PubMed Health⌕ Search

Biomedical subjects

M Geraedts

Publications and source records attributed to M Geraedts.

At least 19 recordsLinked to original sources
PubMed2006

[Health services research in surgery: the example of breast cancer surgery].

The epidemiological relevance of breast cancer in Germany has led to a number of initiatives actually changing the processes and structures of care. The ultimate aim of health services research in surgery is to evaluate the impact of these initiatives on the effectiveness and efficiency of the respective health care services. Results of international studies show for instance breast-conserving therapy to be related to the patients' socioeconomic status. In addition, breast specialists tend to operate more in adherence to practice guidelines and to implement new procedures like sentinel lymph node biopsies earlier. Preliminary results from Germany also demonstrate a considerable practice variation in breast cancer surgery. Causes and effects of such variation still have to be explored. For that purpose, newly available data sources on health care services in relation to breast cancer surgery in Germany could be used. The inherent challenge is to combine data from tumour registries, statutory comparative quality assurance activities and inpatient remuneration via DRGs for health services research in surgery.

Breast Neoplasms↗
PubMed2006

[Development of the quality of surgical gynaecological care in the State of Hesse, Germany under external quality assurance].

UNLABELLED: BACKGROUND AND RESEARCH GOAL: All German hospitals have to participate by law in comparative performance assessment, so called external quality assurance (QA). However, there is only limited research showing a positive impact of such state- and nationwide QA programmes. This article analyses whether the quality of surgical gynaecological care in Hessian hospitals changed after receiving regular feedback on the quality of care between 1998 to 2002. METHODS: Secondary data analysis of data from all hospitals with gynaecological services in Hesse (n = 84) was performed. The requirement of a constant caseload and continuous data supply reduced cases from 218,217 to 148,549. Considering twelve quality indicators we recalculated the performance of all Hessian hospitals for each quarter during 1998 and 2002. Changes over time were analysed by using rank correlation coefficients and considering multiple testing. RESULTS: Two indicators (antibiotic prophylaxis in breast surgeries and hysterectomies) showed a significant quality improvement over time. Six indicators (post-operative infections, inappropriate removals of cyst of ovaries, hormone receptor analysis and x-ray of tumour in breast cancer, ovary-preserving procedures for benign tumours and heparin prophylaxis) demonstrated a slight quality improvement and another four indicators (unplanned revision of operation, organ injuries, adjuvant therapy and breast-preserving surgery in breast cancer) tended towards reduced quality. CONCLUSION: During 1998-2002, we observed only marginal improvements in the quality of care. The expected significant improvement of all quality indicators, based on external QA and comparative performance reporting of all Hessian gynaecological hospitals did not eventuate.

Female↗
PubMed2004

[The German guideline clearing-project on bronchial asthma - part 2: recommendations and key topics for a national guideline on bronchial asthma].

BACKGROUND: In order to promote the quality of asthma management in Germany, a national asthma guidelines clearing project was initiated in 2000 by the German Guidelines Clearinghouse (Sponsors: German Medical Association (GMA), National Association of the Statutory Health Insurance Physicians (NASHIP), German Hospital Federation, Federal Association of the Statutory Sickness Funds. This Part shows the key topics which should be dealt with in a German guideline on bronchial asthma. SUMMARY POINTS: For quality promotion of bronchial asthma management in Germany, the development of a national evidence-based guideline, using the internationally accepted quality criteria for clinical practice guidelines, was recommended by an expert group of the German Guideline Clearinghouse. The experts identified and peer-reviewed 16 out of 54 guidelines, which might be useful as benchmarks and examples for a German asthma guideline. From the peer review results, the expert group identified 18 key topics for a national asthma guideline.

Asthma↗
PubMed2004

[The Guideline Clearing Project COPD. Recommendations for a National Guideline].

