[Reasons for hospitalization of people with dementia-A scoping review]. / Krankenhauseinweisungsgründe für Menschen mit Demenz ­ ein Scoping-Review.

BACKGROUND: Hospitalization represents a high burden for people with dementia, which can accelerate the decline of cognitive and motor skills. Behavioral changes and orientation problems may be increased in people with dementia during hospitalization. Some hospitalizations are potentially preventable by improved outpatient care. OBJECTIVE: To provide an up to date overview of the most common reasons for hospitalization of people with dementia or mild cognitive impairment. MATERIAL AND METHODS: A systematic literature search was conducted in the databases PubMed®, CINAHL and PsycINFO® in May 2020 to conduct the scoping review. Studies in German and English published between July 2010 and May 2020 were included. RESULTS: The most common reasons for hospitalization, which were named in the 14 included studies, were infectious diseases, especially respiratory infections and urinary tract infections, cardiovascular diseases (in general or specific, e.g. heart failure) and injuries, poisoning, fractures and falls, and gastrointestinal diseases. CONCLUSION: Most of the most common reasons for hospitalization are ambulatory care-sensitive hospital cases. Strengthening outpatient care for people with dementia may help prevent hospitalizations.

The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: a retrospective cohort study using health insurance claims data.

BACKGROUND: Multimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA. METHODS: We conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007-2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariable Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD. RESULTS: Among 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 9.6 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one's own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one's home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99-3.60 PWD; HR = 2.81, 95% CI 2.28-3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78-5.55 PWD; HR = 2.81, 95% CI 1.94-4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA. CONCLUSIONS: The quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed.

[Predictors of Admission to Nursing Home in Care-Dependent People - A Longitudinal Secondary Data Analysis]. / Prädiktoren für den Eintritt in ein Pflegeheim bei bestehender Pflegebedürftigkeit ­ Eine Sekundärdatenanalyse im Längsschnittdesign.

OBJECTIVE: To determine predictors of admission to nursing home by means of secondary data analysis of German statutory health insurance claims data and care needs assessments. MATERIALS AND METHODS: A retrospective longitudinal analysis was conducted covering the period 2006-2016 and using routine data. Health insurance data and care needs assessment data for people who became care dependent in 2006 and who lived in their own homes were merged. Cox regression analyses were conducted to identify predictors of admission to a nursing home. RESULTS: The study population comprised 48,892 persons. Dementia, cancer of the brain, cognitive impairment, antipsychotics prescriptions, hospitalized fractures, hospital stays over ten days, and higher age had the highest hazard ratios among the predictors. CONCLUSIONS: Knowledge about the predictors serves to sensitize health care professionals in the care of people in need of care. It facilitates identification of care needs in community-dwelling persons at an increased risk of admission to a nursing home.

Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care.

BACKGROUND: People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision. METHODS: We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators. RESULTS: The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive. CONCLUSIONS: Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary.

[Health-related outcomes in shared-housing arrangements-results of a rapid review]. / Gesundheitsbezogene Versorgungsoutcomes in ambulant betreuten Wohngemeinschaften ­ Ergebnisse eines Rapid Reviews.

BACKGROUND: Shared-housing arrangements are relevant as a possible living arrangement alternative to living in a nursing home or residing in their own home for people in need of care. The aim was to record demonstrable differences in health-related outcomes between residents of shared-housing arrangements and residents of nursing homes. MATERIALS AND METHODS: A rapid review was conducted to identify health-related outcomes in shared-housing arrangements. The literature search was carried out in September 2017 in the databases PubMed, CINAHL, Gerolit and LIVIVO. Comparative studies of German or English language were included when the nursing home was examined as a control group. RESULTS: The majority of the 21 studies included describes a favorable contribution of shared-housing arrangements compared to nursing homes. Quality of life is a frequently examined outcome that provides evidence of an advantage of shared-housing arrangements, especially for persons with dementia. CONCLUSION: A variety of health-related outcomes were examined. The results provide indications of favorable contributions of shared-housing arrangements. For the most part, there is still no conclusive evidence for outcomes based on studies of higher levels of evidence.

Data linkage of German statutory health insurance claims data and care needs assessments preceding a population-based cohort study on nursing home admission.

