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Jürgen Stausberg

Publications and source records attributed to Jürgen Stausberg.

13 recordsLinked to original sources
PubMed2006

Reliability of diagnoses coding with ICD-10.

OBJECTIVE: Reliability of diagnoses coding is essential for the use of routine data in a national health care system. The present investigation compares reliability of diagnoses coding with ICD-10 between three groups of coding subjects. METHOD: One hundred and eighteen students coded 15 diagnoses lists, 27 medical managers from hospitals 34 discharge letters, and 13 coding specialists 12 discharge letters. Agreement in principal diagnosis was assessed using Cohen's Kappa and the fraction of coincidences over the number of pairs, agreement for the full set of diagnoses with a previously developed measure p(om). RESULTS: Kappa values were fair (managers) or moderate (coders) for terminal codes with 0.27 and 0.42 (agreement 29.2% versus 46.8%), substantial for the chapter level with 0.71 and 0.72 (agreement 78.3% versus 80.8%). p(om) was lower for the full set of diagnoses than for principal diagnoses, for example in case of managers with 0.21 versus 0.29 for terminal codes. Best results were achieved by students coding diagnoses lists. In summary, the results are remarkably lower than in earlier publications. CONCLUSION: The refinement of the ICD-10 accompanied by innumerous coding rules has established a complex environment that leads to significant uncertainties even for experts. Use of coded data for quality management, health care financing, and health care policy requires a remarkable simplification of ICD-10 to receive a valid image of health care reality.

Diagnosis-Related Groups↗
PubMed2006

Reliability and validity of pressure ulcer diagnosis and grading: an image-based survey.

BACKGROUND: The reliability and validity of pressure ulcer diagnosis and grading are major methodological issues in studies and reports on pressure ulcer frequency. OBJECTIVES: The aim of the study was to estimate the reliability and validity of pressure ulcer diagnosis and grading within the interdisciplinary pressure ulcer project of the University Clinics of Essen, Germany. DESIGN: Fifty images of wounds from the foot/heel region and 50 images of wounds from the buttock/hip region were classified using a 4-grade scale. A gold standard was established by consensus of two senior physicians. SETTINGS: The images were assessed PC-based, independently by each rater. PARTICIPANTS: Five nursing experts and two physicians participated. METHODS: Mean simple Kappa and per cent agreement were calculated to assess reliability and validity. RESULTS: Mean simple Kappa values showed a moderate interrater agreement for grading and a fair interrater agreement for diagnosis. The percentage of agreements was highest for pressure ulcer diagnosis in the buttock/hip region with 90.5% and lowest for pressure ulcer grading in the buttock/hip region with 63.5%. No differences could be found between nurses and physicians. CONCLUSIONS: The differentiation between pressure ulcers and other skin lesions is rather difficult. It is important to assign the lower grade when the available information does not definitely support the higher grade. The level of agreement found was intermediate in the range of published results. A substantial level of agreement should be obtainable through further standardisation and training. Future studies should control for dependency in the assessment situation and dispense with the category "uncertain".

Buttocks↗
PubMed2006

Problem focused integration of information, quality and process management with empirical research: The example of the Essen Interdisciplinary Pressure Ulcer Project.

Issues of information management, quality management, process management, and empirical research are often seen independently from each other. In the Essen interdisciplinary pressure ulcer project, they were integrated to establish a synergy between quality of care, economics and research. The electronic documentation of events and supplementary information was done with the hospital wide patient administration system. Feedback and automatically requests were used for quality improvement. Codes for reimbursement are generated from the clinical documentation. Research studies had been based on the routine documentation. Prerequisite was the cooperation of all relevant groups, nurses, physicians, informaticians, theoreticians and medical controller. In the future, it will be necessary to extend the approach to other relevant nursing problems and to replace the redundant documentation (paper-based as well as electronic) by an electronic health record.

Empirical Research↗
PubMed2006

Management of data quality--development of a computer-mediated guideline.

Appropriate data quality is a crucial issue in the use of electronically available health data. As source data verification (SDV) and feedback are two standard procedures for measuring and improving data quality it would be worthwhile to adapt these procedures to a current level of quality in order to reduce costs in data management. This project aims to develop a guideline for the management of data quality with special emphasis on this adaptation against the backdrop of research networks in Germany, which operate registers and conduct epidemiological studies. The first step in guideline development was a thorough literature review. The literature offers many measurements as candidates for quality indicators, however, systematic assessments and concepts of SDV and feedback are missing. We assigned possible quality indicators to the levels plausibility, organization, and trueness. Each indicator must be operationally defined to allow automatical calculation. The SDV sample size calculation leads to lower numbers for sites providing data of good quality and larger numbers for sites with poor data quality. The guideline's implementation in a software tool combines two cycles, one for the adaptation of recommendations to a given study/register, the other for the improvement of data quality in a PDCA-like approach. The recommendations will address needs common to medical documentation in daily health care, clinical, epidemiological, and observational studies as well as in surveillance data bases and registers. Further work will have to supplement other aspects of data management.

