Hyperkinetic disorders in children and adolescents in Germany: administrative prevalence and regional differences regarding the frequency of diagnosis assignment [Hyperkinetische Störungen bei Kindern und Jugendlichen in Deutschland: Administrative Prävalenz und regionale Unterschiede in der Diagnosehäufigkeit]
Roick C.,AOK Bundesverband |
Waltersbacher A.,Wissenschaftliches Institute der AOK WIdO
Psychiatrische Praxis | Year: 2015
METHODS: The administrative prevalence of HK (ICD-10 F90) was analysed for 3,6 million children, up to 18 years old and in the whole year 2009 insured by the AOK, using health insurance data. Additionally, administrative prevalence changes between 2006 and 2008 were investigated. The prevalence analyses were differenciated according to postal code areas and regions of the associations of statutory health insurance physicians (SHIP-regions).RESULTS: The analyses revealed a continous increase of the administrative HK-prevalence between 2006 (2,8 %) and 2009 (3,8 %). The administrative prevalence was notably lower in the city states Bremen, Hamburg and Berlin, but rather high in four of five SHIP-regions in the New Laender. 14 % of children with HK were diagnosed with HK and ICD-10 F98.8. In 47 % these different diagnoses had been coded by different physicians.CONCLUSIONS: Regional differences in administrative prevalence rates and discrepancies in diagnosis coding by different physicians may indicate uncertainties regarding HK-diagnosis in routine health care. Future studies should analyse these associations more detailed.OBJECTIVE: To analyse the administrative prevalence and regional differences in hyperkinetic disorder (HK) diagnoses in Germany. © Georg Thieme Verlag KG Stuttgart · New York.
Muller N.,Jena University Hospital |
Heller T.,Jena University Hospital |
Freitag M.H.,Jena University Hospital |
Gerste B.,Wissenschaftliches Institute der AOK WIdO |
And 3 more authors.
Diabetic Medicine | Year: 2015
Aims This population-based study assesses the healthcare utilization of people with Type 2 diabetes by analysing routine data from Allgemeine Orts-Krankenkasse (AOK), the largest statutory health insurance provider in Germany. Methods Anonymized billing data from all AOK-insured persons with at least one day of insurance during the evaluation year 2010 were analysed. Treatment and cost data from all areas of inpatient and outpatient care were available, as was information regarding patient age and sex. International Classification of Diseases (ICD-10) diagnosis and Anatomical Therapeutic Chemical (ATC) classification were used to identify 2.7 million insured persons with diabetes. Results The age- and sex-standardized prevalence of Type 2 diabetes was 9.8%. Of those patients identified, 33.9% had at least one diabetes-related complication and 83.0% had a diagnosis of hypertension. Almost two-thirds (63.1%) received antihyperglycaemic medication. Metformin and sulfonylurea were prescribed most often; medications without proof of benefit in endpoint studies were prescribed much less frequently. People without diabetes were admitted to hospital only half as often as those with Type 2 diabetes. The projected total expenditure in Germany for all people with Type 2 diabetes amounted to approximately €33.3 billion in 2010. Conclusions This study shows an increase in both the prevalence of diabetes and treatment costs. The majority of people with Type 2 diabetes were aged 70 years or older. One third of this group has diabetes-related complications. Antihyperglycaemic medications without proof of benefit in endpoint studies were prescribed much less frequently than drugs with proof of benefit. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.
