Lars Gabrys, Andrea Schaller, Stefan Peters, Anne Barzel, Susanne Berrisch-Rahmel, Karsten E Dreinhöfer, Katharina Eckert, Wiebke Göhner, Wolfgang Geidl, Sonja Krupp, Martin Lange, Roland Nebel, Klaus Pfeifer, Andrea Reusch, Matthias Schmidt-Ohlemann, Philipp Sewerin, Karen Steindorf, Andreas Ströhle, Gorden Sudeck, Hagen Wäsche, Sebastian Wolf, Bettina Wollesen, Christian Thiel
The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.
{"title":"[DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research].","authors":"Lars Gabrys, Andrea Schaller, Stefan Peters, Anne Barzel, Susanne Berrisch-Rahmel, Karsten E Dreinhöfer, Katharina Eckert, Wiebke Göhner, Wolfgang Geidl, Sonja Krupp, Martin Lange, Roland Nebel, Klaus Pfeifer, Andrea Reusch, Matthias Schmidt-Ohlemann, Philipp Sewerin, Karen Steindorf, Andreas Ströhle, Gorden Sudeck, Hagen Wäsche, Sebastian Wolf, Bettina Wollesen, Christian Thiel","doi":"10.1055/a-2340-1669","DOIUrl":"https://doi.org/10.1055/a-2340-1669","url":null,"abstract":"<p><p>The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lena Ansmann, Stefan Nöst, Mirjam Körner, Carolin Auschra, Roland Bal, Marina Böddeker, Ingo Bode, Jeffrey Braithwaite, Clara Breidenbach, Marie Coors, Ibrahim Demirer, Mark Exworthy, Lorenz Harst, Christian Heuser, Julia Hoffmann, Juliane Köberlein-Neu, Karl Krajic, Gregory Maniatopoulos, Russell Mannion, Ralph Möhler, Holger Pfaff, Monika A Rieger, Esther Rind, M A Helge Schnack, M A Anke Wagner, Matthias Weigl, Michel Wensing, Siri Wiig, Eva Wild, Hendrik Wilhelm, Markus Wirtz, Katja Götz
Background: Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community.
Methods: In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field's development.
Results: The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified.
Conclusions: This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries.
{"title":"Navigating the Future of Organisational Health Services Research in Germany and beyond: a Position Paper.","authors":"Lena Ansmann, Stefan Nöst, Mirjam Körner, Carolin Auschra, Roland Bal, Marina Böddeker, Ingo Bode, Jeffrey Braithwaite, Clara Breidenbach, Marie Coors, Ibrahim Demirer, Mark Exworthy, Lorenz Harst, Christian Heuser, Julia Hoffmann, Juliane Köberlein-Neu, Karl Krajic, Gregory Maniatopoulos, Russell Mannion, Ralph Möhler, Holger Pfaff, Monika A Rieger, Esther Rind, M A Helge Schnack, M A Anke Wagner, Matthias Weigl, Michel Wensing, Siri Wiig, Eva Wild, Hendrik Wilhelm, Markus Wirtz, Katja Götz","doi":"10.1055/a-2308-7384","DOIUrl":"10.1055/a-2308-7384","url":null,"abstract":"<p><strong>Background: </strong>Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community.</p><p><strong>Methods: </strong>In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field's development.</p><p><strong>Results: </strong>The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified.</p><p><strong>Conclusions: </strong>This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sophie Gigou, Laura Corazza, Sandra Fett, Martin Tauscher, Roman Gerlach, Ewan Donnachie, Antonius Schneider
Background: Although the number of places at medical schools and physicians in Germany has increased continuously over the past 25 years, there is a threat of a shortage of physicians. Based on data from the Bavarian Medical Association (BLÄK) and the Association of Statutory Health Insurance Physicians of Bavaria (KVB), an analysis of the number of physicians in Bavaria over a longer period of time was carried out in order to understand current developments and possible starting points for the future organization of medical care. The figures were analyzed with regard to the distribution of physicians by outpatient and inpatient sector as well as with regard to the development of the number of employees, the scope of employment and the gender distribution in the outpatient sector.
