[Risk analysis of gastroenterological endoscopies by routine data using the example of endoscopic retrograde cholangio-pancreatography (ERCP)]. / Risikoanalyse gastroenterologischer Endoskopien durch Routinedaten am Beispiel der Endoskopischen Retrograden Cholangio-Pankreaticographie (ERCP).

BACKGROUND: The present study evaluates the analysis of routine data within quality control management by means of ERCP in a tertiary center over five years. METHODS: In a retrospective study, we analyzed pseudonymized routine administrative data according § 21 KHEntgG. These data can be tracked with regard to specific indicators for all hospitals and after data revocation for each individual hospital. Indicators can be selected according to the combination of diagnoses and OPS-numbers. In the present study, the frequency of the combination of ERCP with pancreatitis (nominator) in ratio to ERCP without pancreatitis (denominator) was analyzed at the Helios Clinic Krefeld for the years 2016 to 2020. Data recruitment was done by 3M Germany. Revocation of pseudonymized data was performed by Helios. Data are expressed as absolute values, percentage, mean + SD and range. RESULTS: Overall, 1521 patients and ERCPs with 4981 procedures, including 688 papillotomies, were analyzed. In 30-70% of cases, ERCP was performed during emergency hospitalization. Forty-seven men and 52 women with ERCP-associated pancreatitis and 718 men and 504 women with ERCP without associated pancreatitis were detected. Among these, 99 patients had a combination of ERCP and pancreatitis,Forty-one percent of the patients developed pancreatitis after (n=41) and 59% before the ERCP (n=58). Emergency admission was comparable in both groups (25-83%). All patients developed post-ERCP pancreatitis within 12 hours post intervention. The course of ERCP-induced pancreatitis (n=41) was slight in most of the patients. In 30 patients an edematous, and in 9 patients an exudative pancreatitis developed. In 2 patients, a necrotizing pancreatitis was observed and one patient died. CONCLUSION: The results of our study indicate that the analysis of routine administrative data allows for the simple assessment of the complication rates of elective ERCPs, even with interventions at the naive papilla.

[Are quality indicators derived from routine data suitable for evaluating hospital performance? First results using the AHRQ patient safety indicators in Germany]. / Eignen sich Qualitäitsindikatoren aus Routine- daten zur Qualitätsmessung im Krankenhaus? Erste Ergebnisse mit den amerikanischen Indi- katoren zur Patientensicherheit in Deutschland.

Patients and health insurances are increasingly interested in the quality of care provided by hospitals. Quality indicators are often used to evaluate the quality of inpatient treatment. Most of these evaluations require the collection of additional data. The patient safety indicators (PSI) introduced by the Agency for Healthcare Research and Quality (AHRQ) are precisely validated and exclusively depend on routine data. The original PSI definitions were transferable to the classifications of diagnosis, procedures and DRG used in Germany, and applied to routine data of 2.3 million cases from more than 200 hospitals. The comparison of the results to the US references reveals high concordance between the rates and demonstrates that PSI can be applied to detect critical incidents of patient care. For PSI-based hospital benchmarking further development of appropriate methods of risk adjustment is necessary.