pose additional challenges. In contrast, trauma research has shown that classification of injury severity from administrative data can be achieved and chronic disease scores have been developed for pediatric patients, nurturing confidence that the remaining obstacles can be overcome. Despite the undoubted challenges, interdisciplinary collaboration between clinicians and methodologic experts have resulted in impactful publications from across the world. Efforts to enable the estimation of organ dysfunction and measure outcomes after critical illness are the most urgent tasks to promote the use of administrative data in critical care. Clever analysis and linking of different administrative health care data sets carry the potential to advance observational research in pediatric critical care and ultimately improve clinical care for critically ill children.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna-Lisa Sorg
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig Maximilian University Munich, Munich, Germany.,University Children's Hospital, Eberhard Karls University, Tübingen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Total health insurance costs in children with a migraine diagnosis compared to a control group. J Headache Pain 2021; 22:140. [PMID: 34800970 PMCID: PMC8605561 DOI: 10.1186/s10194-021-01349-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/28/2021] [Indexed: 12/27/2022] Open
Abstract
Background Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this paper we aimed to assess the migraine-related health care costs in 6 to 11 year old children in Germany. Methods Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 (n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 (n = 306,926). The association of migraine and costs was modeled by generalized linear regression (Gamma regression) with adjustment for sex, age and comorbidities. Results Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618). Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more frequent in the migraine group. Mental and behavioural disorders constituted the most expensive comorbidity, accounting for € 105 of the € 400 annual excess costs in the migraine group. Conclusion 6 to 11 year old children with a migraine diagnosis cause significant direct and comorbidity related excess costs in the German health care system. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01349-w.
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Epping J, Geyer S, Eberhard S, Tetzlaff J. [Completely Different or Quite Similar? The Sociodemographic Structure of the AOK Lower Saxony in Comparison to the General and Working Population in Lower Saxony and the Federal Republic of Germany]. DAS GESUNDHEITSWESEN 2021; 83:S77-S86. [PMID: 34695865 DOI: 10.1055/a-1553-3565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZIEL DER STUDIE Routinedaten von Krankenkassen sind als Datenquelle mittlerweile gut etabliert. Hinsichtlich der Verallgemeinerbarkeit der Ergebnisse bei Analysen mit Daten einer Krankenkasse treten Fragen der Repräsentativität der Versichertenpopulation auf, insbesondere da nicht alle Studien auf soziodemografische Merkmale adjustieren. Diese Arbeit untersucht mittels deskriptiver Analyse, ob und inwieweit sich die Sozialstruktur der Versichertenpopulation der AOK Niedersachsen von der Sozialstruktur der Allgemeinbevölkerung und der sozialversicherungspflichtig Beschäftigten in Niedersachsen (NDS) und in der Bundesrepublik (BRD) unterscheiden. METHODIK Die Datengrundlage bilden pseudonymisierte Daten der AOK NDS, die Beschäftigtenstatistik der Bundesagentur für Arbeit und der Bevölkerungsstand in NDS und der BRD. Die Versichertenpopulation wird an zwei Stichtagen 31.12.2012 und 31.12.2017 hinsichtlich der Geschlechter-und Altersstruktur mit der Bevölkerung in NDS und der BRD verglichen. Anschließend werden die Daten der sozialversicherungspflichtig Beschäftigten in der AOK NDS und aus der Beschäftigtenstatistik der Bundesagentur für Arbeit gegenübergestellt, um Ausbildungsabschlüsse, Komplexität der ausgeübten Tätigkeit und elf Berufsbereiche zu vergleichen. ERGEBNISSE Die Geschlechterstruktur unterscheidet sich nicht zwischen den drei Vergleichspopulationen. Verglichen mit der Bevölkerung in NDS und der BRD ist der Anteil der unter 30-Jährigen in der AOK NDS überdurchschnittlich, der Anteil der Personen zwischen 50 und 76 Jahren etwas unterdurchschnittlich. Sozialversicherungspflichtig Beschäftigte mit Hochschulabschluss und in Tätigkeiten mit höherer Komplexität sind in der AOK NDS unterrepräsentiert. Die Verteilung der sozialversicherungspflichtig Beschäftigten auf elf Berufsbereiche unterscheidet sich ebenfalls. SCHLUSSFOLGERUNG Die Studie zeigt, dass soziodemographische und sozio-ökonomische Merkmale in Studien mit Krankenkassendaten wann immer möglich berücksichtigt werden sollten. In Zukunft wird das Informationssystem Versorgungsdaten krankenkassenübergreifende Analysen mit Sekundärdaten ermöglichen. Fragestellungen der gesundheitlichen Ungleichheit können damit jedoch aufgrund des Fehlens von sozio-ökonomischen Merkmalen nicht beantwortet werden. Auch die Identifikation von vulnerablen Gruppen, die gezielt geeigneten Maßnahmen zugeführt werden könnten, ist ohne Berücksichtigung von sozio-ökonomischen Merkmalen erschwert. AIM OF THE WORK Routine data from statutory health insurance funds are now a well-established source of data for scientific research. With regard to the generalizability of findings based on data from one health insurance fund, questions arise regarding the representativeness of the insured population, especially since not all studies adjust for socio-demographic characteristics. Our study examines whether and to what extent socio-demographic and occupational characteristics of the population insured with the AOK Lower Saxony differ from the total and