Methods: Data were taken from the annually published and systematically compiled numbers of physicians from the BLÄK (2000 to 2022) as well as the outpatient billing data of practicing and employed physicians in Bavaria (2010 to 2022), processed by the KVB. Descriptive analyses were performed.
Results: Since 2000, the number of physicians in Bavaria has risen by 83% in the inpatient setting and by 35% in the outpatient setting. As a result, more physicians have been working in hospitals than in outpatient care since 2010. In the outpatient setting the trend is moving away from establishing one's own practice and full-time work towards salaried and part-time employment. Employed physicians have lower average working hours than self-employed physicians. The proportion of women among physicians has steadily increased, with female physicians more likely to be employed and working part-time compared with male physicians. Nevertheless, part-time employment is also prominent among male physicians in some specialties today.
Conclusion: The trend towards practicing in salaried and part-time positions continues unabated and is represented across all specialties, suggesting that more physicians are needed to maintain the number of working hours over time. In addition to incentives and subsidies, this reality must be taken into account when planning care. At the same time, it is questionable whether increasing medical school places without managing them according to need is the right way to address the shortage of physicians in outpatient care when an ever-increasing proportion of physicians is working in inpatient care.
{"title":"[Physician Numbers and Employment in Bavaria: Trends in statistics of the Bavarian Medical Association and the Association of Statutory Health Insurance Physicians of Bavaria].","authors":"Sophie Gigou, Laura Corazza, Sandra Fett, Martin Tauscher, Roman Gerlach, Ewan Donnachie, Antonius Schneider","doi":"10.1055/a-2328-4088","DOIUrl":"https://doi.org/10.1055/a-2328-4088","url":null,"abstract":"<p><strong>Background: </strong>Although the number of places at medical schools and physicians in Germany has increased continuously over the past 25 years, there is a threat of a shortage of physicians. Based on data from the Bavarian Medical Association (BLÄK) and the Association of Statutory Health Insurance Physicians of Bavaria (KVB), an analysis of the number of physicians in Bavaria over a longer period of time was carried out in order to understand current developments and possible starting points for the future organization of medical care. The figures were analyzed with regard to the distribution of physicians by outpatient and inpatient sector as well as with regard to the development of the number of employees, the scope of employment and the gender distribution in the outpatient sector.</p><p><strong>Methods: </strong>Data were taken from the annually published and systematically compiled numbers of physicians from the BLÄK (2000 to 2022) as well as the outpatient billing data of practicing and employed physicians in Bavaria (2010 to 2022), processed by the KVB. Descriptive analyses were performed.</p><p><strong>Results: </strong>Since 2000, the number of physicians in Bavaria has risen by 83% in the inpatient setting and by 35% in the outpatient setting. As a result, more physicians have been working in hospitals than in outpatient care since 2010. In the outpatient setting the trend is moving away from establishing one's own practice and full-time work towards salaried and part-time employment. Employed physicians have lower average working hours than self-employed physicians. The proportion of women among physicians has steadily increased, with female physicians more likely to be employed and working part-time compared with male physicians. Nevertheless, part-time employment is also prominent among male physicians in some specialties today.</p><p><strong>Conclusion: </strong>The trend towards practicing in salaried and part-time positions continues unabated and is represented across all specialties, suggesting that more physicians are needed to maintain the number of working hours over time. In addition to incentives and subsidies, this reality must be taken into account when planning care. At the same time, it is questionable whether increasing medical school places without managing them according to need is the right way to address the shortage of physicians in outpatient care when an ever-increasing proportion of physicians is working in inpatient care.