The patients` perspective on home-based infusion: A longitudinal observational study in the German healthcare setting for patients with lysosomal storage disorders treated with enzyme replacement therapy.

Background: Lysosomal storage diseases (LSDs), metabolic disorders resulting in build-up of endogenous waste and progressive organ damage, can be treated with intravenous enzyme replacement therapy (ERT). ERT can be administered either in specialized clinics, at a physician's office or in the home care setting. Legislative goals in Germany strive to shift to more outpatient care while maintaining treatment objectives. This study investigates the patient perspective on home-based ERT in terms of acceptance, safety, and treatment satisfaction in LSD patients. Methods: This was a longitudinal observational study, carried out under real-world conditions in patients' home environment, covering 30 months from January 2019 to June 2021. Patients with LSDs who were deemed suitable for home-based ERT by their physicians were recruited to the study. Patients were interviewed before the start of the first home-based ERT and then at regular intervals thereafter using standardized questionnaires. Results: Data from 30 patients were analyzed: 18 with Fabry disease, 5 with Gaucher disease, 6 with Pompe disease and 1 with Mucopolysaccharidosis type I (MPS I). Age ranged from 8 to 77 years (mean age 40). The reported average waiting time prior to infusion of more than half an hour decreased from 30% of the patients affected at baseline to 5% across all follow-up time points. All patients felt adequately informed about home-based ERT throughout follow-ups and reported that they would choose home-based ERT again. At almost each time point, patients indicated that home-based ERT had improved their ability to cope with the disease. All but one patient indicated feeling safe at each follow-up time point. Compared to 36.7% at baseline, only 6.9% of patients reported a need for improvement in their care after 6 months of home-based ERT. Mean treatment satisfaction increased by approximately 1.6 scale points after 6 months of home-based ERT compared to baseline, and by another 0.2 scale points after 18 months. In terms of quality of care, all but one patient rated home-based ERT as an equivalent alternative throughout follow-ups. Patients would recommend home-based ERT to other suitable LSD-patients. Conclusion: Home-based ERT increases patients' treatment satisfaction, and patients perceive the quality of care as an equivalent alternative, compared to ERT in a center, clinic, or at a physician's office.

[Prevalence, Costs of Medical Treatment and Modalities of Dialysis-dependent Chronic Renal Failure in Germany: Comparison of Dialysis Care of Nursing Home Residents and in Outpatient Units]. / Prävalenz, Kosten der Versorgung und Formen des dialysepflichtigen chronischen Nierenversagens in Deutschland: Vergleich der Dialyseversorgung innerhalb und außerhalb stationärer Pflegeeinrichtungen.

STUDY OBJECTIVES: Current estimates on the prevalence of chronic renal failure and the costs of dialysis in Germany's population are not available. The aim of this study was to assess the prevalence of dialysis-dependent chronic renal failure and treatment costs of dialysis-dependent patients in Germany as well as differences between those residing in nursing homes and those treated in outpatient units. METHODS: Health insurance claims from 4.5 million anonymized patients in the WIG2 research database were analyzed. Patients of all ages who had received outpatient dialysis treatment for chronic renal failure in 2017 (using uniform value scale code 13602) were included. These insurance claims were extrapolated to the German statutory health insurance population and, using official statistics, further to the entire population of Germany. Data on comorbidities, use of health resources, and costs were compared among patients residing in nursing homes and those treated in outpatient units. RESULTS: In 2017, there were 87,255 dialysis-dependent statutory health insurance patients (≙1,054 person/1 million population, pmp), and 100,202 in Germany's whole population (≙1,210 pmp). About 8% of dialysis-dependent patients (n=7,676) were living in nursing homes. Our analyses predict an increase in dialysis-dependent patients of about 20-23% (up to 120,000-123,000), with an increase of dialysis-dependent nursing home residents of 37-44% (up to 10,500-11,000) by 2040. Almost all dialysis-dependent patients were treated with hemodialysis; peritoneal dialysis was rarely observed. The average annual treatment costs for dialysis-dependent patients residing in nursing homes amounted to 57,205 Euro and 53,996 Euro per patient respectively, with total annual statutory health insurance treatment costs amounting to about 4.73 billion Euro in 2017. CONCLUSION: This study presents current estimates for dialysis-dependent chronic renal failure in Germany. Our findings on prevalence are comparable to data from other European countries and suggest a considerable increase in dialysis dependency by 2040, particularly for nursing home residents, resulting in a further increase in dialysis care costs. Hemodialysis was the most commonly used dialysis modality in patients living both in and out of nursing care facilities, with peritoneal dialysis rarely being used.