working population of Lower Saxony and the Federal Republic of Germany. METHODS The analyses are based on pseudonymised data from the AOK, the employment statistics of the Federal Employment Agency (FEA) and population statistics. The insured population was compared with the population of Lower Saxony and Germany at two cut-off dates (31.12.2012 and 31.12.2017) with respect to the distributions of age and gender. Subsequently, data of employed insured persons were compared with FEA-data in order to compare educational level, complexity of the work and occupational areas. RESULTS The gender structure did not differ between the three populations. The proportion of insured women and men below 30 years of age was above the corresponding figures of Lower Saxony and Germany. Employed individuals holding a university degree or jobs with higher complexity were under-represented in the AOK. The distribution across eleven occupational areas in the AOK also differed from the reference populations. CONCLUSIONS The study shows that socio-demographic and socio-economic characteristics should be considered whenever possible in studies using statutory health insurance data. In future, the new database "Information System Health Care Data" will enable analyses across all statutory health insurance providers. However, research questions of health inequalities cannot be answered with this approach due to the lack of socio-economic characteristics in these data. Identifying vulnerable groups that could be targeted for appropriate interventions is also difficult without taking socio-economic characteristics into account.
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Affiliation(s)
- Jelena Epping
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Siegfried Geyer
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sveja Eberhard
- Stabsbereich Politik, Forschung & Presse, Allgemeine Ortskrankenkasse Niedersachsen, Hannover, Deutschland
| | - Juliane Tetzlaff
- Medizinische Soziologie , Medizinische Hochschule Hannover, Hannover, Deutschland
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Benefits of a Disease Management Program for Sickle Cell Disease in Germany 2011-2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome. J Clin Med 2021; 10:jcm10194543. [PMID: 34640578 PMCID: PMC8509263 DOI: 10.3390/jcm10194543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Sickle Cell Disease (SCD) is the most common monogenic disorder globally but qualifies as a rare disease in Germany. In 2012, the German Society for Paediatric Oncology and Haematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. Besides other activities, this consortium issued treatment guidelines for SCD that strongly favour the use of hydroxyurea and propagated these guidelines in physician and patient education events. In order to quantify the effect of these recommendations, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). While the number of patients with SCD in Germany increased from approximately 2200 in 2011 to approximately 3200 in 2019, important components of the recently issued treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 44% of all patients with SCD being treated with hydroxyurea in 2019. In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased. Similarly, the proportion of patients who required analgesics and hospitals admissions declined. In sum, these data demonstrate an association between the dissemination of treatment guidelines and changes in clinical practice. The close temporal relationship between the increased use of hydroxyurea and the reduction in the incidence of acute chest syndrome in a representative population-based analysis implies that these changes in clinical practice contributed to an improvement in key measures of disease activity.
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Leicht H, Gaertner T, Günster C, Halder AM, Hoffmann R, Jeschke E, Malzahn J, Tempka A, Zacher J. Time to Surgery and Outcome in the Treatment of Proximal Femoral Fractures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:454-461. [PMID: 33734988 DOI: 10.3238/arztebl.m2021.0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/25/2020] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has not been conclusively established whether, or to what extent, the time to surgery affects mortality and the risk of complications after the surgical treatment of proximal femoral fractures. METHODS Data on 106 187 hospitalizations over the period 2015-2017 involving insurees of the German AOK health insurance company aged 20 and above were drawn from pseudonymized billing data and stratified in three subgroups: osteosynthesis for pertrochanteric fracture (PTF-OS: N = 52 358), osteosynthesis for femoral neck fracture (FNF-OS: N = 7970), and endoprosthesis for femoral neck fracture (FNF-EP: N = 45 859). Multivariate regression models were used to analyze the relation between preoperative in-hospital stay (time to surgery, TTS: 0 days [reference category], 1, 2, 3, 4-7 days) and mortality and general complications within 90 days, with risk adjustment for fracture site, operative method, age, sex, accompanying illnesses, and antithrombotic medication in the preceding year. RESULTS Mortality was significantly elevated only with PTF-OS, and only with a TTS of 2 days (odds ratio: 1.12 [95% confidence interval: (1.02; 1.23)]). General complications in relation to TTS were significantly elevated in the following situations: PTF-OS: 2 days: OR 1.24 [1.13; 1.37], 3 days: OR 1.33 [1.11; 1.60], 4-7 days: OR 1.47 [1.21; 1.78]; FNF-EP: 3 days: OR 1.21 [1.06; 1.37], 4-7 days: OR 1.42 [1.25; 1.62]; FNF-OS: 4-7 days: OR 1.86 [1.26; 2.73]. CONCLUSION A prolonged time to surgery is associated with an elevated general complication risk depending on the site of the fracture and the type of surgical procedure used.
