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Biomedical subjects

Karl W Lauterbach

Publications and source records attributed to Karl W Lauterbach.

12 recordsLinked to original sources
PubMed2006

Prevalence of anti-erythropoietin antibodies in hemodialysis patients without clinical signs of pure red cell aplasia. Comparison between hypo- and normoresponsive patients treated with epoetins for renal anemia.

BACKGROUND/AIMS: The prevalence of anti-erythropoietin antibodies in renal patients without clinical evidence of pure red cell aplasia (PRCA) who respond poorly to epoetin is unknown. This study tested for anti-erythropoietin antibodies in hemodialysis patients who were either hypo- or normoresponsive to epoetin treatment. METHODS: Epoetin hyporesponsiveness (hemoglobin < or =10.5 g/dl and epoetin > or =9,000 IU/week) and normoresponsiveness (hemoglobin >10.5 g/dl and epoetin <7,000 IU/week) were arbitrarily defined. Prevalence of anti-erythropoietin antibodies in hemodialysis patients without symptoms of PRCA was determined by screening sera of 536 patients from 35 German KfH dialysis units, using enzyme-linked immunosorbent assay (ELISA). Positive results were verified by radioimmunoprecipitation assay (RIP) and neutralizing activity was determined by bioassay. RESULTS: Anti-erythropoietin antibodies were detected in 3 hyporesponsive and 3 normoresponsive patients using ELISA. One patient per group was verified as borderline by RIP testing; the other 4 were negative. The bioassay was negative for 1 patient; the other died unrelated to PRCA before testing. Follow-up with RIP testing after 15 months under continuous epoetin treatment was negative (4 patients, 2 deceased). CONCLUSION: This survey did not identify anti-erythropoietin antibodies in hemodialysis patient's hyporesponsive to epoetin and does not support presumptive antibody screening as a routine work-up in these patients.

Aged↗
PubMed2005

European comparison of costs and quality in the treatment of acute back pain.

STUDY DESIGN: Retrospective multicenter observational study. OBJECTIVES: To compare the outpatient quality and costs of treating acute back pain in England, Germany, the Netherlands, and Switzerland. SUMMARY OF BACKGROUND DATA: No study has yet attempted to compare the quality, costs, and resource utilization of acute back pain treatment in Europe. METHODS: A total of 130 randomly selected physician practices assessed services for 1 hypothetical average patient during the first 4 weeks of treatment (cost evaluation) and 127 practices reported retrospective data on 1 real patient (quality evaluation) in 2001. Reimbursement fees served as unit costs for Germany and Switzerland. Average reimbursement fees were used to measure resource utilization in all countries. Quality of care was assessed in terms of the following unnecessary treatments and diagnoses: bed rest for more than 2 days; exercise therapy; scheduling of a radiograph or other imaging tests; and referral to another provider. Responses were weighted with the level of scientific evidence for overuse. RESULTS: Weighted-average overuse ranged from 18% in the Netherlands to 31% in Germany. In England, Germany, and Switzerland, at least a third of the resources used to treat back pain were wasted. CONCLUSIONS: There was considerable waste in treating acute back pain. The Netherlands had highest quality and lowest resource utilization in providing treatment for acute back pain.

Acute Disease↗
PubMed2005

Evidence-based medicine is rooted in Protestant exegesis.

Evidence-based medicine (EbM) has been practised for about a decade now. Until now, it has generally been accepted that EbM has its roots in medical thinking of mid-19th century France. Due to the startling fact that France never was a centre of EbM, historical tradition was reconsidered. Since EbM has mainly been flourishing in Protestant countries, a qualitative historical investigation was conducted according to the approach of Max Weber's "The Protestant Ethics". Thus, it could be shown that there are three major prerequisites for EbM to evolve apart from current technical developments, such as the computer and the internet: (1) historical critical exegesis functioned as a methodology to balance contradictory passages; (2) both an equality based relationship among physicians and a Protestant concept that lay people are considered equal in the theologic debate were fundamental to EbM as a new approach of medical thinking; (3) mostly nationally funded health care systems are prone to practise EbM as they are obliged to provide health care which is both fair in access and allocation to the whole population. Against the background of historical exegesis, it has to be taken into account that EbM implies a twist in medicine towards a concept of textual criticism rather than the mere introduction of statistics. Moreover, it both relies upon and enhances a more equal relationship between physicians.