Predictors of patient satisfaction after cardiac pacemaker implantation or ICD implantation.

BACKGROUND AND AIM OF THE STUDY: The study aimed to identify predictors of satisfaction of patients receiving a cardiac pacemaker or an implantable cardioverter-defibrillator (ICD). METHODS: This was a cross-sectional study measuring patient satisfaction postdischarge by using a mailed questionnaire. Study participants included a random sample of hospitalized patients who had undergone implantation of a pacemaker or ICD in 30 hospitals in Germany. RESULTS: Data from 548 respondents (response rate 17.3%) were available for analyses. Logistic regression analysis revealed the following factors associated with satisfaction of inpatients (P < .05): outcome of treatment (odds ratio [OR] = 11.51, 95% confidence interval [CI] = 4.62-28.64), individualized medical care by physicians (OR = 5.04, 95% CI = 2.13-11.92), kindness of nurses (OR = 4.83, 95% CI = 1.52-15.42), and physicians (OR = 3.46, 95% CI = 1.03-11.65), organization of procedures and operations, respectively (OR = 4.45, 95% CI = 1.85-10.75) and thoroughness of the discharge instructions (OR = 2.69, 95% CI = 1.17-6.20). CONCLUSIONS: This study identified six predictors of satisfaction among pacemaker and ICD patients that can be addressed by healthcare providers to increase patients' evaluation of the hospitalization. Identified predictors of satisfaction are alterable by health care professionals and, thus, should be focused on to increase satisfaction ratings of patients who have undergone implantation of a pacemaker or ICD.

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence and disease burden through routine insurance data is challenging because of under-diagnosis and under-treatment, particularly for early stage disease in health care systems where outpatient International Classification of Diseases (ICD) diagnoses are not collected. This poses the question of which criteria are commonly applied to identify COPD patients in claims datasets in the absence of ICD diagnoses, and which information can be used as a substitute. The aim of this systematic review is to summarize previously reported methodological approaches for the identification of COPD patients through routine data and to compile potential criteria for the identification of COPD patients if ICD codes are not available. METHODS: A systematic literature review was performed in Medline via PubMed and Google Scholar from January 2000 through October 2018, followed by a manual review of the included studies by at least two independent raters. Study characteristics and all identifying criteria used in the studies were systematically extracted from the publications, categorized, and compiled in evidence tables. RESULTS: In total, the systematic search yielded 151 publications. After title and abstract screening, 38 publications were included into the systematic assessment. In these studies, the most frequently used (22/38) criteria set to identify COPD patients included ICD codes, hospitalization, and ambulatory visits. Only four out of 38 studies used methods other than ICD coding. In a significant proportion of studies, the age range of the target population (33/38) and hospitalization (30/38) were provided. Ambulatory data were included in 24, physician claims in 22, and pharmaceutical data in 18 studies. Only five studies used spirometry, two used surgery and one used oxygen therapy. CONCLUSIONS: A variety of different criteria is used for the identification of COPD from routine data. The most promising criteria set in data environments where ambulatory diagnosis codes are lacking is the consideration of additional illness-related information with special attention to pharmacotherapy data. Further health services research should focus on the application of more systematic internal and/or external validation approaches.

A Measurement Scale to Assess Children's Satisfaction with Hospitalization in the Andalusian Population.

Background: Patient satisfaction is a principal indicator in the evaluation of the stay of pediatric patients in hospitals, since its consequences can emotionally interfere with health treatment. The aim of this study was to obtain a valid scale to assess children's satisfaction with their time spent as a patient in an Andalusian hospital. Method: The Children's Satisfaction with Hospitalization Questionnaire (CSHQ) was applied to 623 pediatric patients hospitalized in Andalusia. An exploratory factor analysis (EFA) showed one dimension underlying the children's satisfaction with their hospitalization. After that, we developed a depuration analysis process to achieve a valid and unidimensional scale to assess children's satisfaction. Results: The eleven-item one-dimension solution showed suitable consistency and goodness-of-fit indices. The final scale addresses hosting aspects as the main dimension of a minor's satisfaction in Andalusian hospitals. Conclusion: A unidimensional scale has been determined for the assessment of children's satisfaction with their stay in Andalusian hospitals based on hosting aspects. Nonetheless, other dimensions underlying the satisfaction of patients should also be considered.

