Introduction of quality indicators in German hospital capacity planning - Do results show an improvement in quality?

In Germany, the use of quality data to support hospital capacity planning was introduced in 2017. On behalf of the Federal Joint Committee, IQTIG suggested 11 quality indicators and developed a program on how to collect, evaluate and report data for the clinical areas gynaecological surgery, obstetrics and breast surgery. By analysing data from 2015 to 2021, effects of the introduction of the program on indicator results, statistical discrepancies and impact on care quality are examined. Effects on capacity planning are discussed. Since the program started, indicator results improved in all clinical areas, and statistical discrepancies and the number of assessments with insufficient quality decreased due to enhanced adherence to quality standards and data validity. Effects on capacity planning or the allocation of hospitals have not occurred. Thus, a change of the legal basis to allow a better link between quality and hospital planning is recommended. The approach to use quality data on hospital regulation in Germany is evolving. The current hospital reform in Germany also addresses other approaches to quality-based regulation. Already now, there have been clear improvements in specific indicators as well as lessons for quality assurance and its link to capacity planning provided by the program, which are also applicable to other countries.

[Dialysis care in Germany - demand, outpatient care and challenges]. / Dialyseversorgung in Deutschland : Bedarf, Angebot und Herausforderungen.

BACKGROUND: Dialysis is the mostly used renal replacement therapy in patients with end-stage renal disease. The aim of the study was to analyze the present dialysis care system and to scrutinize future changes regarding the need of dialysis as well as the system of care. METHODS: The study is based on a structured literature search in Pubmed; selecting relevant studies by predefined criteria. Prevalence of ESRD and the share of nephrologists in outpatient care were modeled until 2020. Guideline-based interviews with experts including a two-round Delphi survey were conducted to identify options for action. RESULTS: The number of dialysis-dependent patients will increase by one fifth from 83,000 in 2013 to 100,000 in 2020 while the share of nephrologists in outpatient care will decrease by 8% simultaneously. Therefore, young nephrologists and team-building in dialysis care need to be promoted. Home therapy should be used more often to cover the increasing need of dialysis in the future. Besides changes in the structures of care, shared-decision-making needs to be strengthened. CONCLUSIONS: The study offers concrete options to strengthen outpatient care by nephrologists (a) and to use home therapy more often (b) in order to provide adequate and appropriate dialysis care until 2020.

The bone evaluation study (BEST): patient care and persistence to treatment of osteoporosis in Germany.

OBJECTIVE: Data on fracture frequency and medical care of patients with osteoporosis are still insufficient. We aimed to analyze frequency of osteoporosis-related fractures and multiple fractures, re-fracture rates, treatment prevalence, and persistence to osteoporosis-related medication in Germany. METHODS AND MATERIALS: Using claims data of a state health insurer (2006 - 2009), we performed a retrospective "real world" analysis. Inclusion criteria were age of 50 years or older and an osteoporosis diagnosis or a prescription for defined osteoporosis-related medication. We assessed fractures, frequencies, and the number of multiple fractures per patient as well as time to follow-up fracture and drug persistence using Kaplan-Meier analysis. RESULTS: Within the observation period, 27% of the osteoporosis patients sustained fractures; of those with fractures, 69% had multiple fractures. For patients with multiple fractures, re-fracture rate after 360 days was between 69% for patients who received parathyroid hormone and 85% for patients who received no anti-osteoporotic medication 360 days before follow-up fracture. In the patient population, persistence rates after 1 year were between 58% for parathyroid hormone and 2% for other osteoporosis-specific drugs (alfacalcidol, fluorides, nandrolone, calcitonin). CONCLUSIONS: In Germany, the number of patients with osteoporosis-attributable fractures is high. There are still deficits in proper treatment as well as in drug persistence. Low persistence lead to a relatively high proportion of patients with follow-up fractures.

The epidemiology of osteoporosis--Bone Evaluation Study (BEST): an analysis of routine health insurance data.

