scholarly journals Replacement of endoprosthetic implants within a two years follow-up period: a statutory health insurance routine data analysis

2012 ◽  
Vol 13 (1) ◽  
Author(s):  
Roland Linder ◽  
Hardy Müller ◽  
Brigitte Grenz-Farenholtz ◽  
Caroline Wagner ◽  
Martin Stockheim ◽  
...  
Keyword(s):  
Health Insurance ◽  
Data Analysis ◽  
Statutory Health Insurance ◽  
Routine Data

scholarly journals Continuity in palliative care – analysis of intersectoral palliative care based on routine data of a statutory health insurance

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laura Rehner ◽  
Kilson Moon ◽  
Wolfgang Hoffmann ◽  
Neeltje van den Berg
Keyword(s):  
Palliative Care ◽  
Health Insurance ◽  
Statutory Health Insurance ◽  
Routine Data ◽  
Chi Square ◽  
Discharge Management ◽  
Care Training ◽  
Discharge From Hospital ◽  
Ambulatory Health Care

Abstract Background The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death. Methods The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square. Results In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice. Conclusions The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.

scholarly journals Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: A retrospective clinical study and big data analysis of routine data

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244209
Author(s):  
Ralf Kraus ◽  
Joern Zwingmann ◽  
Manfred Jablonski ◽  
M. Sinan Bakir
Keyword(s):  
Big Data ◽  
Data Analysis ◽  
Pediatric Trauma ◽  
Routine Data ◽  
Big Data Analysis ◽  
Sternoclavicular Joint ◽  
Specific Method ◽  
Retrospective Clinical Study ◽  
Dislocation Type

Background Dislocations of the sternoclavicular joint (anterior/posterior) and acromioclavicular joint (SCJ and ACJ, respectively) are rare injuries in childhood/adolescence, each having its own special characteristics. In posterior SCJ dislocation, the concomitant injuries in the upper mediastinum are most important complication, while in anterior SCJ dislocation there is a risk of permanent or recurrent instability. Methods In a retrospective analysis from seven pediatric trauma centers under the leadership of the Section of Pediatric Traumatology of the German Trauma Society, children (<18 years) were analyzed with focus on age, gender, trauma mechanism, diagnostics, treatment strategy and follow-up results. Additional epidemiological big data analysis from routine data was done. Results In total 24 cases with an average age of 14.4 years (23 boys, 1 girl) could be evaluated (7x ACJ dislocation type ≥ Rockwood III; 17x SCJ dislocation type Allman III, including 12 posterior). All ACJ dislocations were treated surgically. Postoperative immobilization lasted 3–6 weeks, after which a movement limit of 90 degrees was recommended until implant removal. Patients with SCJ dislocation were posterior dislocations in 75%, and 15 of 17 were treated surgically. One patient had a tendency toward sub-dislocation and another had a relapse. Conservatively treated injuries healed without complications. Compared to adults, SCJ injuries were equally rarely found in children (< 1% of clavicle-associated injuries), while pediatric ACJ dislocations were significantly less frequent (p<0.001). Conclusions In cases of SCJ dislocations, our cohort analysis confirmed both the heterogeneous spectrum of the treatment strategies in addition to the problems/complications based on previous literature. The indication for the operative or conservative approach and for the specific method is not standardized. In order to be able to create evidence-based standards, a prospective, multicenter-study with a sufficiently long follow-up time would be necessary due to the rarity of these injuries in children. The rarity was emphasized by our routine data analysis.

scholarly journals Treatment Costs of Matrix-Associated Autologous Chondrocyte Implantation Compared With Microfracture: Results of a Matched-Pair Claims Data Analysis on the Treatment of Cartilage Knee Defects in Germany

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988658
Author(s):  
Philipp Niemeyer ◽  
Tino Schubert ◽  
Marco Grebe ◽  
Arnd Hoburg
Keyword(s):  
Health Insurance ◽  
Autologous Chondrocyte Implantation ◽  
Claims Data ◽  
Statutory Health Insurance ◽  
Cartilage Damage ◽  
Treatment Costs ◽  
Chondrocyte Implantation ◽  
Additional Costs ◽  
Autologous Chondrocyte

