[Evaluating the health target "Increasing health competence, strengthening patient sovereignty"]. / Ansätze zur Evaluation des Gesundheitsziels "Gesundheitliche Kompetenz erhöhen, Patient(inn)en-souveränität stärken".

Establishing citizen and patient orientation is a national objective of German health policy. The cooperation network gesundheitsziele.de has defined the target area "Increasing health competence, strengthening patient sovereignty", and its Working Group 8, which bears the same name, has identified four key areas for action: increasing transparency, developing competence, strengthening patients' rights, and improving complaint management. As in the case of all the other targets defined by gesundheitsziele.de, attention is drawn to the need to evaluate the effects and success of the targets and related measures. A group of experts was given the task of developing an evaluation strategy, defining success indicators, and examining the availability of data sources for evaluation. With regard to the health target "Increasing health competence, strengthening patient sovereignty", the evaluation is focusing on what effect the corresponding targets and measures are having on users and how they are perceived (summative evaluation), i.e., primarily on measuring outcomes at the population level. An examination of available studies and surveys shows that to date little is known about the expectations and assessments of health-service users. At the same time, the analysis makes it clear that priority should be given to using continuous data in order to arrive at a continuous and systematic evaluation of the "Increasing health competence, strengthening patient sovereignty" health target and the implementation of citizen and patient orientation in healthcare in general. It would also be useful to include all hitherto underrepresented indicator questions in these surveys and to also examine the implementation of the health target among vulnerable population groups, e.g., elderly people in nursing homes.

[How frequent are diabetes-related amputations of the lower limbs in Germany? An analysis on the basis of routine data]. / Wie häufig sind Diabetes-bedingte Amputationen unterer Extremitäten in Deutschland? Eine Analyse auf Basis von Routinedaten.

BACKGROUND AND OBJECTIVE: The total number of lower limb amputations in Germany as well as the frequency of lower limb amputations attributable to diabetes is unknown. Currently available estimates are based on regional studies resulting in different totals. The aim of this study was to perform a census of all lower limb amputations in Germany in order to obtain valid estimates of the number of amputations attributable to diabetes mellitus in Germany. PATIENTS AND METHODS: Hospital performance and expenditure statistics were used to obtain a comprehensive count of lower limb amputations. The number of amputations in diabetic patients as well as the number of diabetes-related amputations were assessed by calculating the proportion of diabetes among amputees as well as attributable amputations standardized to the age and gender distribution in Germany in 2001, using routine data from the Local Health Insurance Funds (AOK) as well as previous analyses from Germany. RESULTS: In 2001, 43,544 lower limb amputations and additional 3,981 revisions of amputations were performed in Germany. Among these almost 29,000 lower limb amputations were estimated to be performed in diabetic patients. More than 26,000 lower limb amputations per year were estimated to have been attributable to pre-existing diabetes mellitus. CONCLUSIONS: Lower limb amputations as a complication of diabetes mellitus are more frequent in Germany than previously estimated. Intensified prevention and therapy--as intended in disease management programs--are urgently needed to decrease the complications of diabetes and ultimately to reduce diabetes mellitus-related costs.