Abstract Objectives We analysed the degree and impact of consent bias in the prospective study ‘leben in der Arbeit (lidA)’ after linking primary interview data with claims data from German statutory ...health insurance funds as well as with administrative data provided by the German Federal Employment Agency. Study design Prospective cohort study. Methods Within two study waves (2011, 2014) primary data were collected based on computer-assisted personal interviews. During interview informed consent to data linkage was obtained. We used binary logistic regression analyses with participants' consent for record linkage as the dependent variable calculating odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent variables. Several sociodemographic, socio-economic and work-related factors were modelled as potential determinants of consent. Results A total of 4244 participants took part in both waves. After excluding invalid consent, 4178 participants were included in the analysis. About 3918 (93.8%) of these participants gave their consent to link their primary data with data from at least one source. Within regression analyses only moderate bias was found due to region of residence, apprenticeship, professional affiliations, income and number of diseases. Participants from former West Germany were less likely to have their study data linked with both data sources (OR 0.63 95% CI 0.42–0.96) than those from the former East Germany. Participants with no information on income were more likely to refuse consent to both data sources compared to the reference group (net income: under EUR 1000; OR 0.15 95% CI 0.08–0.30). Respondents with two (OR 1.37 95% CI 1.06–1.77) or three and more diseases (OR 1.30 95% CI 1.02–1.66) diagnosed by a doctor agreed more frequently to linking both data sources than participants without disease. There is just a small proportion of variance in consenting explained by the models (R2 : 0.063–0.085). Also, only small changes of factors' prevalence were observed in consenters. Conclusions For the first time in Germany, the lidA-study links primary survey data with health claims and administrative employment data. We conclude that there is only a minor relation between the analysed factors and consent behaviour of the participants. A linked data set may be used in further analyses without substantial biases.
In a case-control study, we investigated the possible etiologic relevance to Parkinson's disease (PD) of rural factors such as farming activity, pesticide exposures, well-water drinking, and animal ...contacts; toxicologic exposures such as wood preservatives, heavy metals, and solvents; general anesthesia; head trauma; and differences in the intrauterine environment. We recruited 380 patients in nine German clinics, 379 neighborhood control subjects, and 376 regional control subjects in the largest case-control study investigating such factors and collected data in structured personal interviews using conditional logistic regression to control for educational status and cigarette smoking. The latter was strongly inversely associated with PD. There were significantly elevated odds ratios (OR) for pesticide use, in particular, for organochlorines and alkylated phosphates, but no association was present between PD and other rural factors. A significantly elevated OR was present for exposure to wood preservatives. Subjective assessment by the probands indicated that exposure to some heavy metals, solvents, exhaust fumes, and carbon monoxide was significantly more frequent among patients than control subjects, but this was not confirmed by a parallel assessment of job histories according to a job exposure matrix. Patients had undergone general anesthesia and suffered severe head trauma more often than control subjects, but a dose-response gradient was not present. Patients reported a significantly larger number of amalgam-filled teeth before their illness than control subjects. The frequency of premature births and birth order did not differ between patients and control subjects. Patients reported significantly more relatives affected with PD than control subjects. These results support a role for environmental and genetic factors in the etiology of PD.
The objective of this case-control study was to identify the main risk factors for community-acquired pneumonia (CAP) in a German adult population. A self-administered questionnaire was given to CAP ...cases provided by the German competence network CAPNETZ and population-based, randomly selected controls (sex- and age-matched). Multivariate analysis showed that in addition to known risk factors such as previous CAP odds ratio (OR) 1·6, 95% confidence interval (CI) 1·3–2·1, more than one respiratory infection during the previous year (OR 3·6, 95% CI 2·9–4·5), chronic pulmonary diseases (OR 2·3, 95% CI 1·7–3·0), number of comorbidities (OR 1·6, 95% CI 1·4–1·9), and number of children in the household (2 children: OR 2·2, 95% CI 1·5–3·4; ⩾3 children: OR 3·2, 95% CI 1·5–7·0) were independent risk factors for CAP. This was pronounced in particular in people aged ⩽65 years. The most likely explanation for this finding is higher exposure to infectious agents.
