Zeitschriftenartikel zum Thema „Allgemeine Ortskrankenkasse“
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Kreft, Daniel, Jonas Keiler, Eberhard Grambow, Sabine Kischkel, Andreas Wree und Gabriele Doblhammer. „Prevalence and Mortality of Venous Leg Diseases of the Deep Veins: An Observational Cohort Study Based on German Health Claims Data“. Angiology 71, Nr. 5 (13.03.2020): 452–64. http://dx.doi.org/10.1177/0003319720905751.
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This study estimates the prevalence and mortality of diseases of the deep veins of the legs such as deep vein thrombosis (DVT), postthrombotic syndrome (PTS), and venous leg ulceration (VLU). We used a random sample of 250 000 patients at age 50+ years of the register of the Allgemeine Ortskrankenkasse from 2004 to 2015. Selected manifestations of venous diseases assumed as risk factors for mortality were analyzed using Cox models while adjusting for various basic demographic and health characteristics. The prevalence in 2004 was 0.05% for DVT of the femoral veins, 0.50% for DVT of any deep veins, 0.86% for PTS, and 0.91% for VLU. The mortality rate in 2004 to 2015 was 20.40 deaths/100 person-years for DVT of the femoral veins, 10.69 for DVT of any deep veins, 4.34 for PTS, and 7.02 for VLU. The model revealed a 35% higher risk ( p < .001) in patients with any DVT, an 88% higher mortality ( p < .001) for femoral DVT, a 23% higher risk ( p < .001) for VLU, and no health disadvantage in persons with PTS. Our study revealed an increased mortality for patients with VLU and DVT. Even after adjustment for embolic events and infections of the venous ulcers mortality remained significantly higher.
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Alyaydin, Emyal, Juergen Reinhard Sindermann, Jeanette Köppe, Joachim Gerss, Patrik Dröge, Thomas Ruhnke, Christian Günster, Holger Reinecke und Jannik Feld. „Depression and Anxiety in Heart Transplant Recipients: Prevalence and Impact on Post-Transplant Outcomes“. Journal of Personalized Medicine 13, Nr. 5 (17.05.2023): 844. http://dx.doi.org/10.3390/jpm13050844.
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Background: Depression and anxiety (DA) are common mental disorders in patients with chronic diseases, but the research regarding their prevalence in heart transplantation (HTx) is still limited. Methods: We performed an analysis of the prevalence and prognostic relevance of DA in patients who underwent HTx between 2010 and 2018 in Germany. Data were obtained from Allgemeine Ortskrankenkasse (AOK), which is the largest public health insurance provider. Results: Overall, 694 patients were identified. More than a third of them were diagnosed with DA before undergoing HTx (n = 260, 37.5%). Patients with DA more often had an ischaemic cardiomyopathy (p < 0.001) and a history of previous myocardial infarction (p = 0.001) or stroke (p = 0.002). The prevalence of hypertension (p < 0.001), diabetes (p = 0.004), dyslipidaemia (p < 0.001) and chronic kidney disease (p = 0.003) was higher amongst transplant recipients with DA. Patients with DA were more likely to suffer an ischaemic stroke (p < 0.001) or haemorrhagic stroke (p = 0.032), or develop septicaemia (p = 0.050) during hospitalisation for HTx. Our analysis found no significant differences between the groups with respect to in-hospital mortality. The female sex and mechanical circulatory support were associated with an inferior prognosis. Pretransplant non-ischaemic cardiomyopathy was related to a favourable outcome. Conclusions: DA affect up to a third of the population undergoing HTx, with a greater prevalence in patients with comorbidities. DA are associated with a higher incidence of stroke and septicaemia after HTx.
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Müller, Angelina, Olga Anastasia Amberger, Anastasiya Glushan, Renate Klaaßen-Mielke, Claudia Witte, Marjan van den Akker, Robin Brünn, Ferdinand M. Gerlach, Martin Beyer und Kateryna Karimova. „Differences in opioid prescription rates between patients with musculoskeletal disorders enrolled in coordinated ambulatory healthcare and patients receiving usual care: a retrospective observational cohort study“. BMJ Open 12, Nr. 8 (August 2022): e062657. http://dx.doi.org/10.1136/bmjopen-2022-062657.
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ObjectivesTo compare opioid prescription rates between patients enrolled in coordinated ambulatory care and patients receiving usual care.DesignIn this retrospective cohort study, we analysed claims data for insured patients with non-specific/specific back pain or osteoarthritis of hip or knee from 2014 to 2017.SettingThe study was based on administrative data provided by the statutory health insurance fund ‘Allgemeine Ortskrankenkasse’, in the state of Baden-Wurttemberg, Germany.ParticipantsThe intervention group consisted of patients enrolled in a coordinated ambulatory healthcare model; the control group included patients receiving usual care. Outcomes were overall strong and weak opioid prescriptions. Generalised linear regression models were used to analyse the effect of the intervention.ResultsOverall, 46 001 (non-specific 18 787/specific 27 214) patients with back pain and 19 366 patients with osteoarthritis belonged to the intervention group, and 7038 (2803/4235) and 963 patients to the control group, respectively. No significant difference in opioid prescriptions existed between the groups. However, the chance of being prescribed strong opioids was significantly lower in the intervention group (non-specific back pain: Odds Ratio (OR) 0.735, 95% Confidential Interval (CI) 0.563 to 0.960; specific back pain: OR 0.702, 95% CI 0.577 to 0.852; osteoarthritis: OR 0.644, 95% CI 0.464 to 0.892). The chance of being prescribed weak opioids was significantly higher in patients with specific back pain (OR 1.243, 95% CI 1.032 to 1.497) and osteoarthritis (OR 1.493, 95% CI 1.037 to 2.149) in the intervention group.ConclusionCoordinated ambulatory healthcare appears to be associated with a lower prescription rate for strong opioids in patients with chronic musculoskeletal disorders.Trial registration numberGerman Clinical Trials Register (DRKS00017548).
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Kunz, Joachim B., Andreas Schlotmann, Andrea Daubenbüchel, Stephan Lobitz, Andrea Jarisch, Regine Grosse, Holger Cario et al. „Benefits of a Disease Management Program for Sickle Cell Disease in Germany 2011–2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome“. Journal of Clinical Medicine 10, Nr. 19 (30.09.2021): 4543. http://dx.doi.org/10.3390/jcm10194543.
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Sickle Cell Disease (SCD) is the most common monogenic disorder globally but qualifies as a rare disease in Germany. In 2012, the German Society for Paediatric Oncology and Haematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. Besides other activities, this consortium issued treatment guidelines for SCD that strongly favour the use of hydroxyurea and propagated these guidelines in physician and patient education events. In order to quantify the effect of these recommendations, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). While the number of patients with SCD in Germany increased from approximately 2200 in 2011 to approximately 3200 in 2019, important components of the recently issued treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 44% of all patients with SCD being treated with hydroxyurea in 2019. In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased. Similarly, the proportion of patients who required analgesics and hospitals admissions declined. In sum, these data demonstrate an association between the dissemination of treatment guidelines and changes in clinical practice. The close temporal relationship between the increased use of hydroxyurea and the reduction in the incidence of acute chest syndrome in a representative population-based analysis implies that these changes in clinical practice contributed to an improvement in key measures of disease activity.
