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Biomedical subjects

J Stausberg

Publications and source records attributed to J Stausberg.

12 recordsLinked to original sources
PubMed2002

[Diagnosis related groups in stroke treatment. An analysis from the stroke data bank of the German Stroke Foundation].

BACKGROUND: The upcoming introduction of diagnosis related groups (DRG) as an exclusive base for future calculation of hospital proceeds in Germany requires a thorough analysis of cost data for various diseases. OBJECTIVE: To compare the resulting combined cost weights of the Australian Refined DRG system (AR-DRG) with the proceeds based on actual per-day rates in stroke treatment. PATIENTS AND METHODS: Between 1998 and 1999, data from 6520 patients (median age 68 years, 43% women) with acute stroke or transient ischemic attack (TIA) were prospectively documented in 15 departments of Neurology with an acute stroke unit, 9 departments of general Neurology and 6 departments of Internal Medicine. Prior to grouping cases into DRGs, all available data were transferred into ICD-10-SGB-V 2.0 or the Australian procedure system (MBS-Extended). Hospital proceeds for the respective cases were calculated based on per-day rates of the documenting hospitals. RESULTS: The resulting cost weights demonstrate a good homogeneity compared to the length of stay. When introducing the AR-DRG with a uniform base rate in Germany, a relative decrease of hospital proceeds can be expected in Neurology Departments and for treatment of TIAs. CONCLUSION: Preservation of the existing structure of acute stroke care in Germany requires a supplement to a uniform base rate in Neurology departments.

Acute Disease↗
PubMed2000

[Surgical specialty department in the world wide web. Tribute to contemporary life style or information network?].

An increasing number of surgical departments is creating its own home-page in the World Wide Web (WWW). We investigated 184 presentations concerning their quality in content and technical realization. Our research revealed that most presentations regard patients as their main target group in order to meet the patients' demand for information and transparency. However, universities are especially concentrating on scientific development and neglecting the patients. Only a few presentations contain means for web-based training. In general, technical realization seems to be much better than the content itself. As patients tend to appear as customers who will choose the hospital they feel comfortable with, every clinical department that is a competitor should create a communication and information base for their customers. Thus, they will be able to keep in touch, present their treatment types and to enable patients to compare a multitude of surgical departments. The usefulness for colleagues or cooperating institutions must be improved. The WWW has become an important center of information in surgery.

Germany↗
PubMed2000

Using ICD-10 for case groups.

The definition of German case groups now uses an adaptation of the ICD-10: ICD-10-SGBV. For the transformation of the existing ICD-9-based definition into the ICD-10-SGBV an ICD-9/ICD-10 conversion table was used. The derived raw definitions were manually refined in detail. Due to the transformation of the classification system, the number of definitions increased immensely, as the ICD-10 SGBV is by far more detailed than the formerly used ICD-9. In our opinion, ICD-10 SGBV is not ideal for the definition of case groups, because this classification system is designed to support statistics on morbidity and mortality, but definitions of case groups are oriented to cost factors. Therefore the definition of case groups should be based on a specially designed classification system or one should reassess the necessity of a parallel definition by codes of classifications as well as by text. In both alternatives the introduction of a detailed and systematic medical documentation with expressive terminology systems will offer the advantage of classifying patients into medical oriented classifications as well as case groups.

Diagnosis-Related Groups↗
PubMed1999

A process model of diagnostic reasoning in medicine.

The paper presents a model-based approach to diagnostic reasoning in medicine. A process model is defined on the levels of static elements, dynamic elements and reasoning control. Static elements, facts, hypotheses and different types of disease knowledge, are identified and variations relevant for hypotheses generation are described. Dynamic elements correspond to actions, which in turn modify static elements, but are also controlled and started by the expressions of the static elements. Hypothesis generation starts with the assessment of a given set of facts. According to their priorities, facts are used for the construction of a diagnostic differential: new hypotheses are considered, existing hypothesis refined or excluded. The purpose of hypotheses generation is to establish a complete diagnostic differential with disjunctive explanations which explain a given set of facts. The presented model could serve as a basis for an implementation in a model-based and process-oriented decision-support system.

Decision Making, Computer-Assisted↗
PubMed1999

Selection of hospital information systems: user participation.

Motivated by economic and quality management issues, many hospitals strive for the introduction of information systems into the clinical environment. To introduce the most suitable software product, a systematic selection procedure is required involving all affected staff. The paper describes a methodology that guides the clinical users to an objective motivated decision. This semi-formal methodology is necessary in view of missing standard models for the description of hospital information systems and leads to high acceptance in practical use. The methodology consists of structured product demonstrations with a quantitative assessment, benefit-value-analyses based on step weights for the functions needed, and test installations. Prerequisite of this procedure was the definition of objectives and priorities in a standard catalog that was used as reference in the whole project. Selecting a software product following this systematic procedure establishes a sound basis for a successful application in the clinical environment.

Cost-Benefit Analysis↗
PubMed1998

Using a computer-based patient record for quality management in surgery.

Our first generation hospital information system is in routine use since 1989. The patient data are used for multiple clinical purposes: operation scheduling, reminder for patient care, case retrieval for research and education, and so on. The computer-based patient record was complemented by a flexible PC-based query and report facility for quality management. A regular export of patient data from the host is translated into a relational database model and assessed via the standard of Open Database Connectivity (ODBC) by a statistical analysis tool. Herewith, descriptive and analytical statistics become available to support the clinical departments in patient care. Concerning the migration of first generation systems to modern architectures the presented approach has to be compared with strategies of replacement and capsulation. A decision on the strategy applied should take into account local resources and opportunities.