Effects of perceptions of care, medical advice, and hospital quality on patient satisfaction after primary total knee replacement: A cross-sectional study.

INTRODUCTION: The increase in the number of patients presenting with osteoarthritis in the past decade has led to a 32% increase in knee replacement surgeries designed to reduce restrictions on patient movement and improve their quality of life. Patient satisfaction is becoming an increasingly important indicator of quality of care. This study was designed to identify predictors of various service components in the treatment process and hospital key performance indicators significantly associated with patient satisfaction. MATERIALS AND METHODS: A multicenter cross-sectional study was conducted with 856 patients having their primary total knee replacements at 41 hospitals. Patient satisfaction was queried via a validated, multidimensional questionnaire mainly using a six-point scale. In addition to bivariate calculations, patient satisfaction was the dependent variable in a binary logistic regression model. RESULTS: The bivariate analysis showed a strong association between satisfaction and sex (male or female), the patients' health before admission, and the length of stay. The number of cases treated at each hospital did not reveal any impact on satisfaction. The multivariate analysis identified three predictors associated with overall satisfaction. The strongest factor was the treatment outcome and the weakest was the quality of food. It became apparent that the statutory procedure minimums were not being met. CONCLUSIONS: The relevant factors influencing patient satisfaction were partially the same as previous study results and allowed more detailed conclusions. The results provide suggestions across hospitals that could help health care providers better meet needs of patients after knee arthroplasties.

Effects of continuous and intermittent renal replacement therapies among adult patients with acute kidney injury.

Background: Dialysis-dependent acute kidney injury (AKI) can be treated using continuous (CRRT) or intermittent renal replacement therapies (IRRT). Although some studies suggest that CRRT may have advantages over IRRT, study findings are inconsistent. This study assessed differences between CRRT and IRRT regarding important clinical outcomes (such as mortality and renal recovery) and cost-effectiveness. Additionally, ethical aspects that are linked to renal replacement therapies in the intensive care setting are considered. Methods: Systematic searches in MEDLINE, EMBASE, and Cochrane Library including RCTs, observational studies, and cost-effectiveness studies were performed. Results were pooled using a random effects-model. Results: Forty-nine studies were included. Findings show a higher rate of renal recovery among survivors who initially received CRRT as compared with IRRT. This advantage applies to the analysis of all studies with different observation periods (Relative Risk (RR) 1.10; 95% Confidence Interval (CI) [1.05, 1.16]) and to a selection of studies with observation periods of 90 days (RR 1.07; 95% CI [1.04, 1.09]). Regarding observation periods beyond there are no differences when only two identified studies were analyzed. Patients initially receiving CRRT have higher mortality as compared to IRRT (RR 1.17; 95% CI [1.06, 1.28]). This difference is attributable to observational studies and may have been caused by allocation bias since seriously ill patients more often initially receive CRRT instead of IRRT. CRRT do not significantly differ from IRRT with respect to change of mean arterial pressure, hypotensive episodes, hemodynamic instability, and length of stay. Data on cost-effectiveness is inconsistent. Recent analyzes indicate that initial CRRT is cost-effective compared to initial IRRT due to a reduction of the rate of long-term dialysis dependence. As regards a short time horizon, this cost benefit has not been shown. Conclusion: Findings of the conducted assessment show that initial CRRT is associated with higher rates of renal recovery. Potential long-term effects on clinical outcomes for more than three months could not be analyzed and should be investigated in further studies. Economical analyzes indicate that initial CRRT is cost-effective when costs of long-term dialysis dependence are considered. However, transferability of the economic analyzes to the German health care system is limited and the conduction of economical analyzes using national cost data should be considered.

Determinants of patient satisfaction and their willingness to return after primary total hip replacement: a cross-sectional study.