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Senft, Jonas D., Michel Wensing, Regina Poss-Doering, Joachim Szecsenyi und Gunter Laux. „Effect of involving certified healthcare assistants in primary care in Germany: a cross-sectional study“. BMJ Open 9, Nr. 12 (Dezember 2019): e033325. http://dx.doi.org/10.1136/bmjopen-2019-033325.
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ObjectivesGrowing prevalence of chronic diseases and limited resources are the key challenges for future healthcare. As a promising approach to maintain high-quality primary care, non-physician healthcare professionals have been trained to broaden qualifications and responsibilities. This study aimed to assess the influence of involving certified healthcare assistants (HCAs, German: Versorgungsassistent/in in der Hausarztpraxis) on quality and efficacy of primary care in Germany.DesignCross-sectional study.SettingPrimary care.ParticipantsPatients insured by the Allgemeine Ortskrankenkasse (AOK) statutory health insurer (AOK, Baden-Wuerttemberg, Germany).InterventionsSince 2008 practice assistants in Germany can enhance their professional education to become certified HCAs.Primary and secondary outcome measuresClaims data related to patients treated in practices employing at least one HCA were compared with data from practices not employing HCAs to determine frequency of consultations, hospital admissions and readmissions. Economic analysis comprised hospitalisation costs, prescriptions of follow-on drugs and outpatient medication costs.ResultsA total of 397 493 patients were treated in HCA practices, 463 730 patients attended to non-HCA practices. Patients in HCA practices had an 8.2% lower rate of specialist consultations (p<0.0001), a 4.0% lower rate of hospitalisations (p<0.0001), a 3.5% lower rate of readmissions (p=0.0463), a 14.2% lower rate of follow-on drug prescriptions (p<0.0001) and 4.7% lower costs of total medication (p<0.0001). No difference was found regarding the consultation rate of general practitioners and hospital costs.ConclusionsFor the first time, this high-volume claims data analysis showed that involving HCAs in primary care in Germany is associated with a reduction in hospital admissions, specialist consultations and medication costs. Consequently, broadening qualifications may be a successful strategy not only to share physicians’ work load but to improve quality and efficacy in primary care to meet future challenges. Future studies may explore specific tasks to be shared with non-physician workforces and standardisation of the professional role.
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Kisch, Rebecca, Eva Grill, Martin Müller, Jens Pietzner, Alexander C. Paulus und Martin Weigl. „Second opinion and time to knee arthroplasty: a prospective cohort study of 142 patients“. BMJ Open 13, Nr. 10 (Oktober 2023): e073497. http://dx.doi.org/10.1136/bmjopen-2023-073497.
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ObjectiveThe objective of this study was to determine the impact of obtaining a second opinion consultation on time to knee arthroplasty (KA). We further examined the frequency of KA and the determinants of KA following the second opinion.DesignProspective cohort study.SettingThe second opinion programme was implemented at the Ludwig Maximilian University Hospital in Munich.ParticipantsParticipants comprised patients with knee osteoarthritis who were insured with one of the largest statutory health insurance Allgemeine Ortskrankenkasse Bayern (mean age 64.3±9.6 years). Patients participated in a second-opinion programme and completed questionnaires on site before and after personal presentation for the second opinion consultation. Follow-up questionnaires were delivered by post at 3 and 12 months after the second opinion consultation. Of the 142 patients included in the study, 47 (33.1%) underwent KA within 12 months after obtaining the second opinion.Primary outcome measuresPrimary outcome measure was time until patients received KA. Cox proportional hazard modelling was used to calculate the associations between the selected predictors and time that elapsed between receipt of the second opinion to KA.ResultsMean time until KA was 17 weeks. Kaplan-Meier curves showed significant differences in time to KA according to the recommendation given at second opinion consultation, knee-related quality of life and Kellgren-Lawrence grade. In multivariate Cox proportional hazard modelling, second opinion recommendation (HR 5.33, 95% CI 1.16, 24.41) and knee-related quality of life (HR 1.03, 95% CI 1.01, 1.06) were significant predictors of time from second opinion to KA.ConclusionsObtaining a second opinion had significant impact on time to knee replacement. Those who were recommended immediate surgery also underwent surgery more quickly after the second opinion. The effect of knee-related quality of life supports the importance of patient-reported outcome measures in the decision for or against KA.
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Hempel, Fabian M., Joachim Krois, Sebastian Paris, Florian Beuer, Adelheid Kuhlmey und Falk Schwendicke. „Prosthetic treatment patterns in the very old: an insurance database analysis from Northeast Germany“. Clinical Oral Investigations 24, Nr. 11 (17.04.2020): 3981–95. http://dx.doi.org/10.1007/s00784-020-03264-x.
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Abstract Objectives We assessed dental prosthetic services utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at one large statutory insurer (Allgemeine Ortskrankenkasse Nordost, acting in the federal states Berlin, Brandenburg, Mecklenburg-Vorpommern), were followed over 6 years (2012–2017). Our outcome was the utilization of prosthetic services, in total and seven subgroups: (1) Crowns/partial crowns, (2) fixed dental prostheses (FDPs), (3) partial removable prostheses (RDPs), (4) full RDPs, (5) temporary services, (6) relining/rebasing/repairing/extending RDPs, (7) repairing FDPs. Association of utilization with (1) gender, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses and (6) German diagnoses related groups (G-DRG) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years; mean follow-up was 1689 (705) days. The mean utilization of any prosthetic service was 27.0%; the most often utilized service type were total RDPs (13.2% utilization), crowns (8.1%), and partial RDPs (7.1%). Utilization decreased with age for nearly all services (except relining/rebasing/repairing/extending RDPs) Utilization of prosthetic services was significantly higher in Berlin and most cities compared with rural municipalities and in individuals with common, less severe conditions according to ICD-10 and DRGs compared with life-threatening conditions or dementia. In multivariable analysis, gender (OR; 95% CI: 0.95; 0.93–0.98), social hardship status (1.19; 1.17–1.21), federal state (Brandenburg 0.57; 0.56–0.59; Mecklenburg-Vorpommern: 0.66; 0.64–0.67) and age significantly affected utilization (0.95; 0.95–0.95/year). Conclusions Patient-related and healthcare factors determine the utilization of prosthetic services in very old Germans. Interventions to maintain sufficient prosthetic care up to high age are required. Clinical significance The utilization of prosthetic services in the very old in Northeast Germany showed significant disparities within populations and service types. There seems to be great need to better understand the drivers of utilization, and to develop and evaluate interventions to maintain sufficient prosthetic care up to high age.
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Kreft, Daniel, Gabriele Doblhammer, Rudolf F. Guthoff und Stefanie Frech. „Incidence, individual, and macro level risk factors of severe binocular visual impairment and blindness in persons aged 50 and older“. PLOS ONE 16, Nr. 5 (03.05.2021): e0251018. http://dx.doi.org/10.1371/journal.pone.0251018.
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Objective This study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older. Methods We designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity. Results The age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany. Conclusion The study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.
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Mau, Jens. „AOK Rheinland und Westfalen“. kma - Klinik Management aktuell 14, Nr. 08 (August 2009): 12. http://dx.doi.org/10.1055/s-0036-1575254.