Background: Articular cartilage damage is caused by traumatic sport accidents or age-related degeneration and might lead to osteoarthritis, which represents a socioeconomic burden to society. Cartilage damage in the knee is commonly treated surgically with microfracture (MFX) or matrix-associated autologous chondrocyte implantation (MACI). Purpose: To quantify the initial and follow-up costs associated with MFX and MACI treatments from the viewpoint of statutory health insurance in Germany. Study Design: Economic decision analysis; Level of evidence, 2. Methods: This comparative study was based on an anonymized representative claims data set of 4 million patients covered by statutory health insurance in Germany. Patients undergoing outpatient or inpatient treatment with MACI or MFX for cartilage damage in the knee between January 1, 2012, and December 31, 2013, were included and evaluated over 5 years. Groups (MACI and MFX) were adjusted via propensity score matching before initial treatment. The matched groups were compared regarding their outpatient, inpatient, pharmaceutical, and other costs during the 5-year period. Results: In total, 127 patients per group were analyzed (59.1% male, 40.9% female; mean age, 37 years). In the year of the initial surgical procedure, costs were €14,804.13 in the MACI group and €5458.59 in the MFX group. In years 2 and 3 after initial surgery, treatment costs were comparable between patients treated with MACI (€2897.97 and €2114.87, respectively) and MFX (€2842.66 and €1967.42, respectively), with slightly higher treatment costs for those treated with MACI. In years 4 and 5 after surgery, costs were less in patients treated with MACI (€2154.79 and €1478.08, respectively) than in those treated with MFX (€2232.57 and €2061.63, respectively). Costs related to revision surgery were, on average, €3732 for MACI and €3765 for MFX. Thus, additional costs in years with revision surgery were €1672 for MACI and €1915 for MFX. Conclusion: This was the first study to analyze a large representative population claims database with propensity score matching, and results indicated that follow-up costs of patients treated with MACI and MFX began to converge over time. We found that total costs for MACI were higher than for MFX but that additional costs for MACI were lower than previously reported. Perceived morbidity may have little to do with cost.

scholarly journals Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 160
Author(s):  
Boris Wittekindt ◽  
Nora Doberschuetz ◽  
Andrea Schmedding ◽  
Till-Martin Theilen ◽  
Rolf Schloesser ◽  
...  
Keyword(s):  
Health Insurance ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Routine Data ◽  
Outcome Data ◽  
Insurance Fund ◽  
Clinical Registries ◽  
Specialized Care ◽  
One Year

Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail.

scholarly journals Comparison of Survival Between Patients Receiving General Ambulatory Palliative Care and Patients Receiving Other Palliative Care - Analysis of Data of a Statutory Health Insurance Data

2021 ◽  
Author(s):  
Kilson Moon ◽  
Laura Rehner ◽  
Wolfgang Hoffmann ◽  
Neeltje van den Berg
Keyword(s):  
Palliative Care ◽  
Health Insurance ◽  
Median Survival ◽  
Statutory Health Insurance ◽  
Survival Curves ◽  
Specialized Care ◽  
Group A ◽  
One Year ◽  
Group B

Abstract Background The care of palliative patients takes place as non-specialized and specialized care, in both ambulatory and stationary settings. However, palliative care is largely provided as non-specialized care in the ambulatory sector (AAPV). This study aimed to investigate whether the survival curves of AAPV patients differed from those of the more intensive palliative care modalities and whether AAPV palliative care was appropriate in terms of timing.Methods The study is based on claims data from a large statutory health insurance. The analysis included 4,177 patients who received palliative care starting in 2015 and who were fully insured one year before and one year after palliative care or until death. The probability of survival was observed for 12 months. Patients were classified into group A, which consisted of patients who received palliative care only with AAPV, and group B including patients who received stationary or specialized ambulatory palliative care. Group A was further divided into two subgroups. Patients who received AAPV on only 1 day were assigned to Subgroup A1, and patients who received AAPV on two or more days were assigned to Subgroup A2. The survival analysis was carried out using Kaplan-Meier curves. The median survival times were compared with the log-rank test.Results The survival curves differed between groups A and B, except in the first quartile of the survival distribution. The median survival was significantly longer in group A (137 days, n=2,763) than in group B (47 days, n=1,424, p<0.0001) and shorter in group A1 (35 days, n=986) than in group A2 (217 days, n=1,767, p<0.0001). The survival rate during the 12-month follow-up was higher in group A (42%) than in group B (11%) and lower in group A1 (38%) than in group A2 (44%).Conclusions The results of the analysis revealed that patients who received the first palliative care shortly before death suspected insufficient care, especially patients who received AAPV for only 1 day and no further palliative care until death or 12-month follow-up. Palliative care should start as early as necessary and be continuous until the end of life.

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