[Medication-based secondary prevention in patients with peripheral arterial occlusive disease : An analysis based on secondary data]. / Medikamentöse Sekundärprävention bei Patienten mit peripherer arterieller Verschlusskrankheit : Eine sekundärdatenbasierte Analyse.

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is an atherosclerotic vascular disease with high morbidity and mortality. A consistent medication-based secondary prevention is part of the essential and evidence-based treatment of PAOD. The aim of this study was to ascertain the status quo of medicinal secondary prevention based on submitted prescriptions. METHODS: In the time period from 2014 to 2017 patients with a confirmed PAOD coding (I70.2-/I73.9-) were identified based on secondary data of the Association of Statutory Health Insurance Physicians Westphalia-Lippe (KVWL). The prescriptions submitted with respect to platelet inhibitors, oral anticoagulants, lipid lowering therapy (LLT) and angiotensin-converting enzyme (ACE) inhibitors in the fourth quarter year after diagnosis coding were collated. RESULTS: In the diagnosis period 2014/2015 a total of 238,397 patients had PAOD in the catchment area of the KVWL. The proportion of submitted prescriptions in the fourth quarter year after diagnosis was 25.9% for LLT, 13.6% for acetylsalicylic acid, 4.5% for clopidogrel, 5.5% for vitamin K antagonists (VKA), 3.5% for non-vitamin K­dependent oral anticoagulants (NOAC) and 26.8% for ACE inhibitors. Over the course of the 3 years (n = 241,375 patients with PAOD 2016/2017) the proportion of submitted prescriptions for all substances except VKA increased (p < 0.001), whereby the largest relative increase was noted for NOAC (relative increase of 81.7%). CONCLUSION: The guideline-conform medicinal secondary prevention in patients with PAOD in Germany is still in need of improvement. A consistent implementation of evidence-based medicinal secondary prevention harbors a great potential for improvement of the overall prognosis in patients with PAOD.

Impact of suspending minimum volume requirements for knee arthroplasty on hospitals in Germany: an uncontrolled before-after study.

BACKGROUND: In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Since then, MVRQs were implemented for seven hospital procedures. This study evaluates the effect of a system-wide intermission of MVRQ for total knee arthroplasty (TKA), demanding 50 annual cases per hospital. METHODS: An uncontrolled before-after study based on federal-level data including the number of hospitals performing TKA, and TKA cases from the external hospital quality assurance programme in Germany (2004-2017). Bi- and multivariate analyses based on hospital-level secondary data of TKA cases and TKA quality indicators extracted from hospital quality reports in Germany (2006-2014). RESULTS: The number of TKAs performed in Germany decreased by 11% after suspending the TKA-MVRQ in 2011, and rose by 13% after its reintroduction in 2015. The number of hospitals with less than 50 cases rose from 10 to 25% and their case share from 2 to 5.5% during suspension. Change in hospital volume after the suspension of TKA-MVRQ was not associated with hospital size, ownership, or region. All four evaluable quality indicators increased significantly in the year after their first public reporting. Compared to hospitals meeting the TKA-MVRQ, three indicators show slight but statistically significant better quality in hospitals below the TKA-MVRQ. CONCLUSIONS: In Germany, TKA-MVRQs seem to induce in-hospital caseload adjustments rather than foster regional inter-hospital case transfers as intended.

Feasibility testing of the Core set of quality Indicators for Paediatric Primary Care in Europe, COSI-PPC-EU.

There is a need to measure and improve the quality of paediatric primary care in Europe where major differences in the delivery and outcomes of child health care exist. A collaborative panel of paediatric senior experts developed a Core Set of Indicators for Paediatric Primary Care in Europe by compiling 42 quality indicators in a modified consensus process following the RAND/UCLA appropriateness method. The aim of this study was to explore the feasibility of the quality indicator set in European paediatric primary care practices. Seventy-nine practices from eight countries participated in a detailed online interview. The practices rated the applicability, relevance, reliability and acceptance of the 42 quality indicator as well as the availability, technical feasibility and effort to retrieve the needed data from their medical records. Most quality indicators were considered applicable, available, reliable, acceptable and relevant for monitoring quality of care in paediatric primary care. Respondents rated feasibility and effort to retrieve the data lowest because of difficulties collecting the data from the medical records.Conclusion: European paediatric primary care practices generally agree with the proposed quality indicator set. They document most of the parameters. However, the collection of specific needed values from available routine patient-data is considered technically difficult and time-consuming. What is Known? • Paediatric primary care systems in Europe show striking differences in their performance. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. • A Core Set of 42 quality indicators for paediatric primary care in Europe was developed by European paediatricians using a systematic literature review and a consensus process following a modified RAND/UCLA appropriateness method. What is New? • Paediatric primary care providers in Europe agree with the idea to use COSI-PPC-EU to monitor and improve the quality of care. The set was considered applicable, available, reliable, acceptable, and relevant for quality improvement. • The score for feasibility and effort to retrieve the data was low, because of technical reasons; the electronical or paper-based medical documentation in most cases does not allow convenient access to all necessary data.