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Mühlnikel, Ingrid. „Kleine Starthilfe für die AOK“. kma - Klinik Management aktuell 13, Nr. 05 (Mai 2008): 30–32. http://dx.doi.org/10.1055/s-0036-1574689.
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Die großen Kassen, allen voran die Allgemeinen Ortskrankenkassen, haben es geschafft, den RSA zu ihren Gunsten zu verändern. Jetzt wird innerhalb des Kassenfinanzausgleichs künftig noch mehr Geld umverteilt: Volksleiden werden subventioniert, ihre Vermeidung dagegen wird nicht honoriert.
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Mühlnikel, Ingrid. „Der Countdown läuft“. kma - Klinik Management aktuell 14, Nr. 12 (Dezember 2009): 9. http://dx.doi.org/10.1055/s-0036-1575415.
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Zahlreiche Kassen bereiten sich derzeit auf die Erhebung von Zusatzbeiträgen im nächsten Jahr vor. Vor allem Ersatzkasssen wie die DAK, aber auch die KKH werden genannt. Insider mutmaßen, auch die Deutsche BKK sowie Allgemeine Ortskrankenkassen wären dabei. Eine offizielle Bestätigung durch die Kassen liegt nicht vor. Die KKH verbreitet: KKH-Allianz startet ohne Zusatzbeitrag ins nächste Jahr.
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Kunz, Joachim B., Andreas Schlotmann, Andrea Daubenbüchel, Stephan Lobitz, Andrea Jarisch, Regine Grosse, Holger Cario et al. „Benefits of a Disease Management Program for SCD in Germany 2011 - 2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome“. Blood 138, Supplement 1 (05.11.2021): 973. http://dx.doi.org/10.1182/blood-2021-148550.
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Abstract Background Worldwide, Sickle Cell Disease (SCD) is the most common single gene disorder affecting >250,000 newborns annually. In Germany, SCD qualifies as a rare disease and almost exclusively affects immigrants from endemic countries and their descendants. The recent surge of immigration from high-prevalence countries increased the numbers of patients with SCD in Germany and raised awareness for the need of specialized care. In 2012, the German Society for Pediatric Oncology and Hematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. This consortium issued treatment guidelines for SCD that strongly favor the use of hydroxyurea, initiated patient and physician education events, prepared for a universal newborn screening program that will start 09/2021, moderated a consensus on the indication of allogeneic stem cell transplantation for patients with SCD, and established a national patient registry. Methods In order to quantify the effect of these activities, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). ICD10 codes were used to identify patients with SCD and their comorbidities. Pharmacologic treatments were quantified using the German Anatomical Therapeutic Chemical (ATC)-Classification with defined daily doses. Results We estimate that the number of patients with SCD in Germany increased from approximately 2,200 in 2011 to approximately 3,200 in 2019. Analyses of administered treatments illustrate that important components of recently issued national treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 45% of all patients with SCD being treated with hydroxyurea in 2019 (Figure 1A). In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased (Figure 1B). While before the widespread use of hydroxyurea (2011-2013) 8.1% of patients with SCD were admitted at least once per year for ACS, this proportion dropped to 6.6% in the period 2017 to 2019. Similarly, the proportion of patients who required analgesics, red blood cell transfusions and hospitals admissions declined from 2011 to 2019, indicating a reduced burden of SCD with the increased use of hydroxyurea. Conclusion In sum, these data demonstrate an association between the dissemination of nationwide treatment guidelines and changes in clinical practice in particular relating to the use of hydroxyurea. These changes translate into a remarkable improvement of key measures of disease activity in a representative population based analysis. Figure 1 Figure 1. Disclosures Lobitz: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; AddMedica: Honoraria, Membership on an entity's Board of Directors or advisory committees; Vertex: Honoraria, Membership on an entity's Board of Directors or advisory committees. Kulozik: BioMedX: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy, Honoraria; bluebird bio, Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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Kraus, Ludwig, Daniela Piontek, Alexander Pabst und Gerhard Bühringer. „Alkoholkonsum und alkoholbezogene Mortalität, Morbidität, soziale Probleme und Folgekosten in Deutschland“. SUCHT 57, Nr. 2 (April 2011): 119–29. http://dx.doi.org/10.1024/0939-5911.a000095.
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Ziel: Ziel dieses Beitrags ist es, einen Überblick über den Alkoholkonsum und die damit verbundenen negativen Konsequenzen in Deutschland zu geben. Methodik: Dargestellt werden Daten zum Alkoholkonsum (Alkoholwirtschaft und Bevölkerungssurveys) sowie zu alkoholbedingter Mortalität (Gesamtsterblichkeit und potenziell verlorene Lebensjahre) und Morbidität (durch Krankheit verlorene Lebensjahre), zu sozialen Folgen (Straftaten, Straßenverkehr und Arbeit) und Folgekosten des Konsums. Ergebnisse: Alkohol war im Jahr 2002 für 48.571 Todesfälle (5,5 % der Gesamtsterblichkeit) in Deutschland verantwortlich, was 970.029 potenziell verlorenen Lebensjahren entspricht. Im Jahr 2004 waren insgesamt 6,2 % der nationalen Belastung durch Krankheit und Verletzungen vom Alkoholkonsum verursacht. Allein die bei den Allgemeinen Ortskrankenkassen (AOK) registrierten alkoholbedingten Arbeitsunfähigkeitstage beliefen sich im Jahr 2008 bei ca. 82.000 Fällen auf 1,09 Mio. Eine Schätzung der durch Morbidität und Mortalität bedingten Gesamtkosten ergab für das Jahr 2002 rund 24 Mrd. Euro (1,16 % des Bruttoinlandsprodukts). Schlussfolgerungen: Die Zahlen zu Umfang und negativen Folgen des Alkoholkonsums unterstreichen die Notwendigkeit der Entwicklung einer umfassenden Alkoholpolitik.
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Krappweis, Jutta. „Chronisch rheumatische Beschwerden und Erkrankungen: Eine repr�sentative L�ngsschnittstudie auf der Grundlage von Daten der Allgemeinen Ortskrankenkasse Dortmund“. Sozial- und Pr�ventivmedizin SPM 38, Nr. 6 (November 1993): 348–55. http://dx.doi.org/10.1007/bf01359188.
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Hentschker, C., C. Mostert, J. Klauber, J. Malzahn, D. Scheller-Kreinsen, G. Schillinger, C. Karagiannidis und R. Busse. „Stationäre und intensivmedizinische Versorgungsstrukturen von COVID-19-Patienten bis Juli 2020“. Medizinische Klinik - Intensivmedizin und Notfallmedizin 116, Nr. 5 (26.01.2021): 431–39. http://dx.doi.org/10.1007/s00063-021-00776-6.