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Affiliation(s)
- Hanna Leicht
- AOK Research Institute (WIdO), Berlin; Medical Service of German Statutory Health Insurance Providers (MDK) Hessen, Oberursel; Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Sommerfeld/Kremmen; BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt; AOK-Bundesverband, Berlin; Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, Berlin; HELIOS Health Kliniken GmbH, Berlin
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Hagenström K, Sauer K, Mohr N, Dettmann M, Glaeske G, Petersen J, Garbe C, Steimle T, Augustin M. Prevalence and Medications of Atopic Dermatitis in Germany: Claims Data Analysis. Clin Epidemiol 2021; 13:593-602. [PMID: 34321929 PMCID: PMC8313108 DOI: 10.2147/clep.s315888] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background Information on the prevalence of atopic dermatitis (AD) varies greatly, and so far, only a few studies describe the healthcare of patients with AD in Germany. Objective The aim of the study is to describe the prevalence and medications of people with AD in Germany. Methods Health insurance data for the year 2019 were examined. Prevalence rates, the severity of disease, comorbidities and pharmaceutical supply were analyzed. Insured persons with AD were identified with at least one outpatient or inpatient International Classification Code of Diseases (L20). Results In 2019, 4.21% [95% CI 4.21−4.22%] of insured persons had AD (3.6 million). Women were affected slightly more frequently than men (4.74% [95% CI 4.73−4.74%] and 3.64% [95% CI 3.64−3.65%]). Adolescents and children under the age of 15 had the highest prevalence of AD compared to other age groups (9.44% [95% CI 9.42−9.46%]). Majority of the insured persons with AD were affected by a mild to moderate form of the disease. The most common co-morbidity was infections of the skin (RR 5.00 [95% CI 4.97−5.02%]). Some patients were treated by a dermatologist, while others by a general practitioner, 39.10% and 36.74%, respectively. Of the anti-inflammatory drugs, systemic glucocorticosteroids preparations were used most frequently and were most frequently prescribed by the general practitioner. With a total of 42,841 prescriptions (1.53%), methotrexate (third-line treatment option) was prescribed more frequently than ciclosporin with 19,628 prescriptions (0.70%) or azathioprine with 25,696 prescriptions (0.92%). Ciclosporin (first-line treatment option) was prescribed much more frequently by a dermatologist (44.00% versus 14.32% by general practitioner). The biological dupilumab was prescribed 30,801 times (1,10%) and was also primarily prescribed by a dermatologist (66.67%). Conclusion The present results reveal that a specialist treats approximately one-third of the patients with AD and that there is still a drug undersupply in some cases, especially concerning innovative drugs.
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Affiliation(s)
- Kristina Hagenström
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kristin Sauer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicole Mohr
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marleen Dettmann
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gerd Glaeske
- Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Jana Petersen
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Garbe
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Hagenström K, Garbe C, Debus ES, Augustin M. Vascular Diagnostic and Surgical Treatments Before Lower Limb Amputations in Patients with Arterial Vascular Diseases: A Population Based Study from 2013 to 2015 in Germany. Eur J Vasc Endovasc Surg 2021; 62:469-475. [PMID: 34274219 DOI: 10.1016/j.ejvs.2021.05.016] [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: 09/25/2020] [Revised: 04/27/2021] [Accepted: 05/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patients with peripheral artery disease (PAD) have an increased risk of lower limb amputation. Given the international wide variance in major amputations, the high mortality rates and follow up costs as well as the significantly reduced quality of life of patients with amputations, vascular diagnostics and vascular surgery treatments are of great importance for lower limb preservation in patients with PAD. This study examines these guideline based procedures in patients before a first lower limb amputation and PAD. METHODS This was a retrospective longitudinal study. Data from a large German statutory health insurance scheme were examined on patients with first amputation of lower extremities and PAD between 2013 and 2015 (incidence). Pre-defined vascular diagnostic and vascular surgical procedures were considered, as specified by guidelines within inpatient and outpatient care in a defined time before lower limb amputation. RESULTS The overall estimated incidence of lower extremity amputations in the total population was 0.12% from 2013 to 2015. Of these, 51.7% had PAD; 81.8% of patients received at least one vascular diagnostic measure and 61.0% a vascular surgery procedure before the lower extremity amputation. There were only minor variations in the use of diagnostic or surgical treatments between patients with major and minor amputation. In total, 63.9% of patients had vascular surgery before the incident major amputation compared with 60.0% of patients with a minor amputation. Noticeable regional differences were found ranging from 91% (Berlin) to 67% (Bremen) regarding diagnostic procedures provided before amputation, and from 83% (Hamburg) to 55% (Saxony-Anhalt) regarding vascular surgery before amputations. CONCLUSION Of patients with PAD, 18.2% did not receive a vascular diagnostic examination before amputation as specified in the guidelines, which reflects an underuse of health services. In one third of patients who did not receive vascular surgery, major amputation probably could have been avoided.
