[Current Potential for Outpatient Care in Urology: What the IGES Report Means if Applied to Real Data]. / Aktuelle Ambulantisierungspotenziale in der Urologie - was bedeutet das IGES Gutachten auf Echtdaten angewendet.

BACKGROUND: The hospital reform initiated through an expert opinion of the German research institute IGES places great emphasis on the aspect of outpatient care. In this context, the current IGES guidelines extend further than has previously been the case. There are only very isolated instances where this theoretical potential has been translated into practical application in urology. This study aims to reflect the theoretical potential calculated using real data from urology with a view to practical application. MATERIAL AND METHODS: Using the algorithm of the "Hospital Structure Navigator" of DKTIG (Deutsche Krankenhaus TrustCenter und Informationsverarbeitung GmbH), focused on the extension of the AOP (Ambulatory Operations and Procedures) catalogue, section-21 data of the year 2022 from the Clinic for Urology at the University Hospital Schleswig-Holstein was analysed. The inclusion and exclusion criteria provided by IGES were applied, along with a limitation of the length of stay to two days and a minimum case number of 30 cases per year. Since this resulted in a very low potential for target DRGs (Diagnosis-Related Groups), the criteria were further modified. With this approach, a plausibility check for the outpatient treatment capability of identified cases was conducted. RESULTS: After applying the inclusion and exclusion criteria, only one applicable DRG (L18B) emerged, but with the expanded criteria, eight DRGs were identified. From the case flat rates determined, three appropriate OPS codes were identified:1.) Ureterorenoscopic removal of stones from the kidney with lithotripsy (5-550.31)2.) Transurethral resection of a bladder tumour, not fluorescence-supported (5-573.40)3.) Bougienage of a ureter, transurethral (5-560.2) CONCLUSION: With the current set of criteria defined by IGES for urology, no significant outpatient potential can be achieved. However, the expansion of criteria has uncovered areas that could be well implemented with a broader set of criteria and are currently seen more systematically in the realm of measures replacing inpatient procedures or hybrid DRGs. In addition to the need to clarify the fundamental outpatient feasibility of the methods on an individual case basis, there are limitations here, especially for multimorbid populations. Therefore, in expanding the catalogue, the legislator must take into account the higher risk and monitoring effort required for these patients.

Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure.

PURPOSE OF REVIEW: Heart failure (HF) is a major public health problem worldwide, affecting more than 64 million people [1]. The complex and severe nature of HF presents challenges in providing cost-effective care as patients often require multiple hospitalizations and treatments. This review of relevant studies with focus on the last 10 years summarizes the health and economic implications of various HF treatment options in Europe and beyond. Although the main cost drivers in HF treatment are clinical (re)admission and decompensation of HF, an assessment of the economic impacts of various other device therapy options for HF care are included in this review. This includes: cardiovascular implantable electronic devices (CIEDs) such as cardiac-resynchronisation-therapy devices that include pacemaking (CRT-P), cardiac-resynchronisation-therapy devices that include defibrillation (CRT-D), implantable cardioverter/defibrillators (ICDs) and various types of pacemakers. The impact of (semi)automated (tele)monitoring as a relevant factor for increasing both the quality and economic impact of care is also taken into consideration. Quality of life adjusted life years (QALYs) are used in the overall context as a composite metric reflecting quantity and quality of life as a standardized measurement of incremental cost-effectiveness ratios (ICER) of different device-based HF interventions. RECENT FINDINGS: In terms of the total cost of different devices, CRT-Ds were found in several studies to be more expensive than all other devices in regards to runtime and maintenance costs including (re)implantation. In the case of CRT combined with an implantable cardioverter-defibrillator (CRT-D) versus ICD alone, CRT-D was found to be the most cost-effective treatment in research work over the past 10 years. Further comparison between CRT-D vs. CRT-P does not show an economic advantage of CRT-D as a minority of patients require shock therapy. Furthermore, a positive health economic effect and higher survival rate is seen in CRT-P full ventricular stimulation vs. right heart only stimulation. Telemedical care has been found to provide a positive health economic impact for selected patient groups-even reducing patient mortality. For heart failure both in ICD and CRT-D subgroups the given telemonitoring benefit seems to be greater in higher-risk populations with a worse HF prognosis. In patients with HF, all CIED therapies are in the range of commonly accepted cost-effectiveness. QALY and ICER calculations provide a more nuanced understanding of the economic impact these therapies create in the healthcare landscape. For severe cases of HF, CRT-D with telemedical care seems to be the better option from a health economic standpoint, as therapy is more expensive, but costs per QALY range below the commonly accepted threshold.

The scientific publication score - a new tool for summarizing evidence and data quality criteria of biomedical publications.

The number of biomedical research articles increases by over 2.5 million publications each year, making it difficult to stay up to date. In this study, we introduce a standardized search and evaluation tool to combat this issue. Employing crowdsourcing, a large database of publications is gathered. Using a standardized data entry format, coined the "scientific publication score" (SPS), specific publication results can be easily aggregated, thereby allowing fast and accurate comparisons for clinical questions. The SPS combines two quality dimensions. The first captures the quality of evidence of the study using the evidence criteria defined by the Centre for Evidence-Based Medicine, Oxford, UK. The second is more fine-grained and considers the magnitude of statistical analyses on individual and specific results. From 2014 to 2019, experts of the European Bone and Joint Infection Society (EBJIS) were asked to enter data of relevant publications about prosthetic joint infection. Data and evidence levels of specific results were averaged, summarized and ranked. A total of 366 publications were divided into two groups: (I) risk factors (e.g., host-related factors, pre- and postoperative issues) with 243 publications and (II) diagnostic methods (e.g., laboratory tests, imaging methods) with 123 publications. After ranking, the highest score for risk factors of prosthetic joint infection were calculated by the SPS for anemia (mean 3.50 ±  SD 0.91), malignancy (mean 3.17 ±  SD 0.29) and previous alloarthroplasty (mean 3.00 ±  SD 0.35). A comparison of the full SPS ranking with the ranking determined at the 2018 International Consensus Meeting (ICM) on Musculoskeletal Infection resulted in a Spearman rank correlation coefficient of 0.48 and a p  value of 0.0382. The diagnostic methods ranked highest by the SPS were aspirate leucocyte count (mean 3.15 ±  SD 1.21), interleukin 6 (mean 3.14 ±  SD 1.07) and aspirate (neutrophils over 80 %) (mean 3.12 ±  SD 0.63). The comparison to the ICM ranking yielded a Spearman rank correlation coefficient of 0.91 and a p  value of 0.0015. Our pilot study evaluated a new tool for the quality assessment of specific results based on the quality of the source publication. The SPS is suitable for a ranking of specific results by evidence and data quality criteria important for systematic reviews.