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Zusammenfassung Hintergrund Hospitalisierte COVID-19-Patienten weisen eine hohe Morbidität und Mortalität auf und sind häufig auf eine intensivstationäre Behandlung und hier vor allem auf eine Beatmungstherapie angewiesen. Bisher ist wenig über die Patientenallokation bekannt. Ziel der Arbeit Die Darstellung der Strukturen der Krankenhausversorgung der COVID-19-Patienten zwischen dem 26. Februar bis zum 31. Juli 2020 Daten und Methoden Für die Analyse der Versorgungsstrukturen wurden die Abrechnungsdaten der Allgemeinen Ortskrankenkassen (AOK) ausgewertet. Es wurden ausschließlich abgeschlossene somatische COVID-19-Fälle ausgewertet, bei denen das Virus durch einen Labortest nachgewiesen wurde. Die Stichprobe umfasst 17.094 COVID-19-Fälle, deren Behandlung in 1082 Krankenhäusern erfolgte. Ergebnisse An der Versorgung der COVID-19-Fälle waren 77 % aller Krankenhäuser beteiligt, an der intensivmedizinischen Behandlung 48 % aller Krankenhäuser. Von den Krankenhäusern, die COVID-19-Fälle behandelt haben, versorgte eine Hälfte 88 % aller Fälle. Das deutet zwar auf einen Zentrierungseffekt der COVID-19-Fälle auf bestimmte Krankenhäuser hin, jedoch verteilten sich die übrigen 12 % der Fälle auf viele Krankenhäuser mit oftmals sehr kleinen Fallzahlen. Des Weiteren wurde knapp ein Viertel der beatmeten COVID-19-Fälle in Krankenhäusern behandelt, die eine unterdurchschnittliche Beatmungserfahrung aufweisen. Diskussion Im Rahmen steigender Infektionszahlen ist es sowohl notwendig die Versorgungsstrukturen von COVID-19-Fällen durch klar definierte und zentral gesteuerte Stufenkonzepte zu verbessern als auch die Versorgung der Patienten ohne COVID-19 weiterhin aufrechtzuerhalten. Ein umfassendes Stufenkonzept mit stärkerer Konzentration erscheint für die Versorgung dieser komplex erkrankten Patienten sinnvoll.
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Nestler, Sophia, Daniel Kreft, Gabriele Doblhammer, Rudolf F. Guthoff und Stefanie Frech. „Progression to severe visual impairment and blindness in POAG patients: pace and risk factors—a cohort study using German health claims data“. BMJ Open Ophthalmology 7, Nr. 1 (Januar 2022): e000838. http://dx.doi.org/10.1136/bmjophth-2021-000838.
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ObjectiveGlaucoma is a leading cause of severe visual impairment and blindness (SVI/B) worldwide. Hence, it is of utmost importance to explore relevant risk factors and study the pace of progression to SVI/B.Methods and analysisWe used a random sample of 250 000 persons from administrative individual-level health records of the Allgemeine Ortskrankenkassen between 2004 and 2015. We identified 3535 primary open-angle glaucoma (POAG) patients aged 55 and older and followed them for up to 10 years. Monocular and binocular SVI/B were defined by the ICD-10 classifications H54.0 and H54.4. Ophthalmological and chronic disease risk factors were analysed by applying a multivariable Cox proportional hazard model.ResultsThe risk of SVI/B in POAG patients was significantly increased by the presence of specific additional eye diseases such as secondary glaucoma (HR: 3.08, p<0.001), retinal vascular occlusion (HR: 3.00, p<0.001) or age-related macular degeneration (AMD) (HR: 2.26, p<0.001). The risk was highest in the first 2 years after the POAG diagnosis and significantly decreased after the fifth year (HR: 0.36, p=0.002). Ocular injuries, other ocular diseases, non-ophthalmological comorbidities, and age and sex had no significant influence (p>0.05).ConclusionAlthough progression to SVI/B is relatively rare in POAG patients in Germany, one must be aware of additional risk factors, such as secondary glaucoma, retinal vascular occlusion and AMD. Regular ophthalmological examinations help prevent the progression of SVI/B, especially in the first years after the POAG diagnosis. Specific, targeted, and timely treatments for the other eye diseases could help prevent or delay SVI/B.
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Jeschke, Elke, Thorsten Gehrke, Christian Günster, Karl-Dieter Heller, Jürgen Malzahn, Axel Marx, Fritz-Uwe Niethard, Peter Schräder, Josef Zacher und Andreas Halder. „Einfluss der Fallzahl pro Klinik auf die 5-Jahres-Überlebensrate des unikondylären Kniegelenkersatzes in Deutschland“. Zeitschrift für Orthopädie und Unfallchirurgie 156, Nr. 01 (23.08.2017): 62–67. http://dx.doi.org/10.1055/s-0043-116490.
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Zusammenfassung Hintergrund Die Angaben zu Überlebensraten des unikondylären Kniegelenkersatzes (UKE) sind ganz unterschiedlich. Der Einfluss von Patientenfaktoren und Implantat wurden bereits untersucht. Ziel der Analyse war es, den Einfluss der Fallzahl pro Klinik auf die 5-Jahres-Überlebensrate (5-JÜR) anhand von Routinedaten der größten Krankenkasse Deutschlands zu überprüfen. Methodik Die Abrechnungsdaten von 20 946 UKEs der Allgemeinen Ortskrankenkasse (AOK) der Jahre 2006 – 2012 wurden analysiert. Zur Ermittlung der Standzeiten wurden Kaplan-Meier-Analysen durchgeführt. Der Einfluss der Fallzahl pro Klinik auf die 5-JÜR wurde mithilfe einer multivariablen Cox-Regression unter Berücksichtigung von Patientenfaktoren analysiert und Hazard Ratios (HR) mit 95%-Konfidenzintervallen (KI) berechnet. Dazu wurden 5 Fallzahlgruppen gebildet: < 12 Fälle, 13 – 24 Fälle, 25 – 52 Fälle, 53 – 104 Fälle, > 104 Fälle (jeweils pro Klinik und Jahr). Ergebnisse Insgesamt betrug die 5-JÜR nach Kaplan-Meier 87,8% (95%-KI: 87,3 – 88,3%). Sie nahm mit der Fallzahl stetig zu (< 12 Fälle: 84,1% vs. > 104 Fälle: 93,2%). Die Cox-Analyse ergab, dass kleinere Fallzahlen einen unabhängigen Risikofaktor für eine Revision darstellen (< 12 Fälle: HR = 2,13 [95%-KI: 1,83 – 2,48]; 13 – 24 Fälle: HR = 1,94 [95%-KI: 1,67 – 2,25]; 25 – 52 Fälle: HR = 1,66 [95%-KI: 1,41 – 1,96]; 53 – 104 Fälle: HR = 1,51 [95%-KI: 1,28 – 1,77]; > 104 Fälle: Referenz). Diskussion In dem untersuchten Kollektiv besteht ein klarer Zusammenhang zwischen einer höheren Fallzahl pro Klinik und der 5-JÜR. Diese nimmt stetig über alle analysierten Fallzahlkategorien zu. So ist etwa das Risiko einer Revision innerhalb von 5 Jahren in Kliniken mit einer Fallzahl von weniger als 25 UKE pro Jahr gegenüber einer Klinik mit mehr als 104 Fällen etwa doppelt so hoch.
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Laux, Gunter, Petra Kaufmann-Kolle, Joachim Szecsenyi, Attila Altiner und Ruediger Leutgeb. „Fall-risk-increasing drugs in older patients: the role of guidelines and GP-centred health care in Germany“. Age and Ageing 52, Nr. 5 (01.05.2023). http://dx.doi.org/10.1093/ageing/afad071.