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Affiliation(s)
- Kristina Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Claudia Garbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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40
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Olm M, Donnachie E, Tauscher M, Gerlach R, Linde K, Maier W, Schwettmann L, Schneider A. Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis. PLoS One 2021; 16:e0253919. [PMID: 34181693 PMCID: PMC8238183 DOI: 10.1371/journal.pone.0253919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and differences of GP-coordinated and uncoordinated patients in Bavaria, Germany, concerning morbidity and ambulatory specialist costs and whether these differences have changed after the abolition of the copayment. We performed a retrospective routine data analysis, using claims data of the Bavarian Association of the Statutory Health Insurance Physicians during the period 2011–2012 (with copayment) and 2013–2016 (without copayment), covering 24 quarters. Coordinated care was defined as specialist contact only with referral. Multinomial regression modelling, including inverse probability of treatment weighting, was used for the cohort analysis of 500 000 randomly selected patients. Longitudinal regression models were calculated for cost estimation. Coordination of care decreased substantially after the abolition of the copayment, accompanied by increasing proportions of patients with chronic and mental diseases in the uncoordinated group, and a corresponding decrease in the coordinated group. In the presence of the copayment, uncoordinated patients had €21.78 higher specialist costs than coordinated patients, increasing to €24.94 after its abolition. The results indicate that patients incur higher healthcare costs for specialist ambulatory care when their care is uncoordinated. This effect slightly increased after abolition of the copayment. Beyond that, the abolition of the copayment led to a substantial reduction in primary care coordination, particularly affecting vulnerable patients. Therefore, coordination of care in the ambulatory setting should be strengthened.
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Affiliation(s)
- Michaela Olm
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
- * E-mail:
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Martin Tauscher
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Roman Gerlach
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Klaus Linde
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bavaria, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bavaria, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle an der Saale, Saxony-Anhalt, Germany
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
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Claessen H, Narres M, Kvitkina T, Wilk A, Friedel H, Günster C, Hoffmann F, Koch M, Jandeleit-Dahm K, Icks A. Renal Replacement Therapy in People With and Without Diabetes in Germany, 2010-2016: An Analysis of More Than 25 Million Inhabitants. Diabetes Care 2021; 44:1291-1299. [PMID: 33947749 PMCID: PMC8247520 DOI: 10.2337/dc20-2477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Epidemiological studies have shown contradictory results regarding the time trend of end-stage renal disease (ESRD) in people with diabetes. This study aims to analyze the incidence of ESRD, defined as chronic renal replacement therapy (RRT), to investigate time trends among people with and without diabetes in Germany and to examine whether these patterns differ by age and sex. RESEARCH DESIGN AND METHODS The data were sourced from nationwide data pooled from two German branches of statutory health insurances covering ∼25 million inhabitants. We estimated age- and sex-standardized incidence rates (IRs) for chronic RRT among people with and without diabetes in 2010-2016 and the corresponding relative risks. Time trends were analyzed using Poisson regression. RESULTS We identified 73,638 people with a first chronic RRT (male 60.0%, diabetes 60.6%, mean age 71.3 years). The IR of chronic RRT among people with diabetes (114.1 per 100,000 person-years [95% CI 110.0-117.2]) was almost six times higher than among people without diabetes (19.6 [19.4-19.8]). A consistent decline in IR was observed among people with diabetes (3% annual reduction, P < 0.0001) for both sexes and all age classes. In contrast, no consistent change of IR was identified in people without diabetes. Only among women aged <40 years (P = 0.0003) and people aged ≥80 years (P < 0.0001) did this IR decrease significantly. CONCLUSIONS Incidence of chronic RRT remained significantly higher among people with diabetes. The IR decreased significantly in people with diabetes independent of age and sex. Time trends were inconsistent in people without diabetes.