Computer Systems↗
PubMed1998

[Classification of surgical interventions in Germany].

Today different classification systems are used in Germany for the standardization and coding of surgical procedures. On January 1, 1995, the German Minister of Health introduced a new classification system called "Operationenschlüssel nach section 301 SGB V" (OPS-301) for surgical procedures performed in hospitals. The standardization by the OPS-301 is limited to inpatients. In outpatient care, surgical procedures are coded by two billing systems: EBM and GOA. Thus, the situation is characterized by coding systems that are used in parallel which are to some extent incompatible. This leads to avoidable workload and lower quality of the documented data. The general goal is the development of a new classification system which on the one hand should be able to provide different views depending on the questions. On the other hand the system should integrate the different views through a clear and consistent structure of surgical procedures.

Ambulatory Surgical Procedures↗
PubMed1997

Evaluation of quality control methods for medical documentation.

A retrospective study about the impact of different quality control methods for medical documentation was performed at the Surgical Center II in Essen. The standardized medical documentation was legislative obliged since the first of 1996 and includes diagnoses and surgical procedures. The patient data were taken from the computer-based patient record of the Surgical Center II which is in routine use since 1989. Quality improvement was aimed at with lectures, training, a quality circle, and systematic approaches like feedback and reminder between 1995 and 1996. The results demonstrate that information and training of physicians is significantly less important for the quality of documentation than a departmental and central control. It is advisable to take this results into account introducing new documentation entities and procedures and to provide functionalities for a periodical control soon.

Data Collection↗
PubMed1995

Terminological reference of a knowledge-based system: the data dictionary.

The development of open and integrated knowledge bases makes new demands on the definition of the used terminology. The definition should be realized in a data dictionary separated from the knowledge base. Within the works done at a reference model of medical knowledge, a data dictionary has been developed and used in different applications: a term definition shell, a documentation tool and a knowledge base. The data dictionary includes that part of terminology, which is largely independent of a certain knowledge model. For that reason, the data dictionary can be used as a basis for integrating knowledge bases into information systems, for knowledge sharing and reuse and for modular development of knowledge-based systems.

Artificial Intelligence↗
PubMedDate not supplied

Classifications in routine use: lessons from ICD-9 and ICPM in surgical practice.

OBJECTIVE: Classifications of diagnoses and procedures are very important for the economical as well as the quality assessment of surgical departments. They should reflect the morbidity of the patients treated and the work done. The authors investigated the fulfillment of these requirements by ICD-9 (International Classification of Diseases: 9th Revision) and OPS-301, a German adaptation of the ICPM (International Classification of Procedures in Medicine), in clinical practice. DESIGN: A retrospective study was conducted using the data warehouse of the Surgical Center II at the Medical Faculty in Essen, Germany. The sample included 28,293 operations from the departments of general surgery, neurosurgery, and trauma surgery. Distribution of cases per ICD-9 and OPS-301 codes, aggregation through the digits of the codes, and concordance between the classifications were used as measurements. Median and range were calculated as distribution parameters. The concentration of cases per code was graphed using Lorenz curves. The most frequent codes of diagnoses were compared with the most frequent codes of surgical procedures concerning their medical information. RESULTS: The total number of codes used from ICD-9 and OPS-301 went up to 14 percent, depending on the surgical field. The median number of cases per code was between 2 and 4. The concentration of codes was enormous: 10 percent of the codes were used for about 70 percent of the surgical procedures. The distribution after an aggregation by digit was better with OPS-301 than with ICD-9. The views with OPS-301 and ICD-9 were quite different. CONCLUSION: Statistics based on ICD-9 or OPS-301 will not properly reflect the morbidity in different surgical departments. Neither classification adequately represents the work done by surgical staff. This is because of an uneven granularity in the classifications. The results demand a replacement of the ICD-9 by an improved terminological system in surgery. The OPS-301 should be maintained and can be used at least in the medium term.

Disease↗
PubMedDate not supplied

Health care providers on the World Wide Web: quality of presentations of surgical departments in Germany.

It is becoming increasingly common for health care providers to present information on the World Wide Web (WWW). Patients, as well as health care professionals, do not really know what they can expect today. Many quality criteria are proposed for the assessment of medical Internet sites focusing mainly on structure and content management. The objective of this study was to assess the quality of presentations by health care providers on the WWW and to detect strengths and weaknesses with regard to potential target groups, patients, colleagues, and students. A sample of 171 presentations was randomly selected in March 2000 from a collection of 469 surgical departments in Germany. Medical doctors undergoing a full-time training in medical informatics rated the presentations. A previously evaluated questionnaire was used to assess the presentations with regard to 12 criteria about content and technical features. For each criterion the categories 'very good', 'sufficient', and 'insufficient' could be used. Twenty medical doctors assessed 168 presentations with one to seven valuations per presentation. Three presentations could not be accessed at the time of evaluation. Sixty-eight per cent of the median values of each criterion were rated as insufficient. The only criteria rated sufficient or better in at least 50% were: employees/map, survey of offered medical services, navigation, and layout. University hospitals and heart centres achieved significantly better results than regional hospitals. In conclusion, the quality of provider information on the W WW is unsatisfactory. Most surgical departments do not provide information that could help patients to choose their physicians. The criteria set developed here could be a useful tool for a target-group-oriented self-assessment of provider presentations on the World Wide Web.

Attitude of Health Personnel↗