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141628075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simone Scheithauer, Julia Hoffmann, Caroline Lang, Diana Fenz, Milena Maria Berens, Antonia Milena Köster, Ivonne Panchyrz, Lorenz Harst, Kristina Adorjan, Christian Apfelbacher, Sandra Ciesek, Claudia Maria Denkinger, Christian Drosten, Max Geraedts, Ruth Hecker, Wolfgang Hoffmann, André Karch, Thea Koch, Dagmar Krefting, Klaus Lieb, Jörg J Meerpohl, Eva Annette Rehfuess, Nicole Skoetz, Saša Sopka, Thomas von Lengerke, Hauke Wiegand, Jochen Schmitt
{"title":"Pandemic Preparedness – A proposal for a research infrastructure and its functionalities for a resilient health research system.","authors":"Simone Scheithauer, Julia Hoffmann, Caroline Lang, Diana Fenz, Milena Maria Berens, Antonia Milena Köster, Ivonne Panchyrz, Lorenz Harst, Kristina Adorjan, Christian Apfelbacher, Sandra Ciesek, Claudia Maria Denkinger, Christian Drosten, Max Geraedts, Ruth Hecker, Wolfgang Hoffmann, André Karch, Thea Koch, Dagmar Krefting, Klaus Lieb, Jörg J Meerpohl, Eva Annette Rehfuess, Nicole Skoetz, Saša Sopka, Thomas von Lengerke, Hauke Wiegand, Jochen Schmitt","doi":"10.1055/a-2365-9179","DOIUrl":"https://doi.org/10.1055/a-2365-9179","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katrin Simone Steul, Regina Fertig, Raphaela Heinrich, Roswitha Reisert, Jürgen Krahn
{"title":"Erkenntnisse aus der Durchführung des Masernschutz-Gesetzes nach den ersten drei Jahren seit Einführung – Daten aus Darmstadt Dieburg (Hessen).","authors":"Katrin Simone Steul, Regina Fertig, Raphaela Heinrich, Roswitha Reisert, Jürgen Krahn","doi":"10.1055/a-2365-1400","DOIUrl":"https://doi.org/10.1055/a-2365-1400","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia Brockschnieder, Julia Haas, Julia Neubauer, Kathrin Prosser, Bertram Szagun
Objectives: The tasks of the Public Health Service include, amongst others, health promotion and disease prevention, health reporting and health planning. In many places, local or district health conferences (HCs) have been established to network and coordinate municipal stakeholders. HCs have been defined in the laws of the German states of Baden-Wurttemberg, Berlin, Hamburg, Hesse, and North Rhine-Westphalia. As systematic and comprehensive studies of HCs are not available, a descriptive analysis of the characteristic features, key topics and activities of HCs in selected states was performed.
Methods: Based on a non-reactive survey of the activities from 2013 to 2022, all HCs in four states (n=110) were covered. Data on structural features, topics and HC activities were gathered in a systematic approach. The topics these conferences dealt with were matched against the health objectives of the states. Following an internal verification of the results, univariate and bivariate analyses were performed for individual states, districts, and the year of establishment.
Results: Overall, topics frequently covered by the HCs are primary care, children's and adolescent health, health at old age, infection prevention and control, physical exercise and diet as well as addiction; in some cases, frequencies of these topics differed heavily among the states and municipalities. The topics covered by the HCs showed a strong association with the health objectives of the respective states. Health care is addressed more often in administrative districts (Landkreise) than in independent cities (kreisfreie Städte). Conferences established more recently (after 2011) exhibited greater activities than older ones in terms of plenary sessions and press releases.
Conclusion: HCs are marked by a wide range of key topics which are based on health objectives of the respective states; however, noticeable differences exist between rural and urban areas. Conferences established more recently show a higher level of activity than older ones, which might point to sustainability issues under the current constraints. Whereas differences between rural and urban areas had already been noted for health-reporting activities, this was not the case for HC activities. The hypotheses derived from this descriptive analysis warrant further examination in order to ensure that the HCs create a sustainable impact.
