Analysis of the practices and influencing factors of referral to inpatient rehabilitation following hip fractures based on data from the Hungarian healthcare funding database / A csípotáji töréseket követo intézményi rehabilitációra utalás gyakorlata és a beutalást befolyásoló tényezok a hazai közfinanszírozási adatok alapján

Introduction: Hip fractures heavily burden healthcare systems in aging populations. The health and quality of life of the patients depend not only on the acute care, but on rehabilitation practices as well. There is insufficient data on Hungarian rehabilitation rates following hip fracture surgeries. Objective: Our goal was to examine the rehabilitation rates within 30 days of hip fracture related admissions and to observe the factors that influence admission to inpatient rehabilitation. Method: We analysed patient level data from the Hungarian healthcare funding database between 2005 and 2015 by multivariate logistic regression, and observed rehabilitation rates through descriptive statistics between 2005 and 2015 and between 1 January 2019 and 31 December 2020. Results: Rehabilitation rates show a rapid increase between 2005 and 2015, and further increase is observed in 2019, while 2020 shows a fall in admission rates. The regression analysis showed significant results for the patients' gender, age, and the variables assessing healthcare practices and accessibility. Complications after the acute care has a strong power on admission to rehabilitation, but the majority of the observed comorbidities have significant effects as well. Conclusion: Admission to rehabilitation after hip fracture shows increasing trends. Factors influencing the admissions show a consistent direction but changing strength. The increasing strength of our regression model suggests that rehabilitation practices grew more consistent over time.

Potential considerations in decision making on laparoscopic colorectal resections in Hungary based on administrative data.

BACKGROUND: Laparoscopic colorectal surgeries offer numerous advantages over their open counterparts. To compare these measurable short-time outcomes of open and laparoscopic resections in Hungary, data of colorectal surgeries were collected and analysed. The study focused on identifying patients' characteristics that can influence the decision on laparoscopic colorectal resections and on comparing efficiency of Hungarian colorectal operations with international data. METHODS: Using patients' data of laparoscopic and open colorectal surgery performed in 2015 and 2016 from the National Health Insurance Fund of Hungary, a countrywide retrospective comparative analysis was done. Logistic regression was used to explore main influencing factors for laparoscopic colorectal surgery. RESULTS: A total of 17,876 colorectal surgical cases, including 14,876 open and 3,000 laparoscopic resections were selected and analysed. Laparoscopy was used only in 16.78% of all cases. Comparison of age groups showed that odds ratio (OR) of laparoscopic colorectal resections was significantly lower in over 40 years than in younger patients (18-39 years). In university institutes patients had higher odds (OR: 2.23 p<0.0001) for laparoscopic colorectal resections. Presence of comorbidity codes and preoperative treatment in internal medicine department decreased odds for laparoscopic colorectal operations. CONCLUSIONS: Patients' age, comorbidities and hospital type influenced the likelihood of decision on laparoscopic colorectal resection. Selection of patients contributed to improved laparoscopic outcomes.

Examination of data validity of hip fracture patients in a Hungarian hospital / A csípotáji törést elszenvedett betegekre vonatkozó adatvaliditási vizsgálat egy magyarországi kórházban.