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Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany .,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Adrian Wilk
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | - Heiko Friedel
- Team Gesundheit, Gesellschaft für Gesundheitsmanagement mbH, Essen, Germany
| | - Christian Günster
- Allgemeine Ortskrankenkasse (AOK) Research Institute, Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael Koch
- Centre of Nephrology, Mettmann, Germany.,Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Karin Jandeleit-Dahm
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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42
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Sorg AL, Obermeier V, Liese JG, von Kries R. Incidence trends of parapneumonic pleural effusions/empyema in children 2009 to 2018 from health insurance data: Only temporal reduction after the introduction of PCV13. Vaccine 2021; 39:3516-3519. [PMID: 34006409 DOI: 10.1016/j.vaccine.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recently, emergence of a higher proportion of serotype 3 in children with parapneumonic pleural effusion/empyema (PPE/PE) were observed in Germany despite general immunization with 13-valent pneumococcal conjugate vaccine (PCV13) since 2009. The impact of PCV13 on the overall incidence of PPE/PE in children is unclear. METHODS Annual incidence of PPE/PE in children were determined using secondary health care data for 2009-2018, provided by the Barmer statutory health insurer, serving about 11% of the German population. Temporal trends of the annual incidence were modelled applying generalized additive models. RESULTS Overall incidence of PPE/PE in children ( ≤18 years) in the ten-year observation period was 18.17 per 100,000. The 0-1 year olds showed the highest incidence (43.09 per 100 000). PPE/PE incidence decreased from 2009 until 2013 (nadir 2013 was 15.36; 95% CI: 13.41-17.31). Since 2013, the data show an annual increase. The nadir of incidence for the 2-5 year olds (15.85; 95% CI: 11.27-20.43) and the 6-18 year olds (12.29; 95% CI: 10.23-14.36) was also in 2013, whereas for the 0-1 year olds it was found in 2014 (32.66; 95% CI: 23.79-41.54). The GAM across all age groups showed a nearly U-shaped curve between time and incidence of PPE/PE by calendar year (p-non-linear = 0.0017). The model confirms the nadir in the year 2013. DISCUSSION We found a nonlinear temporal trend of PPE/PE incidence in children with a decrease from 2009 to 2013 and a subsequent increase until 2018. The former might be explained by a quasi elimination of serotype 1, the latter by an increase in the proportion of serotype 3 as demonstrated in German surveillance data of pediatric PPE/PE cases generated during the same observation period.
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Affiliation(s)
- Anna-Lisa Sorg
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Viola Obermeier
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Johannes G Liese
- University Hospital of Wuerzburg, Department of Pediatrics, Division of Pediatric Infectious Diseases, Wuerzburg, Germany.
| | - Rüdiger von Kries
- Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
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Staubach P, Mann C, Peveling-Oberhag A, Lang BM, Augustin M, Hagenström K, Garbe C, Petersen J. Epidemiology of urticaria in German children. J Dtsch Dermatol Ges 2021; 19:1013-1019. [PMID: 33938627 DOI: 10.1111/ddg.14485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND To date, robust epidemiological metrics as well as data on comorbidity in pediatric urticaria are lacking. They form the basis for the design of efficient healthcare. METHODS Retrospective study to analyze epidemiological data in pediatric urticaria. The analysis is based on routine data of a health insurance company operating throughout Germany (DAK-Gesundheit). Insured people under 18 years of age who received at least one confirmed outpatient or inpatient urticaria diagnosis according to the ICD-10 classification in the years 2010 to 2015 were included in the analysis and compared to children without a corresponding diagnosis. RESULTS Of 2.3 million insured individuals, 313,581 (13.5 %) were under 18 years of age (153,214 female). Urticaria was diagnosed in 1.7 % of the 313,581 patients. The prevalence of urticaria decreased with age from 3.0 % in the 0-3-year age group to 1.0 % in the 14-18-year age group. Boys and girls were almost equally affected in all age groups. Atopic diseases as comorbidity occurred more frequently in children with urticaria than in the control group (16.0 % vs. 8.0 %). Autoimmune diseases, mental health problems, and obesity also occurred more frequently in children with urticaria than in the control group. CONCLUSIONS The increased prevalence of specific comorbidities in children with urticaria suggests an increased need for screening. Multimodal treatment strategies need to be developed and interdisciplinary collaboration promoted.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Caroline Mann
- Department of Dermatology, University Medical Center, Mainz, Germany
| | | | - Berenice M Lang