目标:公共卫生服务机构的任务主要包括促进健康和预防疾病、健康报告和健康规划。许多地方都成立了地方或地区卫生会议 (HCs),以联络和协调市政利益相关者。德国巴登-符腾堡州、柏林州、汉堡州、黑森州和北莱茵-威斯特法伦州的法律都对卫生会议做出了规定。由于目前还没有对市政委员会进行系统全面的研究,因此我们对部分州的市政委员会的特点、主要议题和活动进行了描述性分析:方法:基于对 2013 年至 2022 年期间活动的非反应性调查,涵盖了四个州的所有保健中心(n=110)。通过系统的方法收集了有关结构特征、主题和慧聪网活动的数据。这些会议涉及的主题与各州的卫生目标相匹配。在对结果进行内部核查后,对各个州、地区和成立年份进行了单变量和双变量分析:总体而言,保健中心经常涉及的主题包括初级保健、儿童和青少年健康、老年健康、感染预防和控制、体育锻炼和饮食以及成瘾;在某些情况下,各州和各市涉及这些主题的频率差别很大。保健中心涵盖的主题与各州的保健目标密切相关。行政区(Landkreise)比独立城市(kreisfreie Städte)更经常讨论卫生保健问题。最近(2011 年之后)召开的会议在全体会议和新闻发布方面的活动多于较早召开的会议:根据各州的健康目标,健康大会的主要议题范围广泛,但城乡之间存在明显差异。最近召开的会议比以前召开的会议更活跃,这可能表明在当前的限制条件下存在可持续发展的问题。虽然在健康报告活动方面已经注意到了城乡之间的差异,但在 HC 活动方面情况并非如此。从这一描述性分析中得出的假设值得进一步研究,以确保人道主义协调员产生可持续的影响。
{"title":"[Key Topics and Activities of Local and District Health Conferences between 2013 and 2022: Results of a Non-Reactive Online Screening].","authors":"Julia Brockschnieder, Julia Haas, Julia Neubauer, Kathrin Prosser, Bertram Szagun","doi":"10.1055/a-2305-7716","DOIUrl":"10.1055/a-2305-7716","url":null,"abstract":"<p><strong>Objectives: </strong>The tasks of the Public Health Service include, amongst others, health promotion and disease prevention, health reporting and health planning. In many places, local or district health conferences (HCs) have been established to network and coordinate municipal stakeholders. HCs have been defined in the laws of the German states of Baden-Wurttemberg, Berlin, Hamburg, Hesse, and North Rhine-Westphalia. As systematic and comprehensive studies of HCs are not available, a descriptive analysis of the characteristic features, key topics and activities of HCs in selected states was performed.</p><p><strong>Methods: </strong>Based on a non-reactive survey of the activities from 2013 to 2022, all HCs in four states (n=110) were covered. Data on structural features, topics and HC activities were gathered in a systematic approach. The topics these conferences dealt with were matched against the health objectives of the states. Following an internal verification of the results, univariate and bivariate analyses were performed for individual states, districts, and the year of establishment.</p><p><strong>Results: </strong>Overall, topics frequently covered by the HCs are primary care, children's and adolescent health, health at old age, infection prevention and control, physical exercise and diet as well as addiction; in some cases, frequencies of these topics differed heavily among the states and municipalities. The topics covered by the HCs showed a strong association with the health objectives of the respective states. Health care is addressed more often in administrative districts (Landkreise) than in independent cities (kreisfreie Städte). Conferences established more recently (after 2011) exhibited greater activities than older ones in terms of plenary sessions and press releases.</p><p><strong>Conclusion: </strong>HCs are marked by a wide range of key topics which are based on health objectives of the respective states; however, noticeable differences exist between rural and urban areas. Conferences established more recently show a higher level of activity than older ones, which might point to sustainability issues under the current constraints. Whereas differences between rural and urban areas had already been noted for health-reporting activities, this was not the case for HC activities. The hypotheses derived from this descriptive analysis warrant further examination in order to ensure that the HCs create a sustainable impact.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-10-20DOI: 10.1055/a-2098-3039
Peter Ihle, Udo Schneider, Verena Vogt
Health services research examines the structures and processes of health care under everyday conditions. Routine data of the statutory health insurance (SHI) - the so-called routine practice data - represent real health care and are therefore an important data source for health services research. This paper presents 5 key questions that researchers and data-holding institutions can use to assess the suitability of this data source for answering their health services research question. The aim of these guiding questions is to generate a common understanding between researchers and data-holding institutions of the research project, the research objective, and the feasibility of implementation in health services research. The five guiding questions cover the formulation of the research question, the planned method, the target population, the relevant study periods, and the required information from SHI data. These methodologically oriented guiding questions are supplemented by the question of how the results of the research project could improve care. Thus, for researchers, the five guiding questions provide an initial structuring for data requests; for data-holding institutions, they provide a framework for considering possible involvement in or support of a research idea in health services research.