In order to promote the care of patients with COPD in Germany a national guideline clearing project was initiated jointly by autonomous corporate bodies of the German health care system. Following a systematic search of literature data bases between 1992 and 2002, 20 guidelines were identified that met the inclusion criteria and were evaluated with the German Checklist for Methodological Guideline Appraisal. Following this, a multidisciplinary expert group appointed by the German Guideline Clearinghouse (Leitlinien-Clearingstelle im Arztlichen Zentrum fur Qualitat in der Medizin, AZQ) reviewed the suitability of these guidelines for the use in the German health care system. Referring to methodological aspects, criteria were best met by the guideline of the Veteran's Health Administration/Department of Defense (US), followed by the one of the Deutsche Atemwegsliga and the Deutsche Gesellschaft fur Pneumologie. Aiming at the production respectivly a revision of a German national guideline for COPD the expert group agreed on recommendations organized in 19 chapters. Among others these strengthened the role of a precise definition of COPD based primarily on the pathogenesis, of a subtle description of all diagnostic and therapeutic tools and of a detailed description of quality assurance and quality management. The feasability of recommendations were demonstrated by examples chosen from the evaluated guidelines. Additionally the presented findings may be used as steering tools in the German Health care system.

Delivery of Health Care↗
PubMed2003

[Quality management in and by public health services].

Quality management is nowadays required by almost all organisations using public funds. Hence, quality management in public health services (PHS) first serves to make transparent the services offered, the performance, and the quality of services to comply with public demands for accountability. In addition, by following generally accepted concepts and methods of quality management, it could help to improve the performance of PHS. As a second function, quality management by PHS can be delineated. In this, PHS assumes the role of an independent quality manager of health services by reporting comparatively on regional services, their performance and the quality of care on a population basis. Considering recently introduced statutory incentives in Germany (such as disease management programmes and minimum volume thresholds for certain procedures) that could negatively affect social equity and access to health services, such a comparative quality and performance reporting by PHS is getting more and more important.

Cost-Benefit Analysis↗
PubMed2003

[The German guideline clearing-project on bronchial asthma-part 1: Methodology and results of formal appraisal].

BACKGROUND: In order to promote quality of asthma management in Germany, a national asthma guidelines clearing project was initiated in 2000 by the German Guidelines Clearinghouse (Sponsors: German Medical Association (GMA), National Association of the Statutory Health Insurance Physicians (NASHIP), German Hospital Federation, Federal Association of the Statutory Sickness Funds. Part 1 of this article shows the methodology and the results of the appraisal, part 2 (to be published) shows the key topics which should be dealt with in a german guideline on bronchial asthma. OBJECTIVES: To identify and compare evidence-based, high-quality German- and English language asthma guidelines as benchmarks for ongoing guideline development and implementation programmes. To disseminate information about asthma guidelines developed in accordance with current methodological know-how. To identify and consent key topics for a national evidence-based guideline for Germany. METHODS: Search procedure, formal appraisal: Systematic search using literature databases (XMED, incl. Medline and Embase) and English-/German-language guideline databases (via www. leitlinien.de), published between January 1990 and March 2000. Abstract screening of the search results according to the inclusion criteria (n = 54 of a total of 502 hits). Methodological guideline evaluation of 16 guidelines using the German checklist for methodological guideline appraisal. Appraisal of guidelines' contents: Peer review of guidelines with the following inclusion criteria: Bronchial Asthma-general, German and English language, based in references published later than 1994, new guideline or actual update. Peer review was performed by a multidisciplinary focus group of EBM experts (clinical and ambulatory settings). No expert was involved in guideline production during the review period. RESULTS: Methodological appraisal: 16 out of guidelines were in accordance with the formal minimal standard with a wide range within the following domains: "description of the development process", "declaration of authors' independence", "explicit link between recommendations and the supporting evidence", "management options", "tools for implementation". The focus group recommended for future national asthma guidelines to rely on the following procedures: (1) to formulate the recommendations using standardized, clearly described consensus methods basing on evidence retrieved and selected in a systematic way (2) to prove links between recommendations and supporting evidence (3) to develop guideline versions for health care professionals as well as for consumer/patients (4) to develop guideline-based education tools (5) to ensure periodical updates of the asthma guideline (6) to consider the methodological recommendations and to give reasons for deviations from the methodological recommendations. APPRAISAL OF GUIDELINES CONTENT: None of the guidelines identified comprised information about all of the following key topics considered to be relevant for a German national guideline by the focus group: (1) intended guideline users/goals, (2) definition (3) cause of disease, (4) form of disease, (5) severity, (6) diagnosis, (7) therapeutic goals, (8) prevention, (9) pharmacotherapy, (10) non-pharmacotherapy, (11) therapy control and compliance, (12) emergency treatment, (13) rehabilitation, (14) comorbidity, (15) special aspects, (16) coordination of care, (17) quality assurance/quality management, (18) implementation. SUMMARY POINTS: For quality promotion of bronchial asthma management in Germany, the development of a national evidence-based guideline, using the internationally accepted quality criteria for clinical practice guidelines, was recommended by an expert group of the German Guideline Clearinghouse. The experts identified and peer-reviewed 16 out of 54 guidelines, which might be useful as benchmarks and examples for a German asthma guideline. From the peer review results, the expert group identified 18 key topics for a national asthma guideline.