Christianity↗
PubMed2004

Costs and quality in the treatment of acute depression in primary care: a comparison between England, Germany and Switzerland.

No study has yet compared the costs and quality of depression treatment between European countries. The present study aimed to compare the costs and quality of treatment for the first manifestation of an acute major depression in England, Germany and Switzerland. Seventy-four randomly selected physician practices assessed their services for one hypothetical average patient (cost evaluation) and 73 practices reported retrospective data on one real patient (quality evaluation) for the year 2001. Reimbursement fees served as unit costs for Germany and Switzerland. Average reimbursement fees were used to measure resource utilization in all countries. Resource utilization was lowest in Switzerland. The percentage of patients receiving evidence-based treatment for major depression was insignificantly higher in Switzerland and England compared to Germany (56%, 52% and 35%, respectively; P>0.30). Switzerland was both the most effective and the most efficient country (in terms of resource utilization) in providing outpatient treatment for depression.

Acute Disease↗
PubMed2004

[Centralisation of breast cancer management by giving minimum work-load. Empirical effects in the region of North-Rhine, Germany].

INTRODUCTION: The concentration of treatment on a few hospitals is discussed to improve the outcome of care. For the treatment of the breast cancer the distributional effects are evaluated. METHOD: A systematic literature search in Medline identified six studies dealing with the evidence on the relation between outcome and workload. Using administrative data of a sickness fund in the region of Rhineland, Germany, the number of hospitals and patients affected by minimum work-loads was determined. RESULTS: Study results show that in general a minimum workload of 100 to 150 new diagnosed cases per year and hospital is recommended. These recommendations would lead to 46% of the presently treating hospitals being excluded (minimum work-load of 150 cases; year 2001). If the workload is set to 100 cases, 31% of the hospitals will be excluded from breast cancer management. No significant differences could be detected in the data of the years 2000 and 2001. DISCUSSION: The association between minimum workload and outcome of care seems to be evident. Further studies involving larger regions are needed to evaluate the distributional effects and gains of outcome.

Breast Neoplasms↗
PubMed2004

[Guideline-based medical quality management in dialysis. Motivation and structuring of a quality-management system and integration of earlier disease stages of chronic renal failure].

BACKGROUND AND PURPOSE: Health services are challenged by increasingly complex medical processes and economic restraints in an aging population. Under these circumstances, medical quality management is developed and increasingly applied to survey especially complex and expensive clinical processes in the sense of controlling. In this process, practicability and relevance are fundamental. METHODS: This paper presents the well-established quality management system QiN (quality in nephrology) in the context of dialysis in end-stage renal disease. RESULTS: A quality-management system is well applicable in the case of dialysis. It can positively influence relevant indicators of process and outcome quality, as demonstrated here by the example of dialysis quantity. CONCLUSIONS: Outcome and process quality in dialysis are quantifiable via defined indicators oriented on evidence-based medicine. The program based on benchmarking of basic clinical indicators leads to improved care of dialysis patients. A quality-management program of this type can represent an essential component of interdisciplinary, structured treatment programs, thereby influencing the whole treatment process.

Humans↗
PubMed2003

Threshold volumes associated with higher survival in health care: a systematic review.

BACKGROUND: To date, systematic reviews on the relationship between the volume of specific diagnoses and procedures and patient outcomes have several limitations, including the omission of the most recent publications. OBJECTIVE: To investigate the relationship between hospital and physician volume and patient mortality rate for all diagnoses and interventions in health care. RESEARCH DESIGN: Medline and the Cochrane Library were searched from January 1990 to December 2000 for all studies published in Dutch, English, French, German, and Italian. The following Boolean search statement was used: hospitals AND volume AND (outcome OR mortality OR quality). Studies were included in which patient enrollment ended within 10 years of the current study and that were adjusted for case-mix. For each diagnosis and intervention, the study most likely to provide an unbiased estimate of the effect of volume on mortality rate was identified using a specific algorithm (best study). RESULTS: A total of 34 diagnoses and interventions with at least one qualifying study on the volume-outcome relationship were identified. The summary odds ratio/relative risk for the best studies on hospital and physician volume were 0.87 (95% confidence interval [CI], 0.85-0.89) and 0.87 (95% CI, 0.81-0.94), respectively. From the best studies on hospital volume, 48.5% (16 of 33) were published either in 1999 or 2000. CONCLUSIONS: There is evidence for a volume-mortality relationship for hospitals and physicians. The use of appropriate methods for analyzing additional diagnoses and interventions as well as a continuous systematic evaluation of the evidence is recommended.