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Abstract Background fall-risk-increasing drugs (FRIDs) are a ubiquitous issue, especially for older patients. As part of a German guideline for pharmacotherapy, from 2019, a new quality indicator for this patient group was developed to measure the percentage of patients receiving FRIDs. Methods patients, aged at least 65 years in 2020, insured by the Allgemeine OrtsKrankenkasse statutory health insurance (Allgemeine Ortskrankenkasse, Baden-Wuerttemberg, Germany) with a particular general practitioner (GP) were observed from 1 January to 31 December 2020 cross-sectionally. The intervention group received GP-centred health care. Within GP-centred health care, GPs have the role of gatekeepers for patients within the health system and are—in contrast to regular care GPs in addition to other commitments—obliged to regularly attend training sessions on appropriate pharmacotherapy. The control group received regular GP care. For both groups, we measured the percentage of patients receiving FRIDs as well as the occurrence of (fall-related) fractures as the main outcomes. To test our hypotheses, we performed multivariable regression modelling. Results a total of 634,317 patients were eligible for analysis. Within the intervention group (n = 422,364), we could observe a significantly reduced odds ratio (OR) for obtaining a FRID (OR = 0.842, confidence interval [CI]: [0.826, 0.859], P < 0.0001) in comparison to the control group (n = 211,953). Moreover, we could observe a significantly reduced chance for (fall-related) fractures in the intervention group (OR: 0.932, CI: [0.889, 0.975], P = 0.0071). Conclusions the findings point in the direction that the health care providers’ awareness of the potential danger of FRIDs for older patients is higher in the GP-centred care group.
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Strunz, Stephan. „Figures of Misery: The Berlin Housing Survey (1901-1920) as an Epistemic Project“. Journal of Urban History, 09.06.2022, 009614422211002. http://dx.doi.org/10.1177/00961442221100256.
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From 1901 until 1920, Albert Kohn, director of the Berlin insurance organization Allgemeine Ortskrankenkasse, conducted a systematic housing survey of defective apartments. The work included statistics, reports, and photographs. I situate the project within the context of social surveys in the years around 1900. In the larger history of housing surveys, Kohn’s project was one of the first that amalgamated diverse media and data visualizations. The original publication exhibits a crucial connection between statistics, reports, and apartment photographs. I will show that both reports and photographs epistemically hinged on numerical data gained from a questionnaire. The assemblage of shocking figures in statistics, reports, and photographs was intended to make visible an epistemic object: the misery of the lower classes. Hence, Kohn’s depictions of urban misery did not depend on a specific form of representation, but rather on the consistency between descriptive registers.
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Michels, Julia D., Jan Meis, Noemi Sturm, Florian Bornitz, Selina von Schumann, Aline Weis, Benjamin Neetz et al. „Prevention of invasive ventilation (PRiVENT)—a prospective, mixed-methods interventional, multicentre study with a parallel comparison group: study protocol“. BMC Health Services Research 23, Nr. 1 (30.03.2023). http://dx.doi.org/10.1186/s12913-023-09283-0.
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Abstract Background Invasive mechanical ventilation (IMV) is a standard therapy for intensive care patients with respiratory failure. With increasing population age and multimorbidity, the number of patients who cannot be weaned from IMV increases, resulting in impaired quality of life and high costs. In addition, human resources are tied up in the care of these patients. Methods The PRiVENT intervention is a prospective, mixed-methods interventional, multicentre study with a parallel comparison group selected from insurance claims data of the health insurer Allgemeine Ortskrankenkasse Baden-Württemberg (AOK-BW) conducted in Baden-Württemberg, Germany, over 24 months. Four weaning centres supervise 40 intensive care units (ICUs), that are responsible for patient recruitment. The primary outcome, successful weaning from IMV, will be evaluated using a mixed logistic regression model. Secondary outcomes will be evaluated using mixed regression models. Discussion The overall objective of the PRiVENT project is the evaluation of strategies to prevent long-term IMV. Additional objectives aim to improve weaning expertise in and cooperation with the adjacent Intensive Care Units. Trial registration This study is registered at ClinicalTrials.gov (NCT05260853).
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Engelbertz, Christiane, Jannik Feld, Lena Makowski, Leonie Kühnemund, Alicia Jeanette Fischer, Stefan A. Lange, Christian Günster et al. „Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction depending on renal function: a retrospective analysis“. BMC Cardiovascular Disorders 23, Nr. 1 (02.02.2023). http://dx.doi.org/10.1186/s12872-023-03084-3.
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Abstract Background Cardiovascular disease is often associated with chronic kidney disease (CKD), resulting in an increased risk for poor outcome. We sought to determine short-term mortality and overall survival in ST-elevation myocardial infarction (STEMI) patients with different stages of CKD. Methods In our retrospective cohort study with health insurance claims data of the Allgemeine Ortskrankenkasse (AOK), anonymized data of all STEMI patients hospitalized between 2010 and 2017 were analyzed regarding presence and severity of concomitant CKD. Results A total of 175,187 patients had an index-hospitalisation for STEMI (without CKD: 78.6% patients, CKD stage 1: 0.8%, CKD stage 2: 4.8%, CKD stage 3: 11.7%, CKD stage 4: 2.8%, CKD stage 5: 0.7%, CKD stage 5d: 0.6%). Patients with CKD were older and had more co-morbidities than patients without CKD. With increasing CKD severity, patients received less revascularization therapies (91.2%, 85.9%, 87.0%, 81.8%, 71.7%, 76.9% and 78.6% respectively, p < 0.001). After 1 year, guideline-recommended medications were prescribed less frequently in advanced CKD (83.4%, 79.3%, 81.5%, 74.7%, 65.0%, 59.4% and 53.7%, respectively, p < 0.001). CKD stages 4, 5 and 5d as well as chronic limb threatening ischemia (CLTI) were associated with decreased overall survival [CKD stage 4: hazard ratio (HR) 1.72; 95% CI 1.66–1.78; CKD stage 5: HR 2.55; 95% CI 2.37–2.73; CKD stage 5d: 5.64; 95% CI 5.42–5.86; CLTI: 2.06; 95% CI 1.98–2.13; all p < 0.001]. Conclusions CKD is a frequent co-morbidity in patients with STEMI and is associated with a worse prognosis especially in advanced stages. Guideline-recommended therapies in patients with STEMI and CKD are still underused.
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Safieddine, Batoul, Julia Grasshoff, Siegfried Geyer, Stefanie Sperlich, Jelena Epping und Johannes Beller. „Type 2 diabetes in the employed population: do rates and trends differ among nine occupational sectors? An analysis using German health insurance claims data“. BMC Public Health 24, Nr. 1 (03.05.2024). http://dx.doi.org/10.1186/s12889-024-18705-5.