Zusammenfassung
Durch Auswertung von Abrechnungsdaten belegte J.E. Wennberg informationsträchtige Variationen der Versorgung regionaler Bevölkerungen. Die Variation ist kaum morbiditätsabhängig oder ...präferenzbasiert, aber in Teilen angebotsabhängig. Struktur (Kapazität), Prozesse (Leistungen) und Resultate sind imperfekt gekoppelt, mehr Versorgung bringt nicht notwendig bessere Versorgungsergebnisse. Die Rückmeldung der erhobenen Daten an verantwortliche Leistungserbringer, Kapazitätsbeeinflussung und Förderung der Patientenautonomie werden als wichtige Mechanismen zur Reduktion unbegründeter Versorgungsheterogenität angesehen. Auch in Deutschland finden regionale Auswertungen von Abrechnungs- und Registerdaten regionale Versorgungs- und Ergebnisheterogenität. Deren Reduktion dient dem gesundheitlichen Verbraucherschutz und kann Wirksamkeit und Wirtschaftlichkeit der Versorgung verbessern. Mehr analytische und experimentelle Versorgungswissenschaft ist nötig.
Zusammenfassung
Hintergrund
Obwohl jährlich rund 14 Mio. rettungsdienstliche Einsatzfahrten in Deutschland stattfinden, wird bisher wenig systematische Qualitätssicherung (QS) betrieben, die den ...Verlauf der Patienten, die Ergebnisqualität und überregionale Vergleiche beinhaltet.
Ziel der Arbeit
Stand, Bedarf und die Vision einer integrierten QS werden aufgezeigt.
Methode
Anhand von Literaturrecherchen und Kommunikation mit am Rettungsdienst (RD) beteiligten Akteuren wird die leistungserbringerübergreifende QS im RD auf ihren Ist-Stand hin beleuchtet. Dies geschieht entlang der 4 identifizierten Herausforderungen für die Leitstellen‑, Notfallsanitäter- und Notarztdokumentation:
1. Standardisierung der Datenerhebung,
2. Digitalisierung der Dokumentation,
3. überregionale Analyse verknüpfter Dokumentationen,
4. Messbarkeit relevanter Outcomes.
Weiterhin werden zwei Fallbeispiele aus Hessen und Baden-Württemberg geschildert. Da die Landesrettungsdienstgesetze den Möglichkeitsrahmen für die QS vorgeben, folgt eine Synopse aller 16 Gesetze.
Ergebnisse und Diskussion
Eine integrierte QS bezieht auch die Bedingungen vor dem Rettungsdiensteinsatz (v. a. Versorgung und Gesundheit des Patienten) sowie die Ergebnisse der Rettungsdienstleistungen nach dem Einsatz ein. Der Artikel zeigt, wie eine integrierte QS auf den Weg gebracht werden könnte. Durch eine integrierte QS können faire Qualitätsindikatoren des RD entwickelt werden – als Grundlage für Evaluationen und anstehende Regulationen mit dem Ziel der Verbesserung der gesamten Notfallversorgung.
The growing number of people suffering from chronic diseases and multimorbidity is associated with an increased risk of polypharmacy. The aims of the study are to estimate the prevalence of ...polypharmacy and to analyse its determinants in the transition from in- to outpatient care. Furthermore, we estimate the risk of a potential inappropriate medication (PIM) and its determinants.
The analyses are based on the data of a German statutory health insurance (AOK Saxony-Anhalt) of the third quarter of 2009. The analyses include all insured persons aged 60 years and older who were discharged from hospital within the study period and had filled at least one prescription at the pharmacy (n=21 041). After the analysis of prevalence rates of polypharmacy within 30 days after discharge from hospital, we used binary logistic regression models to estimate the effect of determinants of polypharmacy and PIM. In addition, interaction effects between the number of diseases and the number of practitioners involved in the therapy were calculated.