Feedback↗
PubMed2005

Comparison of cost accounting methods from different DRG systems and their effect on health care quality.

BACKGROUND: Diagnosis related groups (DRGs) are a well-established provider payment system. Because of their imminent potential of cost reduction, they have been widely introduced. In addition to cost cutting, several social objectives - e.g., improving overall health care quality - feed into the DRG system. OBJECTIVES: The WHO compared different provider payment systems with regard to the following objectives: prevention of further health problems, providing services and solving health problems, and responsiveness to people's legitimate expectations. However, no study has been published which takes the impact of different cost accounting systems across the DRG systems into account. METHODS: We compared the impact of different cost accounting methods within DRG-like systems by developing six criteria: integration of patients' health risk into pricing practice, incentives for quality improvement and innovation, availability of high class evidence based therapy, prohibition of economically founded exclusions, reduction of fragmentation incentives, and improvement of patient oriented treatment. RESULTS: We set up a first overview of potential and actual impacts of the pricing practices within Yale-DRGs, AR-DRGs, G-DRGs, Swiss AP-DRGs adoption and Swiss MIPP. It could be demonstrated that DRGs are not only a 'homogenous' group of similar provider payment systems but quite different by fulfilling major health care objectives connected with the used cost accounting methods. CONCLUSIONS: If not only the possible cost reduction is used to put in a good word for DRG-based provider payment systems, maximum accurateness concerning the method of cost accounting should prevail when implementing a new DRG-based provider payment system.

Costs and Cost Analysis↗
PubMed2005

Completeness and accuracy of WWW-based catalogues of medical E-learning modules.

Catalogues of medical E-learning modules offer easy access to learning material that is available on the World Wide Web (WWW) free of charge. Therefore, a study was conducted on the retrieval performance of four WWW-based catalogues: CAL reviews, KELDAmed, LMU, and LRSMed. LRSMed is run by the authors. Completeness was calculated pairwise. Two reviewers checked the availability of 80 modules independently. Five criteria were chosen to calculate accuracy: gynaecology and microbiology as medical fields; case study as type of learning resource; diabetes mellitus and AIDS as free-text diagnoses. Also, two reviewers evaluated independently whether the module is really an appropriate resource for that criterion or not. The analysis is based on a consensual decision about the correct votes. From the URLs, 93% were available at the evaluation of completeness, 92% at the evaluation of accuracy. The kappa values for inter-rater reliability were 0.83 and 0.36. The best service offers 60.8% of the pooled E-learning resources. The resources retrieved by the five criteria were rated as correct in 69.3% (LRSMed), 76.6% (KELDAmed), and 82.7% (CAL reviews). The overall accuracy was 76.7%. Medical students and other potential users of E-learning modules should be aware that the completeness of WWW-based catalogues in this area is not satisfying. The retrieval accuracy is better; four of five resources offered correspond with the search criterion. Up to now, most of the services miss an application-programming interface that could be used for a meta-search to improve completeness.

Computer-Assisted Instruction↗
PubMed2005

Pressure ulcers in secondary care: incidence, prevalence, and relevance.

OBJECTIVE: To compare point and period prevalence rates. DESIGN: Descriptive, cohort, cross-sectional survey. PARTICIPANTS: From a cohort of 25,075 cases, information on pressure ulcer status on admission was recorded for 20,283 cases. From 3237 selected cases, the pressure ulcer team made 2234 assessments. MAIN OUTCOME MEASURES: Point prevalence, period prevalence, and incidence rates. MAIN RESULTS: The cohort showed a period prevalence rate of 1.4% and an incidence rate of 0.6%. Patients with a pressure ulcer were older, were more likely to have had surgery, had longer hospital stays, and had a higher cost weight. The cross-sectional survey revealed a point prevalence rate of 5.3%. Patients within the cross-sectional survey had longer lengths of stay, were more likely to have had surgery, and presented a higher cost weight in comparison with the cohort. CONCLUSIONS: In an unselected hospital sample one can expect a period prevalence rate of 2% and a point prevalence rate of 10%. As demonstrated by the present study, differences between the 2 prevalence measurements are mainly due to the confounding of point prevalence rates by length of stay. Length of stay determines the probability of inclusion in a cross-sectional study and should be considered in pressure ulcer trials in the future.

Adolescent↗
PubMed2005

Trends in free WWW-based E-learning Modules seen from the Learning Resource Server Medicine (LRSMed).