Algorithms↗
PubMed2003

Management patterns and health care use after intracerebral hemorrhage. a cost-of-illness study from a societal perspective in Germany.

BACKGROUND: The German cost-of-illness study of stroke is a multicenter study in 6 departments of internal medicine, 9 departments of general neurology and 15 departments of neurology with an acute stroke unit. The aims of this study are to describe the management patterns, cost of treatment and overall resource utilization after intracerebral hemorrhage (ICH) as well as the major differences to ischemic stroke (IS). METHODS: During a 12-month period, 30 participating centers with a special interest in stroke prospectively included 586 patients with ICH which were collected in a joint data bank. About 75% of all patients could be centrally followed up via structured telephone interviews after 3 and 12 months to assess further acute hospital and rehabilitation stays, outpatient resource utilization, functional outcome and quality of life. RESULTS: Mortality after 3 months (33.5%) was markedly higher than in patients with IS from the same hospitals. Accordingly, only 30.9% of patients had regained independent functional status after 3 months. Cumulative cost of treatment amounted to 5301 EUR for inpatient stay in the documenting hospital and 8920 EUR for the overall hospital stay including rehabilitation. Mean direct cost after discharge during the first year amounted to 4598 EUR and the loss of work force was equivalent to 5537 EUR in all surviving patients. CONCLUSION: This study provides a comprehensive overview of patient characteristics, treatment strategies and health care cost of ICH from a societal perspective in Germany.

Adult↗
PubMed2002

[Measuring case severity with a DRG-based reimbursement system].

BACKGROUND: The Australian Refined Diagnosis-Related Groups (AR-DRGs) will be the model for the German DRGs (G-DRGs). Their system to measure severity of illness will be a major point of interest. METHOD: The most common systems for measuring severity of illness are presented and compared with the AR-DRGs based on criteria regarding applicability. RESULTS: None of the systems for measuring severity of illness fits all the criteria. They can be used for reimbursement of inpatient care or for quality assurance, but not for both at the same time. The designated areas for the use of the systems should not be exceeded. CONCLUSION: AR-DRGs are very complex in measuring the costs per case (severity of illness in terms of efficiency). They are not able to support quality assessment by risk adjustment (severity of illness in terms of medical complexity). A less complex system would have been easier to transfer to Germany with the same incentives for providing effective care.

Diagnosis-Related Groups↗
PubMed2002

[Effectiveness of structural quality in quality assurance--a review].

UNLABELLED: Minimum standards as a part of structural quality are often discussed for the sake of improving the quality of medical care. Before implementing obligatory standards, however, the effectiveness of the demands made should be evaluated. THE METHOD: Our method was a systematrix review (with an eye to structural quality indicators) of literature found by searching Medline; the structural quality indicators taken into account were special forms of medical care, hospital characteristics, certification, internal quality management, internal peer-reviewing, telemedicine, continuing medical education, the use of guidelines, and the caseloads of physicians and hospitals? THE RESULTS: A minimum caseload, the use of guidelines and continuing medical education show positive effects on the outcome of care. The other items show mixed study results or are not measurable in a sense that would make their results of use for quality improvement. Without evidence of effectiveness, minimum standards should not be introduced. Despite the inhomogeneity of the methods used by the studies, minimum caseloads for some diagnoses, the use of guidelines and well-organised continuing medical education are to be recommended.

Delivery of Health Care↗
PubMedDate not supplied

The practice-makes-perfect hypothesis in the context of other production concepts in health care.

Many studies have found a significant relationship between the volume of specific diagnoses and procedures and patient outcomes. Often, these studies have cited the "practice-makes-perfect" hypothesis as a potential explanation. However, the expression "practice-makes-perfect" hypothesis is inappropriate in most circumstances. This article suggests using the expression "routine" hypothesis instead. In addition, this article compares the routine hypothesis with other familiar concepts from industrial production, which also aim at explaining the relationship between factor input and output in health care: economies of scale, economies of scope, the learning curve, and the focused factory. To point out subtle differences among the concepts, this article suggests a taxonomy organized by type of output and outcome. This taxonomy may help ensure the appropriate use of terminology when applying these concepts.

Health Care Sector↗