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kristina Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Garbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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König H, Rommel A, Baumert J, Schmidt C, König HH, Brettschneider C, Konnopka A. Excess costs of type 2 diabetes and their sociodemographic and clinical determinants: a cross-sectional study using data from the German Health Interview and Examination Survey for Adults (DEGS1). BMJ Open 2021; 11:e043944. [PMID: 33883150 PMCID: PMC8061816 DOI: 10.1136/bmjopen-2020-043944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The objectives of this study were to estimate the direct and indirect excess costs of type 2 diabetes mellitus (T2D) using data representative for the German adult population and to investigate the association of sociodemographic and clinical determinants with these excess costs. SETTING We calculated mean annual costs for individuals with T2D and a control group without diabetes, using data on healthcare utilisation and productivity losses from the cross-sectional German Health Interview and Examination Survey for Adults. We adjusted for group differences using entropy balancing and estimated excess costs for total, direct, indirect costs and additional cost categories using generalised linear models. We performed subgroup analyses to investigate the association of sociodemographic (age, sex and education) and clinical determinants (diabetes duration, glycaemic index and complications) with excess costs. PARTICIPANTS The final study sample included n=325 individuals with T2D and n=4490 individuals without diabetes in the age between 18 and 79 years. RESULTS Total excess costs amounted to €927, of which €719 were attributable to direct and €209 to indirect excess costs. Total costs were significantly increased by 28% for T2D compared with controls. Group differences in direct, outpatient and medication costs were statistically significant. Medication costs were 88% higher for T2D and had the highest share in direct excess costs. With respect to specific determinants, direct excess costs ranged from €203 for 4-10 years diabetes duration to €1405 for diabetes complications. Indirect excess costs ranged from €-544 for >10 years diabetes duration to €995 for high education. CONCLUSIONS T2D was associated with high costs, mainly due to direct costs. As pointed out by our results, diabetes complications and comorbidities have a large impact on the costs, leaving medication costs as main contributor of T2D excess costs.
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Affiliation(s)
- Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christian Schmidt
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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45
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Sommer M, Waltersbacher A, Schlotmann A, Schröder H, Strzelczyk A. Prevalence and Therapy Rates for Stuttering, Cluttering, and Developmental Disorders of Speech and Language: Evaluation of German Health Insurance Data. Front Hum Neurosci 2021; 15:645292. [PMID: 33912020 PMCID: PMC8071871 DOI: 10.3389/fnhum.2021.645292] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the prevalence and treatment patterns of speech and language disorders in Germany. Methods A retrospective analysis of data collected from 32% of the German population, insured by the statutory German health insurance (AOK, Local Health Care Funds). We used The International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification (ICD-10 GM) codes for stuttering (F98.5), cluttering (F98.6), and developmental disorders of speech and language (F80) to identify prevalent and newly diagnosed cases each year. Prescription and speech therapy reimbursement data were used to evaluate treatment patterns. Results In 2017, 27,977 patients of all ages were diagnosed with stuttering (21,045 males, 75% and 6,932 females, 25%). Stuttering prevalence peaks at age 5 years (boys, 0.89% and girls, 0.40%). Cluttering was diagnosed in 1,800 patients of all ages (1,287 males, 71.5% and 513 females, 28.5%). Developmental disorders of speech and language were identified in 555,774 AOK-insurants (61.2% males and 38.8% females). Treatment data indicate a substantial proportion newly diagnosed stuttering individuals receive treatment (up to 45% of 6-year-old patients), with slightly fewer than 20 sessions per year, on average. We confirmed a previous study showing increased rates of atopic disorders and neurological and psychiatric comorbidities in individuals with stuttering, cluttering, and developmental disorders of speech and language. Conclusion This is the first nationwide study using health insurance data to analyze the prevalence and newly diagnosed cases of a speech and language disorder. Prevalence and gender ratio data were consistent with the international literature. The crude prevalence of developmental disorders of speech and language increased from 2015 to 2018, whereas the crude prevalence for stuttering remained stable. For cluttering, the numbers were too low to draw reliable conclusions. Proportional treatment allocation for stuttering peaked at 6 years of age, which is the school entrance year, and is later than the prevalence peak of stuttering.
