PubMed Health⌕ Search

Biomedical subjects

E M Bitzer

Publications and source records attributed to E M Bitzer.

12 recordsLinked to original sources
PubMed2000

[Hip joint operations in routine patient management--determinants of quality of life].

The study was conducted in co-operation with a German sickness fund to identify determinants of health related quality of life (HRQL) after hip surgery in routine health care. In 9/97 all beneficiaries (age 40-75 years), which were treated in hospital for osteoarthrosis (n = 1352), were sent a questionnaire on average 5.2 months (t1), postoperatively. The standardized questionnaire contained a.o. items about pre- and postoperative subjective assessment of disease specific symptoms (Lequesne-Index), complications, comorbidity, health related quality of life (SF-36). The response rate at t1 was 67.8%. Patients with hip surgery (n = 390) were sent a second questionnaire 17.2 months (t2) postoperatively. At t2 data from 293 patients were available for analysis. Patients (57.6% male) were on average 61 years of age and 61.2% reported no co-morbidity. 88.4% received total hip replacement. 30.3% of patients reported at least one complication. HRQL in patients after hip surgery is significantly impaired in six of the eight SF-36 subscales compared to the German norms at t1 and t2. From t1 to t2 substantial improvements appear in the SF-36 subscales physical functioning, role physical and bodily pain (p < 0.001). Major determinants of HRQL are comorbidity (if yes: less improvement) and attendance of inpatient rehabilitation (if yes: more improvement). In routine healthcare HRQL after hip surgery is determined by patient characteristics and postoperative rehabilitation. Inspite of substantial improvements patients did not (yet) reach the level of the reference population.

Adult↗
PubMed2000

[The success of hernia surgery in routine care from the patient's perspective].

BACKGROUND: The study was conducted in cooperation with a German sickness fund (Gmünder Ersatzkasse GEK) to determine the success of surgery for inguinal hernia from the patient's perspective. METHODS: We developed a standardized questionnaire containing, among other things, pre- and postoperative subjective assessment of disease-specific symptoms, complications, and health-related quality of life (SF-36). All beneficiaries (age 35-75 years), who were treated in the hospital for inguinal hernia repair (ICD-550) between November 1996 and January 1997 (n = 502) were sent the questionnaire at an average of 3 months (T1) and 14 months postoperatively. The response rate at T1 was 73%. At T2 data from 280 patients were available for analysis: 96% were male (mean age: 54 years). Descriptive and multivariate analysis (GSK model) were performed to reveal determinants of disease-specific symptom alleviation and health-related quality of life. RESULTS: Postoperative hematoma and genital swelling were reported by a quarter of the respondents, each. Pyogenic wound infection appeared in 4%. Compared to the (recalled) preoperative symptom level at T1 substantial and statistical significant improvements were apparent (P < 0.0001). These were maintained at T2 (disease-specific symptom checklist: preoperative: 10.7; T1: 2.8; T2: 2.5). Health-related quality of life reached the level of the German reference population in three of the eight subscales of the SF-36 at T1, and in five SF-36 subscales at T2. However, at T2 (still existing) deviations from the reference population in three of the SF-36 subscales were small. Bi- and multivariate analysis reveals that the appearance of complications from the patient's perspective has to be considered the main determinant of disease-specific symptom alleviation and health-related quality of life after hernia repair. CONCLUSION: Inguinal hernia repair leads to substantial improvements in disease-specific symptoms. Overall, health-related quality of life reaches the level of the reference population. The patient's perception of complications is the major determinant of health outcomes.

Adult↗
PubMed2000

[Surveys on patient satisfaction in ambulatory care. Practicability, acceptance and relevance from the physician's perspective].

Surveys on patient satisfaction have become an integral part in quality management. Adequate survey conduction and appropriate feed back of survey results are essential prerequisites for a successful transfer of survey results into practice. During the validation of a new instrument to assess patient satisfaction in ambulatory care, we assessed the practicability, acceptance and relevance of the procedure used in this study (distribution and return of questionnaires, preparation of results and comparative feed back) from the perspective of the participating physicians (N = 60). Our results confirm, that physicians gain a considerable amount of information on quality of care from the patient's perspective, provided that results are fed back appropriately. Two thirds of the participating physicians (65%) obtained ideas and suggestions for quality management and improvement. Most of the ideas were realised at the time the physician survey took place. Recommendations for conducting patient surveys in ambulatory care and feed back of survey results for participating physicians are presented.