PubMed | Wissenschaftliches Institute der AOK WIdO, University of Hamburg and University of Heidelberg
Type: | Journal: Drug safety | Year: 2016
Drugs that potentially prolong the QT interval carry the risk of life-threatening Torsades de pointes (TdP) ventricular arrhythmia.The objective of this study was to investigate the potential additive risk for ventricular arrhythmia with concomitant prescriptions of QT-prolonging drugs.Claims data for persons aged 65years between 2010 and 2012 in Germany were analyzed and all cases hospitalized for ventricular arrhythmia were selected. In a case-crossover analysis, exposure with QT-prolonging drugs according to the Arizona Center for Education and Research on Therapeutics (AZCERT) classification of known, conditional, and possible TdP risk was determined in respective event and control windows preceding hospitalization. Conditional logistic regression was applied to derive odds ratios (ORs).Among 6,849,622 health-insured persons, we identified 2572 patients newly hospitalized for ventricular arrhythmia. Drugs with known risk were more frequently prescribed in the event window than in the control window (309 vs. 239; P<0.001). The number of drugs with an attributed known risk of TdP was significantly associated with hospitalization for ventricular arrhythmia (OR: 2.22; 95% confidence interval [1.51-3.25]; P<0.001), while increased risk estimates were also obtained upon categorization into one and two or more drugs compared with no drugs for the combined group of drug with known (1.52 [1.16-2.00]) and conditional risk (2.20 [1.42-3.41]). Pairwise comparisons and trend tests based on these classification categories could not demonstrate a significantly increased risk of two or more drugs compared with one drug.Beyond suitable single-drug classifications for QT-associated risk estimation, the situation when there is co-prescription of several drugs appears to be complex and may not be extrapolated to all possible multi-drug combinations.
Addiction Prevalence Rates among Medical Care Patients receiving Unemployment Benefit II (Hartz-IV) in Relation to Recipients of Unemployment Benefit i and employed Patients: An Analysis of Routine Data of all AOK-Insured Persons in 2007-2012 [Suchtdiagnoseraten bei Hartz-IV-Beziehenden in der medizinischen Versorgung im Vergleich zu ALG-I-Arbeitslosen und Erwerbstätigen: eine Auswertung der Leistungsdaten aller AOK-Versicherten der Jahre 2007-2012]
Henkel D.,Frankfurt University of Applied Sciences |
Schroder H.,Wissenschaftliches Institute der AOK WIdO
Suchttherapie | Year: 2015
Objective: We investigated whether patients receiving Unemployment Benefit II (Hartz-IV) differ in their addiction-related prevalence rates from recipients of Unemployment Benefit I (ALG I) and employed patients subjected to social security contributions. Method: For this purpose, we analysed the data of all AOK-insurees who were continuously insured with the AOK in the years 2007-2012 and in outpatient or inpatient treatment. We analysed all addiction-related ICD-10-GM-diagnoses: F10-F19, F50 and F63.0, differentiating between men and women and 3 age groups: 18-29, 30-49 and 50-64 years. To ensure maximum coincidence between the social and employment status and addiction-related diagnosis, we chose quarterly periods as evaluation unit. The data are based on 28 million quarterly cases for the Hartz-IV group and 173 million cases for all 3 groups in the years 2007-2012. As rate of addiction-related diagnoses, the percentage of investigated quarters with medically coded ICD diagnoses was calculated separately for the 3 study groups. Results: For 10.2% of all Hartz-IV quarterly cases at least one addiction-related diagnosis was found. For unemployed ALG-I recipients, the diagnosis rate was 6.3% and 3.7% for employed patients. A similarly striking disparity in diagnosis rates was found for F10 (alcohol), F11 (opioids), F12 (cannabinoids), F13 (sedatives/hypnotics), F17 (tobacco), F19 (multiple substance use) and F50 (eating disorders), both for men and women as well as in all 3 age classes. For the diagnoses F14 (cocaine), F15 (other stimulants), F16 (hallucinogens), F18 (volatile solvent) and F63.0 (pathological gambling), generally little or no coding was found. Conclusions: Conclusions are drawn on the use of screening procedures in primary health care and in relation to the duty of job centers to refer Hartz-IV recipients affected by addiction to facilities of addiction aid.
PubMed | Universitatsklinik Bonn, Ludwig Maximilians University of Munich, Universitatsklinikum Knappschaftskrankenhaus Bochum, Wissenschaftliches Institute der AOK WIdO and 2 more.