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Abstract Background Socioeconomic inequalities in type 2 diabetes (T2D) are well established in the literature. However, within the background of changing work contexts associated with digitalization and its effect on lifestyle and sedentary behavior, little is known on T2D prevalence and trends among different occupational groups. This study aims to examine occupational sector differences in T2D prevalence and trends thereof between 2012 and 2019. Methods The study was done on 1.683.644 employed individuals using data from the German statutory health insurance provider in Lower Saxony, the “Allgemeine Ortskrankenkasse Niedersachsen” (AOKN). Predicted probabilities for T2D prevalence in four two-year periods between 2012 and 2019 were estimated based on logistic regression analyses for nine occupational sectors. Prevalence ratios were calculated to illustrate the effect of time period on the prevalence of T2D among the nine occupational sectors. Analyses were stratified by gender and two age groups. Results Results showed differences among occupational sectors in the predicted probabilities for T2D. The occupational sectors “Transport, logistics, protection and security” and “Health sector, social work, teaching & education” had the highest predicted probabilities, while those working in the sector “Agriculture” had by far the lowest predicted probabilities for T2D. Over all, there appeared to be a rising trend in T2D prevalence among younger employed individuals, with gender differences among occupational sectors. Conclusion The study displayed different vulnerability levels among occupational sectors with respect to T2D prevalence overall and for its rising trend among the younger age group. Specific occupations within the vulnerable sectors need to be focused upon in further research to define specific target groups to which T2D prevention interventions should be tailored.
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Rakuša, Elena, Anne Fink, Gültekin Tamgüney, Michael T. Heneka und Gabriele Doblhammer. „Sporadic Use of Antibiotics in Older Adults and the Risk of Dementia: A Nested Case–Control Study Based on German Health Claims Data“. Journal of Alzheimer's Disease, 05.05.2023, 1–11. http://dx.doi.org/10.3233/jad-221153.
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Background: Antibiotics for systemic use may increase the risk of neurodegeneration, yet antibiotic therapy may be able to halt or mitigate an episode of neurodegenerative decline. Objective: To investigate the association of sporadic use of antibiotics and subsequent dementia risk (including Alzheimer’s disease). Methods: We used data from the largest public health insurance fund in Germany, the Allgemeine Ortskrankenkasse (AOK). Each of the 35,072 dementia cases aged 60 years and older with a new dementia diagnosis during the observation period from 2006 to 2018 was matched with two control-patients by age, sex, and time since 2006. We ran conditional logistic regression models for dementia risk in terms of odds ratios (OR) as a function of antibiotic use for the entire antibiotic group and for each antibiotic subgroup. We controlled for comorbidities, need for long-term care, hospitalizations, and nursing home placement. Results: Antibiotic use was positively associated with dementia (OR = 1.18, 95% confidence interval (95% CI):1.14–1.22), which became negative after adjustment for comorbidities, at least one diagnosis of bacterial infection or disease, and covariates (OR = 0.93, 95% CI:0.90–0.96). Subgroups of antibiotics were also negatively associated with dementia after controlling for covariates: tetracyclines (OR = 0.94, 95% CI:0.90–0.98), beta-lactam antibacterials, penicillins (OR = 0.93, 95% CI:0.90–0.97), other beta-lactam antibacterials (OR = 0.92, 95% CI:0.88–0.95), macrolides, lincosamides, and streptogramins (OR = 0.88, 95% CI:0.85–0.92), and quinolone antibacterials (OR = 0.96, 95% CI:0.92–0.99). Conclusion: Our results suggest that there was a decreased likelihood of dementia for preceding antibiotic use. The benefits of antibiotics in reducing inflammation and thus the risk of dementia need to be carefully weighed against the increase in antibiotic resistance.
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Schwendicke, Falk, Aleksander Krasowski, Jesus Gomez Rossi, Sebastian Paris, Adelheid Kuhlmey, Hendrik Meyer-Lückel und Joachim Krois. „Dental service utilization in the very old: an insurance database analysis from northeast Germany“. Clinical Oral Investigations, 30.09.2020. http://dx.doi.org/10.1007/s00784-020-03591-z.
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Abstract Objectives We assessed dental service utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at a large statutory insurer (Allgemeine Ortskrankenkasse Nordost, active in the federal states Berlin, Brandenburg, Mecklenburg-Western Pomerania), was followed over 6 years (2012–2017). Our outcome was the utilization of dental services, in total (any utilization) and in five subgroups: (1) examinations and associated assessment or advice, (2) restorations, (3) surgery, (4) prevention, (5) outreach care. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) German modified diagnosis-related groups (GM-DRGs) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years. The utilization of any dental service was 73%; utilization was highest for examinations (68%), followed by prevention (44%), surgery (33%), restorations (32%), and outreach care (13%). Utilization decreased with age for nearly all services except outreach care. Service utilization was significantly higher in Berlin and most cities compared with rural municipalities, and in individuals with common, less severe, and short-term conditions compared with life-threatening and long-term conditions. In multi-variable analysis, social hardship status (OR: 1.14; 95% CI: 1.12-1.16), federal state (Brandenburg 0.85; 0.84–0.87; Mecklenburg-Western Pomerania: 0.80; 0.78–0.82), and age significantly affected utilization (0.95; 0.95–0.95/year), together with a range of co-morbidities according to ICD-10 and DRG. Conclusions Social, demographic, regional, and general health aspects were associated with the utilization of dental services in very old Germans. Policies to maintain access to services up to high age are needed. Clinical significance The utilization of dental services in the very old in northeast Germany showed significant disparities within populations. Policies to allow service utilization for sick, economically disadvantaged, rural and very old populations are required. These may include incentives for outreach servicing, treatment-fee increases for specific populations, or referral schemes between general medical practitioners and dentists.
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Lange, S. A., J. Feld, L. Kuehnemund, J. Koeppe, L. Makowski, C. H. Engelbertz, J. Gerss et al. „Acute and long-term outcomes of ST-elevation myocardial infarction in cancer patients“. European Heart Journal 42, Supplement_1 (01.10.2021). http://dx.doi.org/10.1093/eurheartj/ehab724.1119.
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Abstract Background Myocardial infarctions (MI) and cancer are each very serious morbidities. To evaluate their interaction in the “real world”, a retrospective analysis was performed in patients with ST-elevation MI (STEMI) and pre-existing cancer. Methods Anonymized data from patients admitted to hospital between 2010 and 2017 due to STEMI were analyzed from 24 months before and up to nine years after the index hospitalization by one of Germany's largest statutory Health Insurance Funds (Allgemeine Ortskrankenkasse - AOK). Qualitative data were tested via two-sided Chi-squared test and quantitative data were tested using a two- sided Wilcoxon test. The eight year overall survival (OS) rate was determined with a Kaplan Meier estimator. The endpoint OS was analysed using multivariable Cox-regression model. Results From 175,262 STEMI patients, 27,213 had cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older, presented more often with coronary three-vessel-disease, classical risk factors, atrial arrhythmias, kidney disease, heart failure, cerebrovascular and peripheral artery disease (PAD) (each p<0.001). They showed more often previous MI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p<0.001). Acute PCIs were applied approximately 2–6 percent points less frequently compared to those without (w/o) cancer, with less drug-eluting and more often bare metal stents (all p<0.001). In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0% – 57.7%) w/o cancer, and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for death during follow-up found e.g. lung cancer (HR 2.04, 95% CI 1.92–2.17), PAD stage 4–6 (HR 1.78, 95% CI 1.72–1.84) and previous stroke (HR 1.44, 95% CI 1.31–1.54) to have the strongest effect, while obesity (HR 0.95, 95% CI 0.93–0.97) was associated with lower mortality (all p<0.001). Conclusion In this large “real world” health insurance data from Germany, prognosis after STEMI was markedly reduced but differed widely between cancer types. No withholding of revascularization therapies in cancer patients could be observed. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051).
