[Postpartum Care by Midwives: Socioeconomic Status has a Strong Influence on the Amount of Care Received An Analysis with Routine Data from BARMER Health Insurance]. / Aufsuchende Wochenbettbetreuung: Die sozioökonomische Lage hat einen starken Einfluss auf den Betreuungsumfang Eine Analyse mit Routinedaten der BARMER.

BACKGROUND: Socio-economic situation is associated with inequalities in access to health care and health-related resources. This also applies to pregnancy, birth and the postpartum period. Compared to other European countries, Germany has very good care options for the postpartum period. It has an unique system of postpartum care, which comprises home visits by midwives for 12 weeks after birth and beyond in problem cases and thus has structurally good care options. So far, however, there are hardly any studies based on routine data that show which mothers receive homevisits in postpartum care and to what extent. METHOD: The study population comprised 199,978 women insured with BARMER who gave birth to at least one child in the years 2017-2020. Some women were pregnant several times in this period of time. The services billed by freelance midwives for outreach midwifery care in the puerperium were considered for 227,088 births, taking into account the socioeconomic situation of the mothers. RESULTS: According to the definition of the German Institute for Economic Research, 26% of the mothers belonged to a low income group, 46% to a medium income group and 29% to a high income group. Similar to what was shown for midwifery care during pregnancy, large differences were also found with regard to postpartum care: While 90.5% of the women with a high income received home visits, only 83.5% of women with a medium income did so, and only 67.9% of women with a low income. The groups did not differ with regard to other characteristics such as rate of caesarean section, preterm births, twins, age or concomitant diseases to an extent that could explain the differences in care. Women who had received midwifery services in pregnancy were much more likely to receive home visits by a midwife in the postpartum period. Furthermore, there was a correlation with the density of midwives in the respective region. CONCLUSIONS: The results suggest that access to home-based postpartum care by freelance midwives is significantly limited for low-income women. In contrast to antenatal care, women in the postpartum period cannot switch to other service providers, as outreach postpartum care is a reserved activity of midwives. Women with low incomes thus receive less midwifery care, although they have a higher need for support (Eickhorst et al. 2016).

Development of a risk score to identify patients at high risk for a severe course of COVID-19.

Aim: We aimed to develop a risk score to calculate a person's individual risk for a severe COVID-19 course (POINTED score) to support prioritization of especially vulnerable patients for a (booster) vaccination. Subject and methods: This cohort study was based on German claims data and included 623,363 individuals with a COVID-19 diagnosis in 2020. The outcome was COVID-19 related treatment in an intensive care unit, mechanical ventilation, or death after a COVID-19 infection. Data were split into a training and a test sample. Poisson regression models with robust standard errors including 35 predefined risk factors were calculated. Coefficients were rescaled with a min-max normalization to derive numeric score values between 0 and 20 for each risk factor. The scores' discriminatory ability was evaluated by calculating the area under the curve (AUC). Results: Besides age, down syndrome and hematologic cancer with therapy, immunosuppressive therapy, and other neurological conditions were the risk factors with the highest risk for a severe COVID-19 course. The AUC of the POINTED score was 0.889, indicating very good predictive validity. Conclusion: The POINTED score is a valid tool to calculate a person's risk for a severe COVID-19 course. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01884-7.

Optimising the impact of COVID-19 vaccination on mortality and hospitalisations using an individual additive risk measuring approach based on a risk adjustment scheme.

In this population-based cohort study, billing data from German statutory health insurance (BARMER, 10% of population) are used to develop a prioritisation model for COVID-19 vaccinations based on cumulative underlying conditions. Using a morbidity-based classification system, prevalence and risks for COVID-19-related hospitalisations, ventilations and deaths are estimated. Trisomies, behavioural and developmental disorders (relative risk: 2.09), dementia and organic psychoorganic syndromes (POS) (2.23) and (metastasised) malignant neoplasms (1.99) were identified as the most important conditions for escalations of COVID-19 infection. Moreover, optimal vaccination priority schedules for participants are established on the basis of individual cumulative escalation risk and are compared to the prioritisation scheme chosen by the German Government. We estimate how many people would have already received a vaccination prior to escalation. Vaccination schedules based on individual cumulative risk are shown to be 85% faster than random schedules in preventing deaths, and as much as 57% faster than the German approach, which was based primarily on age and specific diseases. In terms of hospitalisation avoidance, the individual cumulative risk approach was 51% and 28% faster. On this basis, it is concluded that using individual cumulative risk-based vaccination schedules, healthcare systems can be relieved and escalations more optimally avoided.

[Utility Analysis of Oncological Centre Building in the Field of Colorectal Cancer]. / Nutzenanalyse onkologischer Zentrenbildung im Bereich der Behandlung des kolorektalen Karzinoms.

BACKGROUND: In the field of colorectal cancer and other cancer entities, there is an ongoing trend to establish multidisciplinary treatment in specialised cancer centres. Little is known by now about the outcomes of this centralised and quality-driven treatment approach. In light of the increasing cost-benefit discussions, assessments of their impact seem to be necessary. This paper discusses positive effects of cancer centres with a particular focus on the multidisciplinary approach and its potential impact on survival outcomes of colorectal cancer patients. The study applies a Markov approach to assess the epidemiological impact of the cancer centre establishment and associated life years gained, both at a regional level and over time. MATERIALS AND METHODS: We conducted a systematic literature review to evaluate effects of multidisciplinary treatment in specialised cancer centres in the field of colorectal cancer. Applying the PRISMA scheme, 602 articles were assessed by title, abstract and full text. Finally, 10 publications met the inclusion criteria and were included in a meta-analysis. Using the example of the "Krebszentrum Nord" at the University Hospital in the federal state of Schleswig-Holstein, we assessed the impact of changes in survival rates at the regional level by simulating expected incidence, mortality and prevalence rates in a Markov model including detailed population data of Schleswig-Holstein. RESULTS: The meta-analysis revealed that multidisciplinary treatment in a cancer centre was associated with a 4.5 % reduction of mortality rates in colorectal cancer patients. The greatest benefits were found for patients in advanced disease stages. At the regional level, 106 life years could be gained through the centre for colorectal cancer until 2020, according to the assumptions of the simulation. CONCLUSION: The establishment of colorectal cancer centres is associated with positive outcomes for patients. However, the scarce evidence base underpins the need for additional studies to further examine the impact of centre building in colorectal cancer care. Cancer registries are a solid foundation for further research. Future requirements for oncological care can be derived from the predicted epidemiological development.

[Incentive for Regional Risk Selection in the German Risk Structure Compensation Scheme]. / Anreize für regionale Risikoselektion unter dem Morbiditätsorientierten Risikostrukturausgleich.

The introduction of the new law GKV-FQWG strengthens the competition between statutory health insurance. If incentives for risk selection exist, they may force a battle for cheap customers. This study aims to document and discuss incentives for regional risk selection in the German risk structure compensation scheme. Identify regional autocorrelation with Moran's l on financial parameters of the risk structure compensation schema. Incentives for regional risk selection do indeed exist. The risk structure compensation schema reduces 91% of the effect and helps to reduce risk selection. Nevertheless, a connection between regional situation and competition could be shown (correlation: 69.5%). Only the integration of regional control variables into the risk compensation eliminates regional autocorrelation. The actual risk structure compensation is leading to regional inequalities and as a consequence to risk selection and distortion in competition.