Our analyses show a significant effect of the number of diseases and the number of practitioners on the risk of polypharmacy. Furthermore, patients who are treated with 5 or more drugs have a significantly higher risk of a PIM prescription. The interaction model illustrates a disproportional rise of polypharmacy risk in women with multiple chronic conditions with an increase in the number of doctors treating them.
The results suggest that polypharmacy is not a result of increasing morbidity alone. Furthermore, the remarkable effect of the number of physicians treating a patient points to an unsolved problem in communication and coordination in outpatient pharmacotherapy and shows the need for centralized medication monitoring.
Using claims data, Wennberg demonstrated regional health-care variation that was not due to differentials in morbidity nor was it preference-based, but was partly supply-sensitive. The structure, ...processes, and outcomes of care are imperfectly coupled, and more services are not necessarily associated with better outcomes. Feeding data back to the responsible providers, restraining capacities, and fostering patient autonomy are seen as important in reducing unwarranted variation in health-care service delivery. In Germany, regional analyses of claims data and disease registries confirm the heterogeneity of processes and outcomes. A reduction in regional variation is in the interest of patient safety and likely to improve the effectiveness and efficiency of medical care. More health-care delivery science-both analytic and experimental-is needed.
In a case-control study, we compared the past dietary habits of 342 Parkinson's disease (PD) patients recruited from nine German clinics with those of 342 controls from the same neighborhood or ...region. Data were gathered with a structured interview and a self-administered food-frequency questionnaire. Nutrient intakes were calculated from the reported food intakes through linkage with the German Federal Food Code and analyzed using multivariate conditional logistic regression to control for total energy intake, educational status, and cigarette smoking. At the macronutrient level, patients reported higher carbohydrate intake than controls after adjustment for total energy intake, smoking, and educational status (OR = 2.74, 95% confidence interval CI: 1.30-6.07, for the highest versus lowest quartile, p trend = 0.02). This was reflected in higher monosaccharide and disaccharide intakes at the nutrient level. There was no difference between patients and controls in protein and fat intake after adjustment for energy intake. We found an inverse association between the intakes of beta-carotene (OR = 0.67, 95% CI: 0.37-1.19, p trend = 0.06) and ascorbic acid (OR = 0.60, 95% CI: 0.33-1.09, p trend = 0.04) by patients, although only the trend for ascorbic acid intake reached statistical significance. There was no difference between groups for alpha-tocopherol intake after adjustment for energy intake. We also found that patients reported a significantly lower intake of niacin than controls (OR = 0.15, 95% CI: 0.07-0.33, p trend < 0.00005). Our results suggest that if antioxidants play a protective role in this disease, the amounts provided by diet alone are insufficient. Although the interpretation of the inverse association between niacin intake and PD is complicated by the high niacin content in coffee and alcoholic beverages, which were also inversely associated with PD in this study, the strength of this association and its biologic plausibility warrant further investigation.
Purpose : Interest in diseases of the nervous system resulting from occupational exposure to mixed organic solvents has greatly increased. The aim of our study was to identify preclinical effects of ...low-level chronic solvent exposure on the central nervous system in car painters by assessing their cognitive performance. Methods : This psychological study involved 169 clinically healthy male volunteers (84 car painters and 85 controls) and is part of a comprehensive study investigating effects of solvent exposure. The test battery included paper-pencil tests (vocabulary test, block design test, c.i., d2 test), computer-based tests (digit span test, simple-choice reaction time test), and a questionnaire to assess the participants' mental state. Results : Car painters with long-term exposure to solvents showed psychological deviations such as deficits in concentration, memory and reaction time compared to unexposed subjects. The significant differences between the two groups were confirmed by multivariate statistical analysis. Conclusions : Our study displayed psychological effects associated with long-term solvent exposure in concentrations below German threshold limit values. These findings emphasize the necessity to promote the resolute compliance with occupational safety and health regulations in affected companies.
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