Összefoglaló. Bevezetés: A csípotáji törések jelentosen terhelik az egészségügyi ellátórendszereket. Magyarországon 13 000-15 000 beteg szenved évente csípotáji törést, jelentos részük mutéten is átesik. A betegek túlélését vizsgálták a EuroHOPE és BRIDGE kutatások, amelyek a Nemzeti Egészségbiztosítási Alapkezelonek a finanszírozási célból gyujtött, esetszintu adataira támaszkodtak. Az ilyen jellegu adatok megbízhatóságát több kutatás vizsgálta eltéro eredményekkel, ezért a további vizsgálatok elott szükségesnek tartottuk a csípotáji törésekre vonatkozóan is ellenorizni oket. Célkituzés: Egy magyarországi kórház reprezentatívan kiválasztott eseteinek vizsgálatán keresztül annak megállapítása, hogy a finanszírozási adatbázis adatai megfelelnek-e a betegdokumentációban rögzített adatoknak. Módszer: Egy magyarországi kórházba 2015-ben csípotáji töréssel felvett betegek kórlapjainak anonim, reprezentatív mintáját összevetettük a EuroHOPE és BRIDGE kutatások adatbázisával tíz különbözo adatelemre vonatkozóan. Az adatbázisokat rekordszinten párosítottuk, az egyezést adatelemre és rekordra vonatkozóan néztük. Eredmények: A reprezentatív minta 259 esetet tartalmazott. Az adatbázisok összevetése során nem találtunk eltérést a beteg neme, életkora, ápolást indokló fodiagnózisa és az osztályról történo távozás dátuma esetén. Egy eltérést találtunk az osztályos felvétel dátumában, a mutét dátumában öt darabot. A beteg további sorsa esetén tíz eltérést találtunk. A mutéttípusok esetén is alacsony mértéku (2-4 eset) eltérést tapasztaltunk. Jelentos mértéku eltérést a társbetegségek és a szövodmények esetén találtunk. Következtetés: Eredményeink alapján további vizsgálatokhoz felhasználhatók az alfanumerikus kódokat, számokat vagy dátumokat tartalmazó mezok (például fodiagnózis, felvételi és távozási dátumok), a társbetegségekre és a szövodményekre vonatkozó adatok azonban nem alkalmazhatók mélyebb elemzések során. Orv Hetil. 2021; 162(18): 712-719. INTRODUCTION: Hip fractures pose a heavy burden on healthcare systems. In Hungary, 13 000-15 000 patients experience hip fractures, most of them undergo surgery. Their survival was examined by the EuroHOPE and BRIDGE studies, using patient level data from the National Health Insurance Fund. Data from healthcare financing reports have been examined worldwide, with contradicting results, so we considered it necessary to observe data validity for hip fractures before further analysis. OBJECTIVE: The aim of our study was to observe a representative sample of patient records in a Hungarian hospital in order to validate the finance reports. METHOD: We matched a representative sample of hip fracture patient records in a Hungarian hospital with hip fractures in 2015 with the database of the EuroHOPE and BRIDGE studies. The databases were matched on record level, the analysis included ten data fields and was conducted for data fields and records. RESULTS: The sample included 259 cases. No differences were observed in the patients' gender, age and main diagnosis, or dates of discharge. One difference was observed in the dates of admission, and 5 in the dates of surgery. Minor differences were found in the types of surgery (2-4 cases), but the differences between the databases in comorbidities and complications were large. CONCLUSION: Based on our results, we can conclude that data fields containing alphanumeric codes, numbers or dates (e.g., main diagnosis, admission, discharge and surgery dates) can be used for further analysis, but comorbidity and complication data are not recommended for research purposes. Orv Hetil. 2021; 162(18): 712-719.

[Changing of the patient safety culture in the pilot institutes of the Hungarian accreditation program]. / A betegbiztonságot támogató szervezeti kultúra változása a hazai akkreditációs programot tesztelo intézményekben.

INTRODUCTION: The accreditation system for health care providers was developed in Hungary aiming to increase safety, efficiency, and efficacy of care and optimise its organisational operation. AIM: The aim of this study was to assess changes of organisational culture in pilot institutes of the accreditation program. METHOD: 7 volunteer pilot institutes using an internationally validated questionnaire were included. The impact study was performed in 2 rounds: the first before the introduction of the accreditation program, and the second a year later, when the standards were already known. Data were analysed using descriptive statistics and logistic regression models. RESULTS: Statistically significant (p<0.05) positive changes were detected in hospitals in three dimensions: organisational learning - continuous improvement, communication openness, teamwork within the unit while in outpatient clinics: overall perceptions of patient safety, and patient safety within the unit. CONCLUSIONS: Organisational culture in the observed institutes needs improvement, but positive changes already point to a safer care. Orv. Hetil., 2016, 157(42), 1667-1673.

[Methods of the EuroHOPE research program]. / A EuroHOPE kutatási program módszertana.

The European Health Care Outcomes, Performance and Efficiency research was financed by the European Union between 2010 and 2013. In this program a new methodology was developed which made the analysis of regularly collected data and international benchmarking of the healthcare results of 5 socially and economically critical diagnosis group between the 7 participant countries possible. This paper presents the most important areas of the development, such as (1) the principles of the methodology, (2) the definition of available databases, code systems, (3) the events to be analysed, (4) the general rules of analyses and indicator development, (5) the exact methodology of data collection, processing, and analysis, (6) the methods of risk adjustment, (7) and the development of the standardised database. The databases which include all information of all patients and healthcare activities serve as perfect inexhaustible data sources for decision makers, healthcare personnel, and researchers. The indicator results of this program serve as starting point for further root cause analysis and development measures based on the results of the abovementioned analyses. Orv. Hetil., 2016, 157(41), 1619-1625.

[Role of reporting and learning systems in the improvement of patient safety]. / A jelentési és tanulórendszerek szerepe a betegbiztonság javításában.

The principles and requirements of a patient safety related reporting and learning system were defined by the World Health Organization Draft Guidelines for Adverse Event Reporting and Learning Systems published in 2005. Since then more and more Hungarian health care organizations aim to improve their patient safety culture. In order to support this goal the NEVES reporting and learning system and the series of Patient Safety Forums for training and consultation were launched in 2006 and significantly renewed recently. Current operative modifications to the Health Law emphasize patient safety, making the introduction of these programs once again necessary.