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Fischer, A. J., J. Feld, L. Kuehnemund, L. Makowski, C. M. Engelbertz, C. Guenster, J. Gerss et al. „Sex-specific differences in first event of st- elevation myocardial infarction; new insights on age-related mortality“. European Heart Journal 42, Supplement_1 (01.10.2021). http://dx.doi.org/10.1093/eurheartj/ehab724.1110.
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Abstract Background For patients with ST-elevation myocardial infarction (STEMI) as the primary manifestation of coronary artery disease (CAD), data on predictors and outcome are limited. We hypothesized that specifically age and sex influence short- and long-term outcome in patients after first event of STEMI. Methods and results Based on claims data of the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse) (≈26 million insurance holders in Germany with ≈83 million inhabitants), adults with STEMI between 01/2014 to 12/2015 and no history of CAD were selected for further analysis. Patient demographics, details on in-hospital treatment as well as age- and sex-related differences in 30-day mortality, re-infarction/ death, major adverse cardiovascular events (MACE), overall and long-term survival were assessed. Overall, 17,444 patients presented with STEMI as the primary manifestation of CAD throughout the study period, thereof 33% were women. At index, women were older compared to men (median age 74 years vs. 60 years) and suffered from more cardiovascular comorbidities such as diabetes (35.8% vs. 25.2% in men), chronic kidney disease (26.0% vs. 14.9% in men), and arterial hypertension (84.6% vs. 72.6%; all p<0.001). Women with STEMI underwent endovascular reperfusion (78.5% vs. 88.1%) or coronary artery bypass grafting (4.2% vs. 5.5%; both p<0.001) less frequently. In-hospital complications such as shock (19.2% vs. 16.0%) and resuscitation (15.1% vs. 12.9%; both p<0.001) were observed more often in women. Female sex was independently associated with adjusted 30-day mortality (Odds Ratio 1.17; p=0.01). Long-term outcomes revealed women to be at increased risk of the combined end-point of re-infarction and/or death (Hazard ratio (HR) 1.09; p=0.01), MACE (HR 1.09; p=0.01) and all-cause mortality (HR 1.10; p=0.01). Particularly in patients younger than 60 years, female sex was a strong predictor of adverse outcomes. Surprisingly, among patients that survived at least 90 days after STEMI, no differences between the sexes were noted regarding long-term survival (HR 0.99; p=0.91) (see Figure for adjusted odds/hazard ratios presenting the association of sex with different endpoints depending on age after first event of STEMI). Conclusion On non-selective data, two-thirds of patients with STEMI as the primary manifestation of CAD were male. Women were observed to receive endovascular reperfusion less frequently than men and suffered from more in-hospital complications. Being female and younger than 60 years was associated with an increased risk of adverse outcomes specifically early after STEMI. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The study is part of the GenderVasc project funded by the joint federal committee, Germany.
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„Junge ADHS-Patienten: Der schwierige Übergang in die Erwachsenenmedizin“. Fortschritte der Neurologie · Psychiatrie 85, Nr. 05 (Mai 2017): 248. http://dx.doi.org/10.1055/s-0043-106151.
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Bei Patienten mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) bricht beim Übergang ins Erwachsenenalter die medizinische Behandlung häufig ab, auch wenn die Störung – mit ihren Risiken – fortbesteht. Dies legt eine Auswertung von Krankenkassendaten nahe durch den Oldenburger Versorgungsforscher Prof. Dr. Falk Hoffmann, die Oldenburger Psychiaterin Prof. Dr. Alexandra Philipsen und der Marburger Kinder- und Jugendpsychiater Prof. Dr. Dr. Christian Bachmann. Sie analysierten dafür Daten von rund 24 Millionen Versicherten der Allgemeinen Ortskrankenkassen (AOK) aus den Jahren 2008 bis 2014.
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Apolinarski, Beate, Birte Burger, Jona T. Stahmeyer, Hanna A. A. Röwer, Nils Schneider, Stephanie Stiel und Franziska A. Herbst. „Finanzierung von Tageshospizen und palliativmedizinischen Tageskliniken: Ergebnisse quantitativer Befragungen von Einrichtungsleitungen und Krankenkassen in Deutschland“. Gesundheitsökonomie & Qualitätsmanagement, 08.12.2021. http://dx.doi.org/10.1055/a-1640-2460.
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Zusammenfassung Zielsetzung Versorgungsverträge von Tageshospizen und palliativmedizinischen Tageskliniken werden untersucht sowie Versorgungsumfang und Ausstattungsmerkmale zwischen bezuschussten und nicht bezuschussten Einrichtungen verglichen. Methodik Alle Allgemeinen Ortskrankenkassen (AOKs) wurden zu Vertrags- und Abrechnungsdaten sowie Tageshospize und palliativmedizinische Tageskliniken zu einrichtungsrelevanten Merkmalen befragt. Ergebnisse Drei Viertel der befragten Einrichtungen finanzieren sich über Zuschüsse von Krankenkassen. Sie bieten ihre Tagesversorgung an mehr Tagen pro Woche an und verfügen über mehr Räumlichkeiten als nicht bezuschusste Einrichtungen. Schlussfolgerungen Versorgungsverträge mit gesetzlichen Krankenkassen können den Einrichtungen eine planbare Finanzierungsperspektive geben, Versorgungsqualität sicherstellen und den Versorgungsumfang langfristig ausweiten.
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Makowski, L. M., J. Feld, J. Koeppe, J. Illner, L. Kuehnemund, A. Wiederhold, J. Gerss, H. Reinecke und E. Freisinger. „Sex related differences in therapy and outcome of patients with low-stage LEAD in a real-world cohort“. European Heart Journal 41, Supplement_2 (01.11.2020). http://dx.doi.org/10.1093/ehjci/ehaa946.2399.