Ambulatory Care↗
PubMed1999

[Health technology assessment in the international context: where does Germany stand? For the "German Scientific Working Group Technology Assessment for Health care"].

The evaluation of medical technologies, Health Technology Assessment (HTA), is gaining more and more importance in Germany. Starting from a comprehensive definition of the term medical technology, this article first describes the development of HTA since the seventies as an instrument for improving decision-making in health policy. HTA is presented as a repetitive cycle of a sequence of steps starting with the prioritization of topics to be evaluated to the analysis of the impact of the results. Current trends in the further improvement of HTA methods are described, such as the formalization of the topic selection. The current situation in Germany is presented with regard to the regulation of licensing/market entry, coverage by the statutory health insurance, and the utilization of medical technologies. Finally, current activities in the field of HTA in Germany as well as the role of the German Scientific Working Group Technology Assessment for Health Care are discussed.

Guidelines as Topic↗
PubMed1998

[Methodological quality of clinical practice guidelines in Germany: results of a systemic assessment of guidelines presented on the Internet].

Critics claim that most of the German clinical practice guidelines are of poor quality having produced by informal ad hoc methodologies without a rigorous approach. This paper reports on the systematic appraisal of 329 guidelines published online by the Association of the Scientific Medical Societies (AWMF) in Germany. The results of this study suggest that most of the guidelines presented in Internet do not meet internationally recognised criteria for quality. Proposals are offered how to enhance the methodological quality of future guidelines.

Humans↗
PubMed1997

Hospital outcomes research in Germany: results from a retrospective survey among sickness fund beneficiaries.

OBJECTIVES: The authors assess the feasibility of using retrospective, indication-specific patient surveys to conduct hospital outcomes research in Germany. Surgical outcome and patient satisfaction were examined in patients who underwent common elective surgical procedures. METHODS: Using the International Classification of Diseases Ninth Revision coding available in the Schwäbisch Gmünd health insurance data base, all patients for a defined period of time with one of the three following diagnoses were selected and questioned retrospectively using an indication-specific survey instrument: (1) varicose veins of the lower extremity; (2) nasal septum deviation; and (3) inner knee joint damage limited to patients undergoing arthroscopic meniscus repair. Survey content focused on preoperative conditions, pre- and postoperative symptoms, postoperative complications, the nature and duration of postoperative follow-up, and satisfaction with surgical outcome. RESULTS: Significant postoperative improvement of preoperative symptoms was found for all three groups. Complete freedom from symptoms was found in 29.7% of patients treated for varicose veins, 24.1% of patients with meniscus repair, and in only 10.6% of patients with nasal septum deviation. Multivariate analyses indicated that postoperative impairment was the decisive variable governing patient satisfaction for all three groups. CONCLUSIONS: The use of retrospective, indication-specific patient surveys constitutes a time-efficient, cost-effective, and patient-focused option for the systematic acquisition and evaluation of health outcomes in Germany. This methodology holds promise for international and domestic efforts to demonstrate the consequences of restructuring activities in the inpatient sector.

Adult↗
PubMed1997

Programme evaluation in problem-based and community-based nursing education.

The article outlines a case study of formative evaluation of a new Master's Degree Programme in Nursing Education. The programme based on a model of problem and community learning is offered at a major South African university. While the findings of the external evaluators are presented, the meta- (second order) evaluation is discussed, providing some current limitations in the evaluation of problem and community-based degree programmes. Guidelines to overcome these limitations are suggested.

Education, Nursing, Graduate↗
PubMed1996

[Clinical success of surgical correction of the nasal septum].

BACKGROUND: We conducted a retrospective survey on patient's evaluation of the outcomes of surgery for a deviated nasal septum. MATERIAL AND METHODS: In January 1995 all working members of a German health insurance plan who were hospitalized between March and September 1994 for ICD-470 (n = 392) were surveyed using a self-administered pretested questionnaire. The response rate was 85.2% (n = 334, 88.8% male; medium age: 35.2 years, average length of stay: 6.5 days). Descriptive and multivariate analysis (GSK model) were preformed. Relative alleviation of symptoms was taken as an indicator for clinical outcome. RESULTS: The most important reasons for undergoing septal surgery from the patient's point of view were nasal obstruction (52%), headache (8.7%) and snoring (7.8%). Ten point six percent of the study population reported complete disappearance of preoperative symptoms (100% relative improvement), whereas in 7.9% no symptom alleviation of nasal related symptoms was described. Postoperative complications were reported by 29.9% of the respondents (i.e., adhesions: 5.7%; perforations; 2.1%). Multivariate analysis revealed that the relative improvement of symptoms increases if no nasal packing is administered, if the patients report minor postoperative discomfort only, and if no postoperative complications appear. CONCLUSION: The clinical outcome of septal surgery is similar compared to that of other studies, but may be improved by not applying postoperative nasal packings. For some of the surgical complications we found higher rates than those that have been reported so far. The results may offer opportunities for clinical audit and quality management.