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Affiliation(s)
- Martin Sommer
- Bundesvereinigung Stottern & Selbsthilfe e.V., German Stuttering Association, Cologne, Germany.,Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Waltersbacher
- Wissenschaftliches Institut der AOK (WIdO), AOK Research Institute, Berlin, Germany
| | - Andreas Schlotmann
- Wissenschaftliches Institut der AOK (WIdO), AOK Research Institute, Berlin, Germany
| | - Helmut Schröder
- Wissenschaftliches Institut der AOK (WIdO), AOK Research Institute, Berlin, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt, Germany
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46
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Schmedding A, Wittekindt B, Schloesser R, Hutter M, Rolle U. Outcome of esophageal atresia in Germany. Dis Esophagus 2021; 34:5912927. [PMID: 32995846 DOI: 10.1093/dote/doaa093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
The aim of this study was to evaluate the outcome of esophageal atresia in Germany in a retrospective observational study of a large cohort. Data from the major health insurance company in Germany, which covers approximately 30% of German patients, were analyzed. All patients born and registered between 2009 and 2013 with a diagnosis of esophageal atresia at first admission to the hospital were included. Mortality was analyzed during the first year of life. We identified 287 patients with esophageal atresia, including 253 with and 34 without tracheoesophageal fistula. Associated anomalies were found in 53.7% of the patients; the most frequent were cardiac anomalies (41.8%), anomalies of the urinary tract (17.4%), and atresia of the colon, rectum, and anus (9.4%). Forty-one patients (14.3%) had a birth weight <1500 g. Seventeen patients (5.9%) died before surgery. Gastrostomy was performed during the index admission in 70 patients (25.9%). The reconstruction of the esophageal passage was performed in 247 patients (93.9%). Forty-eight percent of the patients who underwent an operation required dilatation. The mortality rate in the patients who underwent an operation was 10.4%. These results from Germany correspond to the international results that have been reported. The number of dilatations was in the middle of the range of those reported in the literature; the overall mortality rate was in the upper portion of the range of the international rates. Efforts should be made to establish a clinical registry to measure and improve the quality of care for this and other rare conditions.
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Affiliation(s)
- A Schmedding
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - B Wittekindt
- Department of Neonatology, University Hospital, Goethe University Frankfurt,Frankfurt am Main, Germany
| | - R Schloesser
- Department of Neonatology, University Hospital, Goethe University Frankfurt,Frankfurt am Main, Germany
| | - M Hutter
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - U Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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Stiefler S, Seibert K, Domhoff D, Wolf-Ostermann K, Peschke D. [Predictors of Admission to Nursing Home in Care-Dependent People - A Longitudinal Secondary Data Analysis]. DAS GESUNDHEITSWESEN 2021; 84:139-153. [PMID: 33822335 DOI: 10.1055/a-1276-0525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine predictors of admission to nursing home by means of secondary data analysis of German statutory health insurance claims data and care needs assessments. MATERIALS AND METHODS A retrospective longitudinal analysis was conducted covering the period 2006-2016 and using routine data. Health insurance data and care needs assessment data for people who became care dependent in 2006 and who lived in their own homes were merged. Cox regression analyses were conducted to identify predictors of admission to a nursing home. RESULTS The study population comprised 48,892 persons. Dementia, cancer of the brain, cognitive impairment, antipsychotics prescriptions, hospitalized fractures, hospital stays over ten days, and higher age had the highest hazard ratios among the predictors. CONCLUSIONS Knowledge about the predictors serves to sensitize health care professionals in the care of people in need of care. It facilitates identification of care needs in community-dwelling persons at an increased risk of admission to a nursing home.
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Affiliation(s)
- Susanne Stiefler
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Kathrin Seibert
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Dominik Domhoff
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Karin Wolf-Ostermann
- Institut für Public Health und Pflegeforschung, Universität Bremen Fachbereich 11 Human- und Gesundheitswissenschaften, Bremen
| | - Dirk Peschke
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit Bochum, Bochum
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48
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[Medical specialist undertreatment in nursing home residents-Prevalence and extrapolation]. Z Gerontol Geriatr 2021; 54:479-484. [PMID: 33725195 PMCID: PMC8354900 DOI: 10.1007/s00391-021-01865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
Hintergrund Bisherige Studien deuten darauf hin, dass Pflegebedürftige eine geringere fachärztliche Versorgung aufweisen als Nichtpflegebedürftige. Insbesondere im stationären Setting ist die fachärztliche Versorgungsintensität gering. Aus den bestehenden quantitativen Versorgungsunterschieden lässt sich bislang jedoch nicht ableiten, inwieweit von einer Unterversorgung bei Pflegebedürftigen ausgegangen werden muss. Für die Versorgungsbereiche Sehfähigkeit, Hörfähigkeit, Mundgesundheit und Parkinson-Syndrom wird geprüft, inwieweit Heimbewohner fachärztlich unterversorgt sind. Material und Methoden In 44 Pflegeheimen in Bremen und Niedersachsen wurde der Gesundheitszustand von 409 Pflegebedürftigen mittels standardisierter Assessments und Befragungen erhoben; zusätzlich wurden Diagnosen und die medizinische Versorgung aus der Pflegedokumentation ausgewertet. Ärzteteams beurteilten auf dieser Grundlage für jeden Pflegebedürftigen, inwieweit eine bedarfsgerechte fachärztliche Versorgung vorlag oder nicht. Ergebnisse Gemäß ärztlichem Urteil zeigt sich bei 45 % (Sehfähigkeit), 19 % (Parkinson-Syndrom), 16 % (Mundgesundheit) und 15 % (Hörfähigkeit) der Bewohner mit entsprechendem Versorgungsbedarf eine fachärztliche Unterversorgung. Bei 27 % aller Bewohner zeigt sich in mindestens einem der 4 Versorgungsbereiche eine fachärztliche Unterversorgung. Hochgerechnet entspricht dies bis zu 205.000 fachärztlich unterversorgten Pflegeheimbewohnern in Deutschland. Diskussion Die Studie liefert für ausgewählte Versorgungsbereiche die ersten empirischen Belege über das Ausmaß fachärztlicher Unterversorgung von Pflegeheimbewohnern. Daher erscheint es notwendig, entsprechende Interventionen zur Reduktion der Unterversorgung zu entwickeln und zu erproben. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00391-021-01865-z) enthält eine detaillierte Erklärung zur Methodik der Datenerhebung sowie 6 Tabellen mit weiterführenden Analysen. Beitrag und Zusatzmaterial stehen Ihnen im elektronischen Volltextarchiv auf https://www.springermedizin.de/link/10.1007/10.1007/s0391-021-01865-z zur Verfügung. Sie finden das Video am Beitragsende unter „Supplementary Material“.