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Abstract Background During the last decades, the prevalence of lower extremity artery disease (LEAD) strongly increased worldwide in both, males and females. Sex-related differences relating to therapy and outcome events are a current matter of debate. Purpose Aim of our study was to examine patients with low-stage LEAD in an unselected “real-world” cohort with regard to risk profiles, therapeutic approach and its impact on the progression to chronic limb threatening ischemia (CLTI) and death. Methods We analyzed 42,197 unselected patients of the AOK (Allgemeine Ortskrankenkasse) health insurance that were hospitalized between 01.01.2014–31.12.2015 for a main diagnosis of LEAD at Rutherford stage 1–3. Data files included a baseline period of 2 years previous index hospitalization and a follow-up period of up to 5 years. Results In our dataset, one third of the LEAD patients were female (32.4% female vs. 67.6% male), being 6 years older (median age: 72.6 years female vs. 66.4 years male). Male patients had higher ratio of diabetes mellitus (40.1% female vs. 42.4% male), nicotine abuse (40.8% female vs. 50.7% male) and chronic coronary syndrome (40.6% female vs. 48.2 male). On the other hand, hypertension (90.3% female vs. 86.9% male), obesity (26.7% female vs. 24.9% male) and chronic kidney disease (29.2% female vs. 26.1% male; all p<0.001) was more often co-prevalent in females. Previous vascular procedures of the lower limbs (LL) (10.2% female vs. 11.8% male) and the receipt of guideline-recommended medication (statins: 45.9% female vs. 50.3% male; blood thinner: 37.1% female vs. 42.7% male; all p<0.001) at baseline was higher in male patients. During index hospitalization, revascularization was performed in 82.8% of all patients, while carried out more often in male patients (81.8% female vs. 83.3% male, p<0.001). After adjustment for risk profiles, female sex was associated with decreased adjusted long-term mortality (HR 0.76; 95%-CI 0.72–0.80). Moreover, male gender was linked with an increased risk of the combined endpoint of CLTI (Rutherford stage 4–6 or amputation of the LL or death; HR 0.89; 95%-CI 0.86–0.93). Interestingly, the prescription of guideline-recommended medication (statins: 63.8% female vs. 65.8% male; blood thinner: 60.2% female vs. 63.5% male; all p<0.001) and performed vascular procedures (33.1% female vs. 36.4% male; p<0.001) was increased in male patients during follow-up. Conclusion Female patients with low stage LEAD are older and show less rate of revascularization procedures of the LL and prescription of guideline-recommended medication at baseline and during follow-up. Nevertheless, male gender was an independent risk factor for all-cause mortality and the combined endpoint CLTI during 5 years of long-term follow-up. Further analyses with focus on sex-related differences on health-services supply and outcome quality are needed to correspond to the individual needs of male and female LEAD patients. Kaplan Meier analysis of the endpoints Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National grant
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Koenig, Christian, Daniela Klahn und Kristina Schreiber. „Die Ausschreibungspflichtigkeit von Rabattverträgen gem. § 130a Abs. 8 SGB V nach den Vorgaben des europäischen Vergaberechts“. GesundheitsRecht 6, Nr. 12 (01.01.2007). http://dx.doi.org/10.9785/ovs.gesr.2007.6.12.559.
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Vergaberechtliche Strukturen gewinnen im Recht der gesetzlichen Krankenversicherung an Bedeutung, seit der Gesetzgeber mit dem Ziel einer Verbesserung von Qualität und Wirtschaftlichkeit der Versorgung verstärkt ein wettbewerbsorientiertes Ordnungsmodell für das Leistungserbringungsrecht anstrebt. In diesem System kommt den Rabattverträgen gem. § 130a Abs. 8 SGB V eine wachsende Bedeutung bei der Verordnung und bei der Abgabe von Arzneimitteln zulasten der Kostenträger der gesetzlichen Krankenversicherung zu. Ende September dieses Jahres hat das Bundeskartellamt die von den Allgemeinen Ortskrankenkassen (AOKen) vorgenommene Ausschreibung von Rabattverträgen vom 6.8.2007 vorerst gestoppt. Das Bundeskartellamt hält das beantragte Nachprüfungsverfahren mithin gem. § 110 Abs. 2 GWB für „nicht offensichtlich unzulässig oder unbegründet“. Die AOKen haben im Rahmen der Ausschreibung die Verfahrensvorgaben des europäischen Vergaberechts nicht beachtet; insbesondere wurde keine europaweite Ausschreibung vorgenommen. Unter Beachtung der Bedeutung und Wirkung von Rabattverträgen (I.-II.) ist jedoch der Anwendungsbereich der §§ 97 ff. GWB für die Vergabe dieser Verträge eröffnet (III.-V.).
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Weinand, Sina, Petra A. Thürmann, Patrik Dröge, Jan Koetsenruijter, Mike Klora und Thomas G. Grobe. „Potentiell inadäquate Medikation bei Heimbewohnern: Eine Analyse von Risikofaktoren anhand bundesweiter GKV-Routinedaten der AOK für das Jahr 2017“. Das Gesundheitswesen, 05.03.2021. http://dx.doi.org/10.1055/a-1335-4512.
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Zusammenfassung Ziel der Studie Primäres Ziel dieser Arbeit ist es, Risikofaktoren für die Verordnung potentiell inadäquater Medikamente (PIM) anhand der PRISCUS-Liste bei stationären Heimbewohnern im Jahr 2017 zu identifizieren. Methoden Es erfolgte eine Analyse von GKV-Routinedaten zu versicherten Heimbewohnern ab 65 Jahren der Allgemeinen Ortskrankenkassen (AOKen) aus dem Jahr 2017. PIMs wurden anhand der PRISCUS-Liste identifiziert. Einflüsse von Risikofaktoren wurden in einer multivariaten logistischen Regression ermittelt. Ergebnisse Die Untersuchungspopulation im Jahr 2017 umfasste 259 328 Heimbewohner, von denen 25,5% mindestens ein PIM erhielten (Frauen: 25,6%; Männer: 24,9%). Weibliche sowie jüngere Heimbewohner wiesen ein erhöhtes Risiko für mindestens eine PRISCUS-Verordnung auf. Multimedikation, eine steigende Anzahl an ambulant behandelnden Ärzten und an Krankenhausaufenthalten stellten weitere Risikofaktoren dar. Zudem zeigen sich deutliche Verordnungsunterschiede zwischen den einzelnen Bundesländern. Schlussfolgerung PIM-Verordnungen sind bei Heimbewohnern häufig und insofern ein relevantes Thema im Hinblick auf die Arzneimitteltherapiesicherheit. Nicht auf Bewohnermerkmale zurückzuführende, sondern auch regionale Unterschiede verweisen auf Modifikationsmöglichkeiten und einen weiteren Forschungsbedarf.
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Nestler, Sophia, Daniel Kreft, Peter Donndorf, Hüseyin Ince und Gabriele Doblhammer. „Stents versus bypass surgery: 3-year mortality risk of patients with coronary interventions aged 50+ in Germany“. Journal of Cardiothoracic Surgery 17, Nr. 1 (01.10.2022). http://dx.doi.org/10.1186/s13019-022-02014-2.
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Abstract Objectives Due to demographic aging, the prevalence of coronary artery disease (CAD) is expected to increase in the future, resulting in a growing demand for stent and bypass interventions. This study aims to investigate the mortality risk of patients following conventional coronary artery bypass grafting (CABG) or endovascular procedure by the implantation of bare-metal stents (BMS) or drug-eluting stents (DES). Methods Based on a random sample of 250,000 members of Germany’s largest health insurance ‘Allgemeine Ortskrankenkassen’ (AOK) from 2004 to 2015, incident CAD patients were analyzed by Cox Proportional-Hazard models. Risk adjustment was made for sex, age, other cardiac diseases, non-cardiovascular comorbidities and years since intervention. Due to later admission of DES and thus a shorter observation time, mortality was examined for 3 years since the intervention. Results BMS represented the most frequent procedure (48%). We found similar proportions of CABG (19%) and DES interventions (23%). After risk adjustment, the models showed a 21% (p = 0.004) lower mortality risk of patients with DES and also a 21% (p = 0.002) lower mortality risk of CABG patients compared to persons with BMS. Conclusion Based on a large-scale dataset, our study demonstrated survival advantages of CABG and DES interventions over BMS, with no differences between the DES and CABG groups. The results help to assess the risks of coronary interventions. Aspects of quality of life, severity of postoperative physical limitations, duration of rehabilitation, patients’ preferences, and aspects of cost-effectiveness for hospitals and society should be further considered. Graphical abstract