Adult↗
PubMed1996

[Patient satisfaction as health care outcome--the example of surgical correction of the nasal septum].

BACKGROUND: Presented is a study, that investigates the relevance of patient satisfaction as evaluative criteria for effectiveness of medical measures exemplary in patients who underwent surgery for a deviated nasal septum. MATERIAL AND METHODS: A standardised Instrument was specifically developed and pretested (n = 30). In January 1995 all working members of a German sickness fund hospitalised between March and September 1994 for ICD-470 (deviated nasal septum) were surveyed retrospectively by means of a written questionnaire. The response rate was 85.2% (n = 334, 88.8% male; medium age: 35.2 years, average length of stay: 6.5 days). Descriptive and multivariate analysis were performed. RESULTS: 10.6% of the study population reported a complete decrease of preoperative symptoms (100% relative improvement), whereas in 7.9% no alleviation of nasal related symptoms was reported. 45.2% of the patients are satisfied with the outcome of septal surgery, 35.6% are satisfied to a limited extent, 19.2% express their "dissatisfaction". Multivariate analysis was performed to investigate the main determinants of patient satisfaction. It can be seen that the percentage of satisfied patients increases if there is a large alleviation of that symptom cited as main reason for undergoing nasal surgery, if the discomfort caused by nasal packings is small and if the overall burden of nasal associated symptoms is low postoperatively. CONCLUSION: Patient criteria for evaluating the surgical outcome are plausible and include dimensions also relevant from the clinician's perspective. Therefore, the integration of systematic patient-oriented assessments into the evaluation of medical care seems to be a promising approach. It might be used i.e. to identify high priority areas in the context of quality management.

Adult↗
PubMed1996

[A video-based teacher educational and support program for first-year nursing students].

A video-based method of instruction was introduced to develop students academically as well as to implement parallel medium instruction. An action research approach was followed. Lectures were video-taped beforehand and worked through with the students by a tutor in scheduled Afrikaans or English periods. Simultaneously a live class situation was handled by the lecturer in the other language. Over and above these methods additional video-based support sessions were conducted by tutors for high risk students. A survey indicated that 85% of students were satisfied with this method of instruction. The perceptions of high risk students to VSI were positive and they passed the examinations. Video lectures need to be carefully planned in order to be acceptable as one of a number of possible instruction methods at a multi-cultural university.

Education, Nursing, Baccalaureate↗
PubMed1995

[Longitudinal analysis of utilization of inpatient treatment based on insurance data of mandatory health insurance].

AIM: To investigate which of the routinely collected claims data from the German "Legal sickness funds" on hospital utilisation may be used, in addition to that prescribed by the legislator. DESIGN: We used claims data to study a cohort of sickness fund beneficiaries who were insured during the complete year 1992 (n = 81,309). Six utilisation parameters, using the number of cases and in hospital days overall as well as diseases specific (i.e. readmission rates, in-hospital days per person with [at least] one hospital stay) were calculated. RESULTS: There are 88 persons with (at least) one hospital stay, 116 hospital cases and a total of 1306 in-hospital days per 1000 insured persons in the study cohort. The average hospital days per person (14.8 days) are ca. 30% higher than the average length of stay (11.2 days). Hospital utilisation increases with age. Hospital stays associated with ICD-239 (neoplasms of unknown origin) resulted in a higher than average number of hospital days in total although the mean length of stay is not above the average. This is due to a high readmission rate. Hospital stays associated with elective surgical procedures have a high prevalence rate but a low readmission ratio and short length of stay. CONCLUSION: The parameters related to insured persons, cases and specifically personal parameters of hospital utilisation allow a detailed analysis of hospital care; different utilisation and user patterns can be investigated and possible determinants of utilisation can be identified. After technical transformation, routine data of the sickness funds can be used to obtain information relevant for health care planners as well as for quality management.

Adolescent↗