Associations between hospital characteristics and patient satisfaction in Germany.

BACKGROUND: The patient perspective is increasingly recognized as a central pillar of quality in hospital care. International evidence suggests that an array of interacting factors may influence patient satisfaction with hospital care, whereas only a few studies have examined the impact of hospital characteristics. OBJECTIVE: To explore which hospital characteristics exert an influence on patient satisfaction with inpatient care. DESIGN: Cross-sectional study using secondary data. SETTING AND PARTICIPANTS: A total of 999 hospitals in Germany with 300 200 patient surveys from 2013 formed the study population. Patient satisfaction was surveyed using the Patients' Experience Questionnaire, and hospital characteristics were extracted from mandatory quality reports. Only hospitals with at least 75 surveys were included in the analysis. MAIN VARIABLES STUDIED AND MAIN OUTCOME MEASURES: Four dimensions of patient satisfaction (medical care, nursing care, organization and overall impression) were studied as the outcome measures. Region, profit orientation, size, staffing per bed and quality scores were considered possible influencing hospital characteristics. We performed risk-adjusted multivariate analyses. RESULTS: All of the characteristics had a significant influence on the patient satisfaction dimensions (P<.05), and patients in East Germany, in small hospitals or in not-for-profit hospitals, were more satisfied. Additionally, more staffing per bed as well as a better process and outcome quality were associated with more satisfied patients. CONCLUSION: Structural and quality characteristics of hospitals have a significant impact on patient satisfaction. This association confirms that patients are sensitive to important hospital quality measures and reinforces the consideration of patient satisfaction as an indicator of the quality of care.

Impact of public reporting on the quality of hospital care in Germany: A controlled before-after analysis based on secondary data.

BACKGROUND: Since 2005 all German hospitals are obliged to publish structured quality reports (QR). International studies suggest that mandatory reporting motivates hospitals to improve the quality of care. We examine whether such an effect can be demonstrated for hospitals in Germany and whether differences exist between for-profit and non-profit hospitals. METHOD: The study was designed as a controlled pre-post intervention study, whereby the intervention consisted in the first notification of the obligation to publish values for clinical quality indicators (QI). The data basis consisted of those QI reported in identical manner from 2006 to 2012 and multivariable statistical analyses were performed. QI from the same clinical area but without reporting obligation in 2006, served as control group. RESULTS: Six QI were included in the intervention group and demonstrated significant quality improvement. The major part of improvements occurred immediately after the intervention. 31 QI were included in the control group, with about 60% showing improvement trends. In comparison, the biggest proportional improvements were registered for publicly reported QI. No significant differences in relation to profit orientation were found. CONCLUSION: Results indicate a positive effect of public reporting on hospital care, independent of a hospital's profit orientation. Improvements in the quality of care were registered for all observed QI over time, but public reporting stimulated an accelerated QI improvement.

[Trade-off between quality, price, and profit orientation in Germany's nursing homes]. / Verhältnis zwischen Qualität, Preis und Profitorientierung deutscher Pflegeheime.

BACKGROUND: International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated. METHODS: We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann-Whitney U- and Kruskal-Wallis test, respectively, followed by a multivariate analysis of variance which also covered the interaction effect between quality, price and type of ownership. RESULTS: 41% of 10,168 German nursing homes were for-profit organizations charging on average about 10% less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with higher cost per day. However, with four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes persisted, irrespective independently of the price. CONCLUSION: When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.

Trade-off Between Quality, Price, and Profit Orientation in Germany's Nursing Homes.

International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated. We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann-Whitney U-Test and Kruskal-Wallis Test respectively, followed by a multivariate variance analysis which also covered the interaction effect between quality, price and type of ownership. 41 % of 10,168 German nursing homes were for-profit charging on average about 10 % less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with increasing prices per day. However, for four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes existed independent of the price charged. When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.