{"title":"[Five Key Questions for Health Services Research: are SHI Claims Data Suitable for Your Research Project?]","authors":"Peter Ihle, Udo Schneider, Verena Vogt","doi":"10.1055/a-2098-3039","DOIUrl":"10.1055/a-2098-3039","url":null,"abstract":"<p><p>Health services research examines the structures and processes of health care under everyday conditions. Routine data of the statutory health insurance (SHI) - the so-called routine practice data - represent real health care and are therefore an important data source for health services research. This paper presents 5 key questions that researchers and data-holding institutions can use to assess the suitability of this data source for answering their health services research question. The aim of these guiding questions is to generate a common understanding between researchers and data-holding institutions of the research project, the research objective, and the feasibility of implementation in health services research. The five guiding questions cover the formulation of the research question, the planned method, the target population, the relevant study periods, and the required information from SHI data. These methodologically oriented guiding questions are supplemented by the question of how the results of the research project could improve care. Thus, for researchers, the five guiding questions provide an initial structuring for data requests; for data-holding institutions, they provide a framework for considering possible involvement in or support of a research idea in health services research.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-29DOI: 10.1055/a-2312-4993
Ingo Meyer
{"title":"AGENS Methodenworkshop und Career Day 2023 – face2face in Köln.","authors":"Ingo Meyer","doi":"10.1055/a-2312-4993","DOIUrl":"10.1055/a-2312-4993","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-05-30DOI: 10.1055/a-2061-6954
Lukas Reitzle, Ingrid Köster, Oktay Tuncer, Christian Schmidt, Ingo Meyer
Background: Surveillance of diabetes requires up-to-date information on the prevalence of diabetes and its complications over time. For this purpose, statutory health insurance (SHI) data is being increasingly used, as the data is available in a timely fashion and case numbers enable detailed estimates also of diabetes complications. The aim of the present study was the development and internal validation of case definitions for the prevalence estimation of diabetic retinopathy (DRP), diabetic polyneuropathy (DPN) and diabetic foot syndrome (DFS).
Methods: Persons with diabetes differentiated by type 1, type 2, and other diabetes in an age- and sex-stratified sample of persons insured by Barmer SHI in 2018 (n=72,744) comprised the study popuation. Based on the central ICD codes for microvascular complications (DRP: H36.0; DPN: G63.2; DFS: E1X.74/.75), case definitions were developed including additional ICD codes for complications without direct diabetes reference. Subsequently, the case definitions were internally validated. For the validation, coding in the inpatient setting (m1S) or repeatedly in the outpatient setting (m2Q) as well as coding of specific procedures (EBM, OPS) and drug prescriptions or by relevant specialists were considered. Additionally, we analysed the documentation of the diagnoses in the previous years.
Results: In 2018, the prevalence of the central ICD codes was 8.4% for DRP (H36.0), 18.9% for DPN (G63.2) and 13.4% for DFS (E1X.74/.75). After inclusion of additional ICD codes in the case definition, prevalence increased significantly for DRP (9.6%) and DPN (20.7%), and barely for DFS (13.5%). Internal validation confirmed the majority of diagnoses (DRP: 96.7%; DPN: 96.5% DFS: 95.8%) and m2Q represented the most relevant criterion. When up to four previous years were considered, prevalences were up to 30% higher for DPN and DFS and up to 64% higher for DRP.
Conclusion: The inclusion of additional ICD codes in the case definition of microvascular complications of diabetes appears meaningful, as this increases the sensitivity of the prevalence estimate. Internal validation suggests that the documented diagnoses are plausible. However, not all diagnoses are documented annually, leading to an underestimation of the prevalence using a cross-sectional study design of one year.