BACKGROUND: Surveys of patient satisfaction and their willingness to return can be used for the optimization of processes, improving their quality, and increasing the satisfaction and loyalty in customers. This study looked at the factors significantly associated with patient satisfaction after primary total hip replacement (THR), and which affect the patients' willingness to return to the same hospital for future treatment, even when unrelated to their THR. METHODS: Data for the study was collected by written survey from 810 patients of 43 hospitals following their THR. Satisfaction and willingness to return were measured using a validated, multidimensional questionnaire, primarily based on six-point scales, which were then evaluated together with routine hospital data, according to bivariate and multivariate analyses. RESULTS: The bivariate analysis showed a strong correlation between satisfaction or willingness to return and the health condition before hospitalization as well as the perceived length of stay. In contrast, the patient's gender and the number of inpatient cases in a hospital with THR had no influence. The binary logistic regression analyses identified three predictors associated with overall satisfaction and seven predictors associated with willingness to return. The strongest factor for both dependent variables was the perceived length of stay, and the weakest factor for satisfaction was the treatment outcome. CONCLUSIONS: Overall, with all of the medical and service-related issues considered, high levels of satisfaction were reached. Despite the high satisfaction scores, probable causes for declining the willingness to return were identified. The results provide incentives for hospitals and medical professionals to attain a high satisfaction levels in their THR patients.

Patient satisfaction in urology: effects of hospital characteristics, demographic data and patients' perceptions of received care.

PURPOSE: To identify factors that are significantly associated with patient satisfaction in urology and to assess the extent to which satisfaction ratings might be related to hospital and patient characteristics. MATERIALS AND METHODS: Data used in this study were obtained from 1040 randomly selected urology patients discharged from nine hospitals who responded to a mailed survey. Bivariate and multivariate techniques were used to reveal relations between patient assessments of received care, hospital and patient characteristics. RESULTS: Bivariate analysis showed a strong association between satisfaction scores and length of stay, provider status, work load of nurses and hospital size, with weaker findings pertaining to type of hospital (teaching versus non-teaching) and patient demographics. The multivariate analysis identified nine vari­ables which are associated with overall satisfaction. Strong factors were treatment outcome, the interper­sonal manner of medical practitioners and nurses, as well as hotel aspects like accommodation and quality of food. Variables reflecting information receiving about the undergoing treatment were not found to have a significant influence on patient satisfaction. CONCLUSION: This study identified variables that are related to satisfaction in a urological setting and de­livers information about aspects of the hospital stay that are not perceived as relevant by patients. These findings support healthcare professionals with valuable information to meet needs and preferences of pa­tients in urology.

Patient satisfaction and willingness to return to the provider among women undergoing gynecological surgery.

PURPOSE: To identify factors associated with 'patient satisfaction' and 'willingness to return to the provider' in gynecology and to assess similarities as well as differences between the two concepts. METHODS: Study data were obtained from 968 randomly selected gynecology patients discharged from 22 hospitals who responded to a mailed survey. The validated instrument consisted of 37 items and assessed medical and service aspects of care, patient and visit characteristics. The dependent variables consisted of ratings of willingness to return to the provider and overall satisfaction. Bivariate and multivariate techniques were used to reveal relationships between indicators and both dependent variables. RESULTS: The multivariate analyses identified individualized medical care, kindness of medical practitioners, treatment outcome and organization of discharge as the most consistent predictors of the patients' likelihood to return and overall satisfaction. Differences between both concepts pertained to the significance of service variables (cleanliness and quality of food) for patient satisfaction and visit-related characteristics (length of stay and occurrence of complications) for willingness to return. CONCLUSIONS: Study findings suggest that patient satisfaction and willingness to return to the provider do not reflect the same concepts. Although service aspects such as quality of food influence satisfaction ratings, they do not increase the likelihood that patients choose the same hospital in case of another treatment. Communication between patients and medical practitioners is highly important. Revealed predictors of both concepts are alterable by healthcare professionals and should be focused on to enhance patient satisfaction and to increase the probability patients return to their provider.

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Research has established a clear correlation between high patient satisfaction and better clinical outcomes, so understanding what can improve patients' perception of healthcare services may help improve care.

Analysis of factors associated with patient satisfaction in ophthalmology: the influence of demographic data, visit characteristics and perceptions of received care.

