[Epidemiology of long-term care: prevalence and utilisation as well as the healthcare of long-term care recipients in Germany]. / Epidemiologie der Pflege: Prävalenz und Inanspruchnahme sowie die gesundheitliche Versorgung von Pflegebedürftigen in Deutschland.

According to official statistics from the German long-term care insurance funds, around six out of every one hundred people with statutory health insurance are considered to be in need of long-term care. In this context, "need of long-term care" is defined according to the Eleventh Book of the Social Code (SGB XI) and therefore follows a demand-driven understanding of care, which also aligns with public discourse.In order to meet the increasing number of people in need of long term care - mostly caused by demographic change - with needs-based service structures, knowledge and evaluation of several factors are necessary: the prevalence of care dependency as defined by the SGB XI, the different degrees of severity, and the utilisation of long-term care and healthcare services.In this respect, the article presents findings and calculations based on currently available administrative data from German health and long-term care insurance funds and states its limitations. In terms of an actual epidemiological approach to the topic of long-term care, the aim should be broader reporting based on primary surveys.

[Pressure ulcer in German Nursing Homes: Quality Assessment Using Claims Data of Statutory Health and Long-Term Care Insurance]. / Qualitätsmessung mit Routinedaten im Pflegeheim am Beispiel Dekubitus.

OBJECTIVE: Although administrative data on health care in Germany are part of legal quality assurance in hospital care, they are not part of quality assessment in long-term care. However, claims data of German statutory health and long-term care insurance provide valuable information on outcome quality in nursing homes. Claims data-based quality measurement in nursing homes has hardly been researched and basic work in secondary data analysis is required. This involves the claims data linkage of both statutory health and long-term care insurance as well as new ways of operationalization for quality indicators and their risk adjustment for fair facility comparisons. Using the example of pressure ulcer (PU) occurrence in nursing homes, this study develops a claims data-based quality indicator and discusses potentials and methodological challenges. METHODS: The analysis is based on administrative data from eleven statutory health and long-term care insurance funds (AOK, 2015). The dataset covers 31% of German nursing homes. The operationalisation of PU acquired within the facility included ICD-10 diagnoses, and prescriptions on dressings. Relevance and validity of claims data on PU-specific aids were also checked in this context. Our risk adjustment strategy followed the one already established by the claims data-based QSR (Quality assurance of inpatient health-care). The Standardized Morbidity Ratio was based on logistic regression with robust standard errors. RESULTS AND CONCLUSION: In 2015, 7.2% of the nursing home residents had at least one PU incident within the facility. The outcome quality considerably varied between facilities. Overall, claims data-based measurement of PU occurrence as outcome quality indicator is feasible for inpatient long-term care and can contribute to transparency and evaluation of care in nursing homes. Information derived from an assessment of care dependency as well as within the amended legal quality assurance system for long-term care may offer new opportunities for routine data-based quality indicators in nursing homes.

Healthcare Utilization of Patients With Acute Coronary Syndrome in Germany.

BACKGROUND: The aim of this study was to determine the health care utilization of patients with acute coronary syndrome (ACS) of one German statutory health insurance. The utilization of ambulatory services as well as of inpatient rehabilitation should be regarded. Moreover, the study should reveal the prescription of drugs for secondary prevention. Here, patients showing guideline corresponding prescriptions should be compared with patients without such prescriptions. METHODS: A retrospective claims data analysis of one German statutory health insurance was conducted. Health care utilization was considered in the first year after an index hospitalization due to ACS. Beneficiaries for whom an ICD-10 discharge diagnosis of ACS was reported between January 1st 2007 and December 31st 2009 were included. In order to reveal differences in health care utilization depending on the type of ACS (STEMI versus NSTEMI/UA) stratified analyses were performed. Another stratification was done for patients with and without defined drug prescriptions. RESULTS: From 45,188 patients with ACS almost three quarters were assigned to the group of NSTEMI/UA. For 8.9% of all ACS patients (18.74% STEMI, 8.89% NSTEMI/UA), inpatient post-hospital rehabilitation related to ACS was recorded. Ambulatory care related to CHD diagnosis was utilized by 77.6% of patients, more often by STEMI than by NSTEMI/UA patients. For 36.7% and 45.7% of ACS patients, a prescription of aspirin or clopidogrel was recorded, respectively, 79.4% of STEMI patients received at least one prescription for antiplatelet drugs, the corresponding proportion of NSTEMI/UA was 59.8%. A considerable part of patients without prescription dropped out within the first 90 days after the index event. CONCLUSIONS: A claims data analysis of one German statutory health insurance fund showed that health care utilization of ACS patients varied depending on the ACS type. It is necessary to distinguish between STEMI and NSTEMI/UA patients when discussing the ambulatory drug utilization.