{"title":"[Development and Internal Validation of Case Definitions for Prevalence Estimation of Microvascular Complications of Diabetes in Routine Data].","authors":"Lukas Reitzle, Ingrid Köster, Oktay Tuncer, Christian Schmidt, Ingo Meyer","doi":"10.1055/a-2061-6954","DOIUrl":"10.1055/a-2061-6954","url":null,"abstract":"<p><strong>Background: </strong>Surveillance of diabetes requires up-to-date information on the prevalence of diabetes and its complications over time. For this purpose, statutory health insurance (SHI) data is being increasingly used, as the data is available in a timely fashion and case numbers enable detailed estimates also of diabetes complications. The aim of the present study was the development and internal validation of case definitions for the prevalence estimation of diabetic retinopathy (DRP), diabetic polyneuropathy (DPN) and diabetic foot syndrome (DFS).</p><p><strong>Methods: </strong>Persons with diabetes differentiated by type 1, type 2, and other diabetes in an age- and sex-stratified sample of persons insured by Barmer SHI in 2018 (n=72,744) comprised the study popuation. Based on the central ICD codes for microvascular complications (DRP: H36.0; DPN: G63.2; DFS: E1X.74/.75), case definitions were developed including additional ICD codes for complications without direct diabetes reference. Subsequently, the case definitions were internally validated. For the validation, coding in the inpatient setting (m1S) or repeatedly in the outpatient setting (m2Q) as well as coding of specific procedures (EBM, OPS) and drug prescriptions or by relevant specialists were considered. Additionally, we analysed the documentation of the diagnoses in the previous years.</p><p><strong>Results: </strong>In 2018, the prevalence of the central ICD codes was 8.4% for DRP (H36.0), 18.9% for DPN (G63.2) and 13.4% for DFS (E1X.74/.75). After inclusion of additional ICD codes in the case definition, prevalence increased significantly for DRP (9.6%) and DPN (20.7%), and barely for DFS (13.5%). Internal validation confirmed the majority of diagnoses (DRP: 96.7%; DPN: 96.5% DFS: 95.8%) and m2Q represented the most relevant criterion. When up to four previous years were considered, prevalences were up to 30% higher for DPN and DFS and up to 64% higher for DRP.</p><p><strong>Conclusion: </strong>The inclusion of additional ICD codes in the case definition of microvascular complications of diabetes appears meaningful, as this increases the sensitivity of the prevalence estimate. Internal validation suggests that the documented diagnoses are plausible. However, not all diagnoses are documented annually, leading to an underestimation of the prevalence using a cross-sectional study design of one year.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9548514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-12-22DOI: 10.1055/a-2173-8160
Felix Wicke, Eva Lorenz, Roman Michael Pokora
Ziel war es die Wirksamkeit der Influenza-Impfung (VE) für die Grippesaison 2014/2015 auf Grundlage von Routinedaten aus Krankenkassendatensatz zu schätzen und zu replizieren. Zusätzlich sollten methodische Aspekte untersucht werden. Es wurden Abrechnungsdaten von 2,64 Millionen Versicherten der AOK Baden-Württemberg mit dortigem Wohnsitz ab 15 Jahren analysiert. Basierend auf Abrechnungsdaten für die Influenza-Impfung 2014, wurden die Teilnehmer als ungeimpft oder geimpft klassifiziert. Kovariablen, die den Zusammenhang zwischen Impfung und Influenzainfektion beeinträchtigen könnten, wurden berücksichtigt. Hierzu gehörten Alter, Geschlecht, Wohnort sowie Kovariablen, die auf den Gesundheitszustand und die Inanspruchnahme von Gesundheitsdienstleistungen hinweisen. Der primäre Endpunkt war ein Krankenhausaufenthalt wegen Influenza während der Grippesaison 2015. Zu den sekundären Endpunkten gehörten unter anderem Krankenhausaufenthalte wegen Lungenentzündung und die Gesamtmortalität. Um eine vergleichbare Gruppe von geimpften und ungeimpften Teilnehmern zu ermitteln, wurde ein Propensity-Score-Matching (PSM) durchgeführt. Es wurde eine Bias-Analyse durchgeführt, bei der die VE vor und nach der Grippesaison geschätzt wurde, also zu Zeitpunkten, in denen angenommen wurde, dass die Influenza nicht in der Bevölkerung zirkulierte und die Impfung nicht wirken konnte. Insgesamt konnten 839.706 Teilnehmer 1:1 gematcht werden. Die geschätzte VE (basierend auf Influenza bedingten Krankenhausaufenthalten) betrug 27% [95%Konfidenzintervall (KI): 17%; 36%], was der Schätzung des RKI für dieselbe Saison (27% [95%KI: -1%; 47%]) entspricht. Die Bias-Analyse zeigte, dass das Ergebnis teilweise durch residuale Konfundierung erklärt werden kann, was zu einer potenziellen Überschätzung des zugrunde liegenden Effekts führt. Die Ergebnisse der sekundären Endpunkte zeigten ähnliche Ergebnisse, obwohl sie wahrscheinlich in höherem Maße durch residuale Konfundierung bedingt sind. Zusammenfassend zeigt sich, dass (1) sekundäre Daten der deutschen Krankenkassen verwendet werden können, um plausible VE-Schätzungen abzuleiten, und dass (2) das PSM eine nützliche und transparente Methode zur Ableitung dieser Schätzungen ist. Darüber hinaus ist (3) residuale Konfundierung ein relevantes Problem in Beobachtungsstudien zu VE und (4) Bias-Analysen vor- und nach der Grippesaison sind eine wesentliche Ergänzung für die Interpretation der Ergebnisse.