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Krensel M, Petersen J, Stephan B, Katalinic A, Augustin J. Vergleich der Patientenpfade bei der Früherkennungsuntersuchung auf Hautkrebs – eine Sekundärdatenanalyse. J Dtsch Dermatol Ges 2021; 19:389-399. [PMID: 33709581 DOI: 10.1111/ddg.14318_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Magdalene Krensel
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Jana Petersen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Brigitte Stephan
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Lübeck (UKSH), Lübeck
| | - Jobst Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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Althaus AE, Arendt U, Hoffmann F, Lüske J, Freitag MH, Jobski K, Dörks M. [Epistaxis and anticoagulation therapy: an analysis based on health insurance data from Lower Saxony]. HNO 2021; 69:206-212. [PMID: 32929520 PMCID: PMC8289754 DOI: 10.1007/s00106-020-00940-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hintergrund Die Epistaxis ist ein häufiges Symptom in der Arztpraxis und assoziiert mit verschiedenen Komorbiditäten und Medikamenten, insbesondere Antikoagulanzien. Trotz ihrer Alltäglichkeit gibt es nur wenige Daten zur Häufigkeit ihres Auftretens und möglichen Risikofaktoren. Methoden Die Studie untersuchte anhand einer großen Patientenpopulation (AOK Niedersachsen) über 10 Jahre (2007–2016) die Versorgung von Epistaxis in Niedersachsen. Alter bei Diagnose, Begleitmedikation und Komorbiditäten wurden analysiert und die Prävalenz dargestellt. Ergebnisse 162.167 Versicherte der AOK Niedersachen wurden zwischen 2007 und 2016 aufgrund einer Epistaxis in 308.947 Fällen ärztlich vorstellig. Die meisten Patienten wurden ausschließlich ambulant behandelt (96,6 %). Über den Studienzeitraum stieg die Prävalenz um 21 % (Anstieg von 8,7 auf 9,3 pro 1000 Versicherte/Jahr) bei stabiler Prävalenz für stationäre Vorstellungen (0,2 pro 1000 Versicherte/Jahr). Die höchsten Prävalenzen fanden sich bei Personen bis 20 und über 80 Jahre. In 17,5 % aller Epistaxisfälle wurden Antithrombotika erfasst (9,5 % orale Antikoagulanzien). Über den Studienzeitraum konnte eine erhöhte Verschreibung von Antikoagulanzien (7,7 % in 2007 auf 11,8 % in 2016, insbesondere NOAK) dokumentiert werden. Schlussfolgerung Neben der arteriellen Hypertonie, dem männlichen Geschlecht sowie der typischen Altersverteilung bestand auch häufig eine Medikation mit Antikoagulanzien. Über den untersuchten Zeitraum zeigte sich eine Zunahme von Epistaxisfällen bei gleichzeitig ansteigender Verschreibungshäufigkeit von NOAK, nicht jedoch von schweren hospitalisationsbedürftigen Epistaxisfällen. Eine abschließende Beurteilung hinsichtlich eines möglichen kausalen Zusammenhangs muss in weiteren Studien untersucht werden.
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Affiliation(s)
- A E Althaus
- Department für Versorgungsforschung, Abteilung Allgemeinmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland. .,, Theaterwall 43, 26122, Oldenburg, Deutschland.
| | - U Arendt
- Department für Versorgungsforschung, Abteilung Allgemeinmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - F Hoffmann
- Department für Versorgungsforschung, Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - J Lüske
- Praxis Dr. Lüske, Oldenburg, Deutschland
| | - M H Freitag
- Department für Versorgungsforschung, Abteilung Allgemeinmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - K Jobski
- Department für Versorgungsforschung, Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - M Dörks
- Department für Versorgungsforschung, Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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