Type: Journal Article | Journal: Zeitschrift fur Orthopadie und Unfallchirurgie | Year: 2016
External quality assurance for revisions of total knee arthroplasty (TKA) and total hip arthroplasty (THA) are carried out through the AQUA institute in Germany. Data are collected by the providers and are analyzed based on predefined quality indicators from the hospital stay in which the revision was performed. The present study explores the possibility to add routine data analysis to the existing external quality assurance (EQS). Differences between methods are displayed. The study aims to quantify the benefit of an additional analysis that allows patients to be followed up beyond the hospitalization itself.All persons insured in an AOK sickness fund formed the population for analysis. Revisions were identified using the same algorithm as the existing external quality assurance. Adverse events were defined according to the AQUA indicators for the years 2008 to 2011.The hospital stay in which the revision took place and a follow-up of 30 days were included. For re-operation and dislocation we also defined a 365 days interval for additional follow-up. The results were compared to the external quality control reports.Almost all indicators showed higher events in claims data analysis than in external quality control. Major differences are seen for dislocation (EQS SD: 1.87 vs. claims data [cd] SD: 2.06%, cd+30d: 2.91%, cd+365d: 7.27%) and reoperation (hip revision: EQS SD: 5.88% vs. claims data SD: 8.79% cd+30d: 9.82%, cd+365d: 15.0%/knee revision: EQS SD: 3.21% vs. claims data SD: 4.07%, cd+30d: 4.6%, cd+365d: 15.43%). Claims data could show additional adverse events for all indicators after the initial hospital stay, rising to 77% of all events.The number of adverse events differs between the existing external quality control and our claims data analysis. Claims data give the opportunity to complement existing methods of quality control though a longer follow-up, when many complications become evident.
Godman B.,Karolinska University Hospital |
Godman B.,Mario Negri Institute for Pharmacological Research |
Godman B.,University of Liverpool |
Paterson K.,Scottish Medicines Consortium |
And 4 more authors.
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2012
The Managed Introduction of New Medicines Ljubljana, Slovenia, 19-21 March 2012 The 3-day course on the managed entry of new medicines was run by the Piperska group, which is a pan-European group striving to enhance the health of the public as a whole and the individual patient through exchanging ideas and research around the rational use of drugs. Participants included health authority and health insurance personnel, academics and those from commercial organizations. The principal aim of the conference was to bring together people to discuss ways to improve the managed entry of new drugs. © 2012 Expert Reviews Ltd.
Cases and duration of mechanical ventilation in German hospitals: An analysis of DRG incentives and developments in respiratory medicine [Beatmungsfälle und Beatmungsdauer in deutschen Krankenhäusern: Eine Analyse von DRG-Anreizen und Entwicklungen in der Beatmungsmedizin]
Biermann A.,Wissenschaftliches Institute der AOK WIdO |
Geissler A.,TU Berlin
Anaesthesist | Year: 2016
Background: Diagnosis-related groups (DRGs) have been used to reimburse hospitals services in Germany since 2003/04. Like any other reimbursement system, DRGs offer specific incentives for hospitals that may lead to unintended consequences for patients. In the German context, specific procedures and their documentation are suspected to be primarily performed to increase hospital revenues. Mechanical ventilation of patients and particularly the duration of ventilation, which is an important variable for the DRG-classification, are often discussed to be among these procedures. Objectives: The aim of this study was to examine incentives created by the German DRG-based payment system with regard to mechanical ventilation and to identify factors that explain the considerable increase of mechanically ventilated patients in recent years. Moreover, the assumption that hospitals perform mechanical ventilation in order to gain economic