{"title":"[Schätzung der Wirksamkeit der Grippeimpfung anhand von Sekundärdaten: Eine Kohortenstudie und Propensity-Score-Matching-Analyse von Leistungsdaten aus Baden-Württemberg].","authors":"Felix Wicke, Eva Lorenz, Roman Michael Pokora","doi":"10.1055/a-2173-8160","DOIUrl":"10.1055/a-2173-8160","url":null,"abstract":"<p><p>Ziel war es die Wirksamkeit der Influenza-Impfung (VE) für die Grippesaison 2014/2015 auf Grundlage von Routinedaten aus Krankenkassendatensatz zu schätzen und zu replizieren. Zusätzlich sollten methodische Aspekte untersucht werden. Es wurden Abrechnungsdaten von 2,64 Millionen Versicherten der AOK Baden-Württemberg mit dortigem Wohnsitz ab 15 Jahren analysiert. Basierend auf Abrechnungsdaten für die Influenza-Impfung 2014, wurden die Teilnehmer als ungeimpft oder geimpft klassifiziert. Kovariablen, die den Zusammenhang zwischen Impfung und Influenzainfektion beeinträchtigen könnten, wurden berücksichtigt. Hierzu gehörten Alter, Geschlecht, Wohnort sowie Kovariablen, die auf den Gesundheitszustand und die Inanspruchnahme von Gesundheitsdienstleistungen hinweisen. Der primäre Endpunkt war ein Krankenhausaufenthalt wegen Influenza während der Grippesaison 2015. Zu den sekundären Endpunkten gehörten unter anderem Krankenhausaufenthalte wegen Lungenentzündung und die Gesamtmortalität. Um eine vergleichbare Gruppe von geimpften und ungeimpften Teilnehmern zu ermitteln, wurde ein Propensity-Score-Matching (PSM) durchgeführt. Es wurde eine Bias-Analyse durchgeführt, bei der die VE vor und nach der Grippesaison geschätzt wurde, also zu Zeitpunkten, in denen angenommen wurde, dass die Influenza nicht in der Bevölkerung zirkulierte und die Impfung nicht wirken konnte. Insgesamt konnten 839.706 Teilnehmer 1:1 gematcht werden. Die geschätzte VE (basierend auf Influenza bedingten Krankenhausaufenthalten) betrug 27% [95%Konfidenzintervall (KI): 17%; 36%], was der Schätzung des RKI für dieselbe Saison (27% [95%KI: -1%; 47%]) entspricht. Die Bias-Analyse zeigte, dass das Ergebnis teilweise durch residuale Konfundierung erklärt werden kann, was zu einer potenziellen Überschätzung des zugrunde liegenden Effekts führt. Die Ergebnisse der sekundären Endpunkte zeigten ähnliche Ergebnisse, obwohl sie wahrscheinlich in höherem Maße durch residuale Konfundierung bedingt sind. Zusammenfassend zeigt sich, dass (1) sekundäre Daten der deutschen Krankenkassen verwendet werden können, um plausible VE-Schätzungen abzuleiten, und dass (2) das PSM eine nützliche und transparente Methode zur Ableitung dieser Schätzungen ist. Darüber hinaus ist (3) residuale Konfundierung ein relevantes Problem in Beobachtungsstudien zu VE und (4) Bias-Analysen vor- und nach der Grippesaison sind eine wesentliche Ergänzung für die Interpretation der Ergebnisse.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}