OBJECTIVES: We perform and evaluate record linkage of German Care Needs Assessment (CNA) data to Statutory Health Insurance (SHI) claims data. The resulting dataset should enable the identification of factors in healthcare predicting the time between the onset of long-term care dependency and the admission to a nursing home in Germany in subsequent analyses. DESIGN: A deterministic record linkage was conducted using the key variables region, sex, date of birth and care level. In further steps, the underlying cause of care dependency (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10)) was added for a higher level of distinction. Before linkage, the suitability of the two datasets for these procedures was assessed. After linkage, the results of each stage were analysed and the resulting dataset was evaluated cross-sectionally with respect to bias generated through this process. SETTING: The study comprises data from the German SHI and Statutory Long-Term Care Insurance. PARTICIPANTS: The study cohort comprised 158 069 individuals who became care dependent in 2006. We obtained CNA data for the year 2006 including 188 935 individuals. RESULTS: We could link CNAs to 66 310 individuals of the original study cohort, corresponding to 42.0%. Records from two federal states could not be matched due to missing data. Linkage rates were lower where more people shared the same attributes. The resulting dataset showed minor differences regarding age, sex and care level compared to the original cohort. CONCLUSIONS: Data linkage between German SHI claims data and CNA data is feasible. Failure to link was mostly attributable to a lack of distinction between individuals using available identifiers. The resulting dataset contains relevant information from both health services provision and functional status of care dependent people and is suitable for further analyses with critical reflection of representativity.

[Quality of ambulatory medical care in the context of age and care-dependency: Results of a cross-sectional analysis of German health claims data]. / Ambulante Versorgungsqualität im Kontext von Alter und Pflegebedürftigkeit ­ Ergebnisse einer Querschnittsanalyse von GKV-Routinedaten aus Deutschland.

BACKGROUND AND AIM: Care-dependent community dwelling people are vulnerable to deficits in medical care provided by the German statutory health insurance (GKV). Quality of care indicators (QIs) contribute to the identification of deficits and of potential for the optimization of care. To investigate the discriminatory ability of QIs in a population of elderly people with and without care dependency and different age structures, insights into the feasibility of such QIs based on health claims data are of interest. The aim of this study is an explorative approach to health claims based QIs for the ambulatory medical care of care-dependent elderly which can be used to optimize health care processes. METHODS: This cross-sectional study used anonymised health claims data of a sample of statutory health insurance members from all German federal states of the year 2016. The sample consisted of 5,934,986 insured persons aged 65 years or older, who were community dwelling with (n = 785,135) or without care-dependency (n = 4,799,369) or who were residents of a nursing home (n = 350,482). 47 QIs focusing on ambulatory care-sensitive conditions such as, asthma, chronic obstructive pulmonary disease, cardiovascular diseases, diabetes mellitus type 2 and depression were calculated on a quarterly basis and are reported descriptively as the arithmetic mean of four quarters stratified by place of residence and age group. RESULTS: The majority of QI values vary between the observed groups with an overarching trend to the disadvantage of older individuals. Even though care-dependent insured persons show higher prevalence rates of the underlying diagnoses of the QIs (except for asthma diagnoses), they score more detrimental QI values than those without care-dependency. This finding holds true after stratification by age group. DISCUSSION: This study describes differences in the quality of medical care for elderly people. Considering prior empirical evidence of deficits in medical care, factors that act as barriers or facilitators of guideline-oriented medical care need to be investigated. The contribution of patients' preferences, access to medical care or prioritisation by medical and nursing care providers when initiating diagnostic or therapeutic procedures remains unclear. Methodical limitations of this study notably derive from the selection process of the observed groups using two stratification variables. For the further development of QIs other influencing factors on both an individual and a population-related level as well as the providers' ability to influence these factors need to be taken into account and incorporated in a risk-adjusted description of QIs. CONCLUSION: Measurement of ambulatory medical care of an elderly population based on health claims data is feasible and shows differences in care processes of older and care-dependent individuals if place of residency and level of care-dependency are considered. Further development of the QIs explored should incorporate a thorough methodical foundation, particularly with regard to risk adjustment. In addition, the contribution of individual and contextual factors on QIs remains to be examined with a view to the community-dwelling care-dependent elderly and their ongoing residency in this setting.

[Influencing factors for nursing home admission in case of pre-existing need of care - a systematic review]. / Einflussfaktoren für einen Heimeintritt bei bestehender Pflegebedürftigkeit ­ eine systematische Übersichtsarbeit.