BACKGROUND: Osteoporosis is a widespread disease of the skeleton that becomes more common with advancing age. Its prevalence is still inadequately documented. The goal of this study is to determine how common osteoporosis is in Germany. METHODS: The routine billing data of a large statutory health insurance carrier in Germany (the TK company) from the years 2006 to 2009 were anonymized and retrospectively analyzed. Insurees aged 50 and above with osteoporosis were identified either from their bearing the diagnosis of osteoporosis or of osteoporosis-related fractures, or from their having received prescription medication for osteoporosis. The prevalence and incidence of osteoporosis and the frequency of osteoporotic fractures were calculated for TK insurees and extrapolated to the overall German population. RESULTS: The prevalence of osteoporosis among persons aged 50 and above, as revealed by diagnoses of osteoporosis or osteoporotic fractures, or by the prescription of medication for osteoporosis, was found to be 14% (240,657 of 1.7 million insurees) in the year 2009; the sex-specific prevalence was 24% in women and 6% in men. An extrapolation of these figures implies that 6.3 million persons in Germany have osteoporosis. The incidence of osteoporosis in the same age group, as revealed by a diagnosis of osteoporosis or prescription of medication for osteoporosis, was found to be 2.1% per year, with 104,528 insurees having an index event for osteoporosis (initial diagnosis of osteoporosis or first prescription of a medication for osteoporosis). An extrapolation of this figure implies that 885,000 persons newly develop osteoporosis in Germany each year. Over the period of observation, 52% of the affected persons (total, 172,473 persons) sustained fractures, many of which were multiple. CONCLUSION: Osteoporosis is still common in Germany. The large number of insurees with single and multiple fractures implies that the treatment of this disease in Germany needs to be improved.

Future relevance of genetic testing: a systematic horizon scanning analysis.

OBJECTIVES: The aim of this study was to identify research and development on genetic testing to find out if research addresses important disease areas, how far it is from potential clinical use, and what consequences might arise for the prioritization of health technology assessment (HTA) activities. Also a horizon scanning methodology developed in Germany is demonstrated. METHODS: A systematic search on genetic testing was conducted in an innovation database (ZIM database). Based on a daily monitoring of literature and Internet sources, reports from 2003 up to 2005 were classified related to the type of innovation, the addressed disease categories, and the developmental phase of the technology. More detailed analyses for the most frequently addressed groups of diseases were conducted. RESULTS: From 239 relevant reports, 41 percent referred to neoplasms; 10 percent to diseases of the cardiovascular system; 9 percent to diseases of the nervous system; 7 percent to mental and behavioral disorders; and 5 percent to endocrine, nutritional, and metabolic diseases. A total of 69 percent of research is situated in basic preclinical research, 22 percent in clinical/experimental research, and 6 percent are genetic tests being used. Diagnostic applications were most frequently reported (28 percent), followed by therapeutic prediction (22 percent), preventive prediction (18 percent), pharmacogenetics (16 percent), and screening (16 percent). CONCLUSIONS: Widespread diseases are frequently addressed in research. HTA on genetic testing might focus on innovations addressing neoplastic diseases (in particular breast, colon, and prostate cancers) and pharmacogenetic applications for therapeutic prediction. The horizon scanning approach seems useful in the early steps of HTA processes to identify emerging new technologies that might have significant impact on future health care.

Gender differences for ghrelin levels in alcohol-dependent patients and differences between alcoholics and healthy controls.

BACKGROUND: Ghrelin is a 28-amino acid gut-brain peptide, mainly secreted by the gastric mucosa. Its effects are linked to energy homeostasis and particularly seem to increase hunger and food intake. In recent years, studies suggested that appetite-regulating peptides, such as ghrelin play a relevant role in alcoholism. Since data published to date on the potential role of ghrelin as state and/or trait marker in alcoholism and the association with craving are controversial, we aimed at further elucidating these aspects. PATIENTS AND METHODS: One-hundred nine alcohol-dependent abstinent patients after withdrawal (27 f, 82 m), (ICD 10 F 10.25) and 45 healthy volunteers (12 f, 33 m) were included. Laboratory testing (Ghrelin RIA 90, Mediagnost Inc., Germany) was performed and several craving scales [Obsessive Compulsive Drinking Scale, Alcohol Urge Questionnaire and Visual Analogue Scale (VAS)] were applied at the beginning and at the end of the 3-week rehabilitation program. RESULTS: (1) Ghrelin levels are significantly higher in female alcohol-dependent patients as compared to controls, not, however, in men alcoholics. (2) In several statistical subanalyses, an association of craving and ghrelin was found. The results, however, remain heterogeneous. CONCLUSION: The data suggest gender-dependent ghrelin levels in alcohol-dependent patients. We therefore conclude, that it might be useful to perform statistical analyses gender-specific. With regard to a potential correlation of ghrelin and craving the results seem to depend on gender, duration of the abstinence period and the instrument used.