benefits was examined. Material and methods: In order to gain insights on the development of the number of mechanically ventilated patients, patient-level data provided by the German Federal Statistical Office and the German Institute for the Hospital Remuneration System were analyzed. The type of performed ventilation, the total number of ventilation hours, the age distribution, mortality and the DRG distribution for mechanical ventilation were calculated, using methods of descriptive and inferential statistics. Furthermore, changes in DRG-definitions and changes in respiratory medicine were compared for the years 2005–2012. Results: Since the introduction of the DRG-based payment system in Germany, the hours of ventilation and the number of mechanically ventilated patients have substantially increased, while mortality has decreased. During the same period there has been a switch to less invasive ventilation methods. The age distribution has shifted to higher age-groups. A ventilation duration determined by DRG definitions could not be found. Conclusion: Due to advances in respiratory medicine, new ventilation methods have been introduced that are less prone to complications. This development has simultaneously improved survival rates. There was no evidence supporting the assumption that the duration of mechanical ventilation is influenced by the time intervals relevant for DRG grouping. However, presumably operational routines such as staff availability within early and late shifts of the hospital have a significant impact on the termination of mechanical ventilation. © 2016 Springer-Verlag Berlin Heidelberg
PubMed | Wissenschaftliches Institute der AOK WIdO and TU Berlin
Type: Journal Article | Journal: Der Anaesthesist | Year: 2016
Diagnosis-related groups (DRGs) have been used to reimburse hospitals services in Germany since 2003/04. Like any other reimbursement system, DRGs offer specific incentives for hospitals that may lead to unintended consequences for patients. In the German context, specific procedures and their documentation are suspected to be primarily performed to increase hospital revenues. Mechanical ventilation of patients and particularly the duration of ventilation, which is an important variable for the DRG-classification, are often discussed to be among these procedures.The aim of this study was to examine incentives created by the German DRG-based payment system with regard to mechanical ventilation and to identify factors that explain the considerable increase of mechanically ventilated patients in recent years. Moreover, the assumption that hospitals perform mechanical ventilation in order to gain economic benefits was examined.In order to gain insights on the development of the number of mechanically ventilated patients, patient-level data provided by the German Federal Statistical Office and the German Institute for the Hospital Remuneration System were analyzed. The type of performed ventilation, the total number of ventilation hours, the age distribution, mortality and the DRG distribution for mechanical ventilation were calculated, using methods of descriptive and inferential statistics. Furthermore, changes in DRG-definitions and changes in respiratory medicine were compared for the years 2005-2012.Since the introduction of the DRG-based payment system in Germany, the hours of ventilation and the number of mechanically ventilated patients have substantially increased, while mortality has decreased. During the same period there has been aswitch to less invasive ventilation methods. The age distribution has shifted to higher age-groups. Aventilation duration determined by DRG definitions could not be found.Due to advances in respiratory medicine, new ventilation methods have been introduced that are less prone to complications. This development has simultaneously improved survival rates. There was no evidence supporting the assumption that the duration of mechanical ventilation is influenced by the time intervals relevant for DRG grouping. However, presumably operational routines such as staff availability within early and late shifts of the hospital have asignificant impact on the termination of mechanical ventilation.