INTRODUCTION: Knowledge about predictors of nursing home placement is highly relevant. If they are known, targeted interventions such as counselling can help prevent or delay relocation to a nursing home. Above all, preventive and structural measures can target influenceable predictors. The aim of the review was to map predictors of nursing home admission and thus the permanent stay in inpatient long-term care for the target group of people with a pre-existing need for care. METHODS: A systematic literature search in the databases The Cochrane Library, PubMed, CINAHL, GeroLit and CareLit® was conducted in September 2017. Longitudinal studies with quantitative analyses were included. The methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: 45 cohort studies were included. 21 studies examined study populations with need for care, in 24 studies the care status was unclear. A variety of predictors of nursing home admission with at least one-and-a-half times higher risk for both study populations could be identified, including higher age, dementia, underweight, higher age of caregiver, psychiatric symptoms, smoking status, ethnicity, challenging behaviour in people with dementia, higher number of hospitalizations and lower level of life satisfaction. DISCUSSION: All the predictors identified are relevant to people in need of care. No predictors for the study population with need of care could be identified that are particularly important in contrast to persons with an unclear care status. However, the quality of studies among people with care and support needs is limited compared to studies targeting people with unclear care status. CONCLUSIONS: Many factors seem to predict the admission to a nursing facility. For the first time, these factors are listed in this systematic review for the target group of people in need of care. Interventions or preventive measures based on known influenceable predictors can help prevent or delay nursing home admission.

[A systematic review on population-based indicators of the quality of care in formal and informal provider networks and their application in health economic evaluations]. / Systematische Literaturübersicht zu populationsbasierten Indikatoren der Versorgungsqualität in formalen und informellen Versorgungsnetzwerken und deren Einsatz in gesundheitsökonomischen Evaluationen.

BACKGROUND: Provider networks in healthcare can emerge as either formal or informal networks. For sector-encompassing population-based quality measurement in informal networks, which allows for conclusions about the cost-effectiveness of care for home-dwelling persons in need of care, a comprehensive review on suitable quality indicators that can be derived from German social health insurance claims data is still lacking. OBJECTIVE: Primary review questions: Which population-based indicators of quality of care in formal and informal provider networks are described in the international literature? Which of these indicators are used as outcome parameters in health economic evaluations, and what are the methodological approaches in these evaluations? Rating approaches and methods for establishing thresholds as well as the validity and suitability of quality indicators to predict quality of care as well as the potential for the calculation of quality indicators based on German social health insurance claims data are included in the secondary review questions. SEARCH METHODS: Databases searched in May 2017 and July 2018 included PubMed, The Cochrane Library und NHS EED, CINAHL, GeroLit and EconLit. In addition, we hand-searched references of the studies identified and screened the project database Health Services Research Germany. SELECTION CRITERIA: Quantitative design, German or English language. Any kind of formal or informal network for which distinct members regarding single providers are named and population-based quality indicators for adults (18 years or older) are described. DATA COLLECTION AND ANALYSIS: Two authors (Cohen's Kappa = 0.64) independently screened titles, abstracts and full texts. A third independent reviewer was consulted in cases of uncertainty regarding the inclusion of studies. Critical appraisal was conducted using AMSTAR, the Cochrane Risk-of-Bias Tool, the Newcastle-Ottawa Scale (NOS), the Appraisal Tool for Cross-Sectional Studies (AXIS) and the criteria of the Drummond Checklist. MAIN RESULTS: 137 studies were included, five of which evaluated informal provider networks and applied indicators for medical conditions such as diabetes mellitus or heart failure or events like ambulatory care-sensitive hospitalisations, which were also utilized for formal networks. Five out of 14 health economic evaluations also assessed associations between costs and quality of care. The majority of studies did not include evidence on rating approaches and/or thresholds. Even though the validity and reliability of the used data in single studies is frequently discussed, only one in four of the included studies undertook a discussion of the suitability of the applied indicators. 121 studies explored indicators that can, in whole or in part, potentially be calculated on the basis of German social health insurance claims data and that target medical conditions such as osteoarthritis, asthma, chronic pain, chronic obstructive pulmonary disease, cardiovascular disease, dementia, diabetes mellitus, osteoporosis or mental health disorders as well as ambulatory care-sensitive events, appropriate medication of the elderly and polypharmacy, preventive care and continuity of care. AUTHORS' CONCLUSIONS: This systematic review identified quality indicators that were predominantly used in formal provider networks and, with sufficient testing and further development, include the possibility of being used for measuring the quality of care in informal networks. The need for further research on suitable approaches to measure the interactions of quality of care and costs and on the validity, reliability and predictive suitability of single indicators as well as the finding that quality indicators especially developed for the German ambulatory sector were rarely used in the included studies constitute promising starting points for both an intensified methodological debate and the critical discussion of issues concerning population-based, sector-encompassing measurement of quality of care in health services research.