[Health Care Provision and Volume-Outcome Relationship for Acute Myocardial Infarction: Long-Term Analysis of German Nationwide Hospital Discharge Data 2005-2015]. / Versorgungsstrukturen und Mengen-Ergebnis-Beziehung beim akuten Herzinfarkt ­ Verlaufsbetrachtung der deutschlandweiten Krankenhausabrechnungsdaten von 2005 bis 2015.

BACKGROUND: Studies on acute myocardial infarction have reported that higher hospital volume is associated with better outcomes. In this context, changes of acute hospital care for myocardial infarction and of the volume-outcome relationship were analysed. The aim of this study was to assess developments of hospital care in order to derive approaches for improving care for acute myocardial infarction in German hospitals. METHODS: Inpatient cases of acute myocardial infarction in the first admitting hospital were identified from the complete national hospital discharge data (DRG statistics) 2005-2015. These cases were assigned to quintiles according to the annual myocardial infarction case volume of the treating hospital. RESULTS: From 2005 to 2015, there was an increase in the proportion of patients with myocardial infarction treated with a coronary intervention. In-hospital mortality in first treating hospitals declined from 12.1 to 8.7%. In all the years of observation, mortality was lower in higher volume hospitals quintiles than in the very-low volume quintile. In 2015, the risk of in-hospital death in hospitals with medium, high, or very high volume was 20% lower (adjusted OR 0.8 [95% KI 0.7-0.9] respectively), compared to very-low volume hospitals. More than 40% of very-low volume hospitals were located in urban areas. CONCLUSION: Hospital care for acute myocardial infarction in Germany can be improved further, if patients with heart attack symptoms were primarily allocated to hospitals with high volumes. For reasons of medical quality and economic efficiency, such a targeted referral is essential particularly in urban regions.

[Volume Growth of Inpatient Treatments for Spinal Disease - Analysis of German Nationwide Hospital Discharge Data from 2005 to 2014]. / Mengenentwicklung stationärer Behandlungen bei Erkrankungen der Wirbelsäule ­ Analyse der deutschlandweiten Krankenhausabrechnungsdaten von 2005 bis 2014.

BACKGROUND: Marked volume growth of inpatient treatments for spinal disease has been observed since diagnosis related groups (DRG) were introduced as payment for inpatient services in Germany. This study aims to analyse this increase by population and stratified by types of treatment. MATERIAL AND METHODS: Using German nationwide hospital discharge data (DRG statistics), inpatient treatments for spinal disease with or without surgery were identified. Trends in case numbers were analysed from 2005 to 2014 with consideration of demographic changes, in order to explore which age groups and which types of treatment are affected by volume growth. RESULTS: In 2014 (2005), 289 000 (177 000) inpatient treatments with surgery and 463 000 (287 000) treatments without surgery were identified. After adjusting for demographic factors, treatments with and without surgery exhibited a relative volume growth of + 50%. This increase affected higher age groups and women, in particular. Depending on the type of treatment, very different degrees of volume growth were observed. For example, disc surgeries adjusted for demographic change increased by about + 5%, whereas spinal fusion and vertebral replacement surgeries, kypho-/vertebroplasties and decompression of the spine more than doubled. Within the non-surgically treated cases, local pain therapies of the spine increased after adjustment for demographic changes by about + 142%. The conservatively treated cases showed a demographically adjusted increase of + 22%. CONCLUSION: Apart from demographic changes, this analysis cannot resolve the underlying causes of volume growth in treatments for spinal disease. However, the stratified analysis of various subgroups may help to classify these developments in a more differentiated manner. The results may support a more targeted debate about potential over- or misallocation of inpatient services in this area.