Wienhold R.,Universitats Medizin Leipzig |
Scholz M.,University of Leipzig |
Adler J.-B.,Wissenschaftliches Institute der AOK WIdO |
Gunster C.,Universitats Medizin Leipzig |
Paschke R.,Universitats Medizin Leipzig
Deutsches Arzteblatt International | Year: 2013
Background: In Germany, about 59 000 thyroid operations are performed each year for unior multinodular goiter, most of them for diagnostic purposes. The rate of detection of thyroid cancer in such operations is relatively low, at 1:15. Evidence suggests that the preoperative tests recommended in guidelines for estimating the risk of cancer are not being performed as often as they should. In the present study, we determined the measures that were actually taken to diagnose and treat thyroid nodules and compared the findings with the guideline recommendations. Method: We retrospectively analyzed data from a single, large statutory health-insurance carrier in Germany (AOK), determining the diagnostic and therapeutic measures that were reimbursed for 25 600 patients in whom a unior multi-nodular goiter was newly diagnosed in the second quarter of 2006 (none of these patients had carried such a diagnosis 1 year previously). We recorded the diagnostic measures performed in the preceding 9 months and all other tests and treatments, including surgery and radioactive iodine treatment, in the 2 years thereafter. Results: Among patients who underwent surgery for uninodular goiter, the preoperative diagnostic studies included ultrasonography (in 100% of patients), scintigraphy (94%), measurement of thyroid-stimulating hormone (95%), measurement of calcitonin (9%), and fine-needle aspiration cytology (FNAC) (21%). An ultrasonographic examination was billed for only 28% of patients with uninodular goiter in the two years after the diagnosis was made. 13% of patients with uninodular goiter who were not operated on were given L-thyroxine, even though this is against guideline recommendations. Conclusion: Inadequate preoperative risk stratification of thyroid nodules may explain the large number of thyroid operations that are performed for diagnostic purposes, resulting in a low percentage of malignancies detected. Preoperative FNAC and calcitonin measurement should be used in the diagnostic evaluation of thyroid nodules far more often than this is now done. As a rule, follow-up ultrasonography should be performed for all thyroid nodules that are not operated on. Patients with non-operated thyroid nodules should not be given thyroxine. A limitation of this study is that diagnostic measures were only recorded if they were performed in the 9 months before surgery, with earlier diagnostic measures (if any) being missed.
The relationship of in-hospital and post-discharge complications and implications for quality measurement in hip replacement surgery - An analysis of AOK administrative data [Der Zusammenhang von Komplikationen im Krankenhaus und im Follow-up und Implikationen für die Qualitätsmessung bei Hü ftgelenksendoprothesen - Eine Analyse von AOK-Routinedaten]
Jeschke E.,Wissenschaftliches Institute der AOK WIdO |
Heyde K.,Wissenschaftliches Institute der AOK WIdO |
Gunster C.,Wissenschaftliches Institute der AOK WIdO
Gesundheitswesen | Year: 2013
Aim: This study analyses the information gain achieved by additionally taking into account complications in the follow-up period instead of merely considering in-house events for a hospital-based quality measurement using the example of hip replacement. Method: The analysis was performed with anonymous statutory health insurance data (AOK) for the years 2007-2009 within the framework of the quality measurement method "Quality Assurance with Administrative Data (QSR)". It included cases of hip replacement surgery due to osteoarthritis. In order to analyse hospital-related outcome quality, 6 quality indicators were formed (revision surgery within 365 days, surgical complications within 90 days, thrombosis/pulmonary embolism within 90 days, femur fracture within 90 days, mortality within 90 days and complication index). For each hospital, the adjusted SMRs (standardised mortality or morbidity ratio) with 95% confidence intervals were calculated. The relation between the in-hospital and the follow-up SMR was analysed by Spearman's rank correlation coefficient. Furthermore, the percentage consistency of hospital SMRs categorised into quartiles on the basis of in-hospital and post-discharge events was determined. Results: A total of 154 470 AOK patients from 930 hospitals were included in the analysis. The hospitals had a median overall complication rate of 11,22%. One quarter of the hospitals had complication rates of 8,18% or below. Another quarter of the hospitals had complication rates nearly twice as high (≥15,49%). Nearly one-third of all complications occurred after the initial hospitalisation. Regarding clinic-related complications, there was little correlation between the events in the initial case and during follow-up (r<0,3) for all indicators. The order of the hospitals defined by quartiles of SMR changed significantly by adding the complications in the follow-up for the indicators considered (min 21%, max 47% changes between quartiles). In particular, for the indicators revision and death, a change in the SMR quartile occurred in almost 50% of all hospitals. Conclusion: Quality assessment of hip replacement surgery based exclusively on in-house events is quite unreliable. On the one hand, nearly a third of all complications occur in the follow-up period. On the other hand, predicting the occurrence of post-discharge events from in-house complications of a clinic is not considered acceptable for the indicators analysed in this study. © Georg Thieme Verlag KG Stuttgart, New York.