PURPOSE: To identify factors associated with satisfaction among patients receiving ophthalmic services and to indicate the intensity of this relationship. METHODS: The data used was obtained through a self-administered, post-visit questionnaire from randomly selected 507 patients treated in seven eye clinics in Germany. The instrument assessed satisfaction with several aspects of care and patient baseline and visit characteristics. Bivariate and multivariate techniques were used to reveal relations between indicators and overall satisfaction. RESULTS: Factor analysis yielded two factors, 'medical aspects of care' and 'performance of service', explaining 55% of total variance. Cronbach's α coefficient for both scales indicates acceptable internal consistency. Bivariate analysis showed strong relations between overall satisfaction and perceived care with weaker findings pertaining to visit characteristics. Not any of the demographic variables was associated with overall satisfaction. Perceived length of stay, intention to return to the clinic, and occurrence of complications were influential attributes on satisfaction ratings. The multivariate analysis identified seven factors associated with overall satisfaction including the treatment outcome (OR: 4.57), kindness of the nurses (OR: 5.27) and medical practitioners (OR: 2.23), room amenities (OR: 2.72), organization of procedures and operations (OR: 2.71), information about anaesthesia (OR: 1.95), and cleanliness (OR: 1.93). CONCLUSIONS: Factors associated with patient satisfaction in ophthalmology concern medical aspects like the organization of procedures and operations but also aspects that are not directly related to technical care, such as kindness of the nurses and cleanliness. Results show that patients' subjective experiences of received care and services relate more strongly and consistently to overall satisfaction than patient demographic data or visit characteristics. Revealed factors predicting patient satisfaction are alterable by health care managers. Therefore, focusing on these attributes represents an effective manner to enhance patient satisfaction in ophthalmology.

Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany.

OBJECTIVE: To identify key determinants of patient satisfaction. DESIGN: Data used were obtained through a self-administered, post-visit questionnaire by random sampling during the period of January 2009 to September 2009. SETTING: Thirty-nine hospitals in Germany. PARTICIPANTS: A total of 8,428 patients. MAIN OUTCOME MEASURE: Global patient satisfaction was measured by a single item question. Attributes of medical aspects of care were measured using 12 items, performance of service using 3 items and different dimensions of patient expectations using 12 items. Medical aspects of care and performance of service items were entered into logistic regression analysis to identify determinants of patient satisfaction. RESULTS: The results of the analysis showed that there are 10 determinants of global patient satisfaction. The outcome of treatment was overall, the most salient predictor followed by nursing kindness as the second most important component. Items reflecting information receiving about the undergoing treatment do not have a major influence on patient satisfaction. CONCLUSION: The analysis identified key determinants that should be altered first in order to improve global patient satisfaction. The results also indicate that some aspects of the hospital stay are not seen as relevant by patients and therefore are unrelated to satisfaction ratings. The findings suggest that variables measuring patients' perceptions of care are more important determinants of global patient satisfaction in comparison to demographics and visit characteristics. Results of the present study have implications for health providers aiming at improving the service quality and quality of care.

Factors associated with patient satisfaction in surgery: the role of patients' perceptions of received care, visit characteristics, and demographic variables.

BACKGROUND: Measures of satisfaction of surgical patients can be used to evaluate and redesign the process of care or to complement established procedures to improve quality of services. However, study findings regarding aspects of patient satisfaction are often inconsistent and depend on the setting. The primary goals of this research were to identify factors associated with satisfaction among patients in a surgical setting. MATERIALS AND METHODS: Data used in this study were obtained from randomly selected 2699 surgical patients discharged during January-December 2008 from 26 hospitals who responded to a mailed survey. The instrument assessed satisfaction regarding 23 items of perceived care, patient demographic, and visit characteristics. Bivariate and multivariate techniques were used to reveal relations between indicators and overall satisfaction. RESULTS: Bivariate statistics showed strong relations between overall satisfaction and perceived care with weaker findings pertaining to demographic and visit characteristics. The Multivariate logistic regression predicting overall satisfaction demonstrated that patients receiving surgical services predominantly have similar demands and priorities regardless of age and gender. The strongest factors were (P < 0.05) the interpersonal manner of medical practitioners and nurses, organization of operations, admittance, and discharge, as well as perceived length of stay. CONCLUSIONS: This study identified factors that are related to satisfaction of surgical patients and indicated the intensity of this relationship. These findings support health care providers and medical practitioners with valuable information to meet needs and preferences of patients receiving surgical services.