[Routine Data from Emergency Departments: Varying Documentation Standards, Billing Modalities and Data Custodians at an Identical Unit of Care]. / Routinedaten aus Notaufnahmen: Unterschiedliche Dokumentationsanforderungen, Abrechnungsmodalitäten und Datenhalter bei identischem Ort der Leistungserbringung.

BACKGROUND: Currently, there is a big need for data on emergency department (ED) utilization in Germany. One reason is the ongoing reorganisation of emergency care. Possible sources are routine data that are being collected based on legal regulations. Different payers and compensation systems have their own requirements for data collection. METHODOLOGICAL CHALLENGES: Due to the sectoral separation of health care services, there is no dataset or data holder to provide information on all ED treatments in Germany. From an administrative point of view, emergency care in Germany is considered ambulatory outpatient or inpatient care from the time point of admission to the ED. In contrast, clinical decision about inpatient admission can sometimes only be made towards the end of emergency care. EDs themselves cannot be identified in claims data; only the medical discipline (e. g. surgery) is classified. In the case of outpatient treatment, reimbursed by the Association of Statutory Health Insurance Physicians, at least one coded diagnosis (ICD) has to be recorded, accompanied by an additional code for the likelihood of this diagnosis. In case of multiple ICDs, a primary diagnosis cannot be specified. In the case of in-hospital treatment, an admission diagnosis must be recorded. After completion of hospital treatment, the main diagnosis and possibly secondary diagnoses are transferred to the respective health insurance fund. The statutory occupational accident insurance has its own requirements. SOLUTIONS: Depending on the research question and study design, different approaches are required. If data are queried directly in emergency departments or hospitals, additional information on the designated data holder and billing mode is crucial. When using health insurance data from inpatient care, the identification of emergency departments can be estimated on the basis of the reason for hospital admission and defined "unique" emergency ICDs. The case-related hospital statistics has its own limitations, but includes inpatients of all payers. DISCUSSION: Differing requirements for the administrative documentation cause a high workload in emergency departments. A standardised data collection system for all payers for inpatient and outpatient emergency care is recommended. This would contribute to the creation of valid and comparable datasets. The introduction of a particular identifier for EDs in claims data would enhance health services research.

[Good Practice Data Linkage]. / Gute Praxis Datenlinkage (GPD).

Individual data linkage of different data sources for research purposes is being increasingly used in Germany in recent years. However, generally accepted methodological guidance is missing. The aim of this article is to define such methodological standards for research projects. Another aim is to provide readers with a checklist for critical appraisal of research proposals and articles. Since 2016, an expert panel of members of different German scientific societies have worked together and developed 7 guidelines with a total of 27 practical recommendations. These recommendations include (1) research aims, questions, data sources and resources, (2) infrastructure and data flow, (3) data privacy, (4) ethics, (5) key variables and type of linkage, (6) data validation/quality assurance and (7) long-term use for future research questions. The authors provide a rationale for each recommendation. Future revisions will include any new developments in science and data privacy.

[A social network analysis regarding geographic variation for patients with depression in Germany]. / Analyse von Versorgernetzwerken und räumlichen Versorgungsunterschieden bei Patienten mit Depressionen in Deutschland.

BACKGROUND: Worldwide there is an acute requirement for an early and needs-based treatment for patients with depression. The successful treatment of depression requires the collaborative care of all healthcare providers. AIM: The aim of this work was to identify virtual networks of physicians treating patients with depression in Germany. We identified specialists who are involved in the care of patients with depression, including geographic variations. METHODS: The analyses were based on claims data of physician practices and psychotherapists in Germany. The data of 18- to 79-year-old patients with depression during 2016 were analysed. Methods and algorithms related to the network analysis were taken from mathematical graph theory. In addition, analyses were stratified by geographical areas (17 associations of statutory health insurance physicians). RESULTS: The analyses presented an opportunity to generate maps illustrating patient sharing networks within the 17 associations. The analyses demonstrated that general practitioners, psychiatrists and neurologists play a major role in the treatment of patients with depression. It was also shown that different cooperation and cost structures varied by geographical area. Complete-coverage networking of all physicians was shown in Schleswig-Holstein. By contrast Rhineland-Palatinate had four distinct areas. CONCLUSION: In the future, differences in healthcare processes and cooperation between physicians might become more visible through network analyses. This would create opportunities for cooperation and coordination between different practitioners of higher quality.

Antimicrobial usage in German acute care hospitals: results of the third national point prevalence survey and comparison with previous national point prevalence surveys.

Objectives: Previous point prevalence surveys (PPSs) revealed the potential for improving antimicrobial usage (AU) in German acute care hospitals. Data from the 2016 German national PPS on healthcare-associated infections and AU were used to evaluate efforts in antimicrobial stewardship (AMS). Methods: A national PPS in Germany was organized by the German National Reference Centre for Surveillance of Nosocomial Infections in 2016 as part of the European PPS initiated by the ECDC. The data were collected in May and June 2016. Results were compared with data from the PPS 2011. Results: A total of 218 hospitals with 64 412 observed patients participated in the PPS 2016. The prevalence of patients with AU was 25.9% (95% CI 25.6%-26.3%). No significant increase or decrease in AU prevalence was revealed in the group of all participating hospitals. Prolonged surgical prophylaxis was found to be common (56.1% of all surgical prophylaxes on the prevalence day), but significantly less prevalent than in 2011 (P < 0.01). The most frequently administered antimicrobial groups were penicillins plus ß-lactamase inhibitors (BLIs) (23.2%), second-generation cephalosporins (12.9%) and fluoroquinolones (11.3%). Significantly more penicillins plus BLIs and fewer second-generation cephalosporins and fluoroquinolones were used in 2016. Overall, an increase in the consumption of broad-spectrum antimicrobials was noted. For 68.7% of all administered antimicrobials, the indication was documented in the patient notes. Conclusions: The current data reaffirm the points of improvement that previous data identified and reveal that recent efforts in AMS in German hospitals require further intensification.

Good Practice Data Linkage (GPD): A Translation of the German Version.

The data linkage of different data sources for research purposes is being increasingly used in recent years. However, generally accepted methodological guidance is missing. The aim of this article is to provide methodological guidelines and recommendations for research projects that have been consented to across different German research societies. Another aim is to endow readers with a checklist for the critical appraisal of research proposals and articles. This Good Practice Data Linkage (GPD) was already published in German in 2019, but the aspects mentioned can easily be transferred to an international context, especially for other European Union (EU) member states. Therefore, it is now also published in English. Since 2016, an expert panel of members of different German scientific societies have worked together and developed seven guidelines with a total of 27 practical recommendations. These recommendations include (1) the research objectives, research questions, data sources, and resources; (2) the data infrastructure and data flow; (3) data protection; (4) ethics; (5) the key variables and linkage methods; (6) data validation/quality assurance; and (7) the long-term use of data for questions still to be determined. The authors provide a rationale for each recommendation. Future revisions will include new developments in science and updates of data privacy regulations.