Despite the lost enthusiasm concerning E-learning a lot of material is available on the World Wide Web (WWW) free of charge. This material is collected and systematically described by services like the Learning Resource Server Medicine (LRSMed) at http://mmedia.medizin.uni-essen.de/portal/. With the LRSMed E-learning modules are made available for medical students by means of a metadata description that can be used for a catalogue search. The number of resources included has risen enormously from 100 in 1999 up to 805 today. Especially in 2004 there was an exponential increase in the LRSMed's content. Anatomy is still the field with the highest amount of available material, but general medicine has improved its position over the years and is now the second one. Technically and didactically simple material as scripts, textbooks, and link lists (called info services) is still dominating. Similar to 1999, there is not one module which could be truly referred to as tutorial dialogue. Simple material can not replace face-to-face-teaching. But it could be combined with conventional courses to establish some kind of blending learning. The scene of free E-learning modules on the WWW is ready to meet current challenges for efficient training of students and continuing education in medicine.

Computer-Assisted Instruction↗
PubMed2005

[Employment of WHO criteria for the assessment of provider payment systems in diagnosis related groups].

The concept of Diagnosis Related Groups (DRGs) is a well-established provider payment system for in-patient institutions. While the original aims of the system were to reduce costs as well as to increase quality and benefit of health care, the emphasis has progressively shifted to cost reduction, leaving the quality-oriented parameters in a secondary role. A major part of any patient-classification system is the pricing practice used to define the revenues for each patient group on the basis of single cases. To estimate the effects of different cost accounting methods on health care quality, we designed a new assessment system based on the employment of a WHO approach to compare different provider payment systems. The designed system is based on six different parameters recommended by the WHO: integration of patients' health risk into pricing practice, incentives for quality improvement and innovation, availability of high-class evidence-based therapy, prohibition of economically-founded exclusions, reduction of fragmentation incentives, and improvement of patient-oriented treatment. This assessment system enables the investigation of calculation processes of different patient-classification systems (and of provider payments in general), in view of their impact on quality.

Diagnosis-Related Groups↗
PubMed2003

A meta-data-based learning resource server for medicine.

The World Wide Web (WWW) promises many advantages in the distribution and presentation of electronic learning modules for medical education. However, there is a well-known obstacle: finding the right offers on demand. We developed a solution based on international standards called Learning Resource Server Medicine (LRSMed), which provides a meta-data collection of electronic learning modules. Based on the meta-data, LRSMed offers a service for the learners to retrieve WWW resources at the time of learning. We used the IMS Learning Resource Meta-data Information Model as suitable meta-data specification, the eXtensible Markup Language (XML) as syntax for interfaces and the Oracle suite for implementation. LRSMed is available at http://mmedia.medizin.uni-essen.de/portal/. More than 260 learning resources are currently registered and described. So far a user-interface has been implemented which allows searching, commenting and editing. In the next future we will add an application programming interface (API) for the integration of LRSMed in portals, learning platforms and information systems of hospitals, medical practices or healthcare networks.

Internet↗
PubMed2003

Guideline validation in multiple trauma care through business process modeling.

Clinical guidelines can improve the quality of care in multiple trauma. In our Department of Trauma Surgery a specific guideline is available paper-based as a set of flowcharts. This format is appropriate for the use by experienced physicians but insufficient for electronic support of learning, workflow and process optimization. A formal and logically consistent version represented with a standardized meta-model is necessary for automatic processing. In our project we transferred the paper-based into an electronic format and analyzed the structure with respect to formal errors. Several errors were detected in seven error categories. The errors were corrected to reach a formally and logically consistent process model. In a second step the clinical content of the guideline was revised interactively using a process-modeling tool. Our study reveals that guideline development should be assisted by process modeling tools, which check the content in comparison to a meta-model. The meta-model itself could support the domain experts in formulating their knowledge systematically. To assure sustainability of guideline development a representation independent of specific applications or specific provider is necessary. Then, clinical guidelines could be used for eLearning, process optimization and workflow management additionally.

Humans↗
PubMed2002

Guideline validation in multiple trauma care through business process modeling.

Clinical guidelines can improve the quality of care in multiple trauma. In our Department of Trauma Surgery a specific guideline is available paper-based as a set of flowcharts. This format is appropriate for the use by experienced physicians but insufficient for electronic support of learning, workflow and process optimization. A formal and logically consistent version represented with a standardized meta-model is necessary for automatic processing. In our project we transferred the paper-based into an electronic format and analyzed the structure with respect to formal errors. Several errors were detected in 7 error categories. The errors were corrected to reach a formal and logically consistent process model. In a second step the clinical content of the guideline was revised interactively using a process modeling tool. Our study reveals that guideline development should be assisted by process modeling tools, which check the content in comparison to a meta-model. The meta-model itself could support the domain experts in formulating their knowledge systematically. To assure sustainability of guideline development a representation independent of specific applications or specific provider is necessary. Then clinical guidelines could be used for training, process optimization and workflow management additionally.

Germany↗