Asthma↗
PubMed2002

[Effects of a regional intervention to promote asthma guidelines implementation].

AIM: Despite of asthma guidelines existing for years, secondary data analysis shows insufficient medical care of asthmatics in Germany. The aim of the present study was to improve asthma guideline adherence by promoting guidelines implementation. METHOD: We analyzed prospectively pre- and post-interventional medical care of a sample of 127 asthmatics who were recruited by physicians working in ambulatory care and in hospitals of the Region Neckar-Alb, Germany. Data came primarily from patient interviews by phone. Our intervention to promote guidelines implementation consisted of following methods: 1. analyzing regional asthma care followed by a feedback performance report to physicians; 2. delivering asthma patient diaries and peak flow meters to study patients; 3. developing and adapting regionally asthma guidelines for adult asthmatics in the Region of Neckar-Alb; 4. promoting guidelines utilization by publishing the adapted guidelines in a scientific journal, direct mailing of a short version to the practitioners, and boosting the guidelines at regional CE meetings; 5. reanalyzing asthma care of the study cohort and the implementation of the guidelines 13 months after the beginning of the intervention. We studied the effect of the intervention using a qualitative model comprising 18 quality indicators measuring the proportion of patients who were treated in accordance to the guidelines. To compare pre- and post-interventional proportions we used the McNemar test for statistical analysis. RESULTS: The proportion of asthmatics treated in accordance to the guidelines improved significantly from 48 % to 57 %. The increase was mainly due to an improvement of guidelines adherence within the field of promoting asthma self-management and continuous monitoring of patients (42 % pre- and 57 % post-intervention), whereas guidelines adherence in pharmacotherapy improved only from 53 % to 56 %. CONCLUSION: The proportion of asthmatics treated in accordance to guidelines can be improved by using a multifaceted regional approach to promote guidelines implementation.

Adult↗
PubMed2001

[Current research perspectives of health system research and health economics in Germany].

The German statutory health insurance scheme is confronted with a steadily rapid progress of medical sciences and increasing difficulties to mobilize the financial resources necessary for applying the new scientific knowledge in health care. Therefore it is absolutely imperative to intensify the efforts to improve the effectiveness and efficiency of health care. Health policies based on health targets, the development of patterns requiring integrated care, redefining the bunch of health insurance benefits, and a more regular use of methods of economic evaluation have been proposed as promising approaches towards optimizing resource allocation in health care. However, an analysis of these approaches demonstrates that a valid appraisal of their potential to improve the effectiveness and efficiency of health care requires further research. In addition, European integration may produce tendencies towards a convergence of the national health care systems; this makes it rather difficult to assess how the room for autonomous national health policies will develop in the future.

Cost-Benefit Analysis↗
PubMed2000

Germany's long-term-care insurance: putting a social insurance model into practice.

A growing population of elderly has intensified the demand for long-term care (LTC) services. In response to the mounting need, Germany put into effect a LTC Insurance Act in 1995 that introduced mandatory public or private LTC insurance for the entire population of 82 million. The program was based on the organizational principles that define the German social insurance system. Those individuals in the public system and their employers each pay contributions equal to 0.85 percent of each employee's gross wages or salary. Ten percent of the population with the highest incomes have chosen the option of purchasing private long term care insurance. Provisions were made for uniform eligibility criteria, benefits based on level of care needs, cost containment, and quality assurance. Over the first four years of its operation, the system has proved financially sound and has expanded access to organized LTC services. The German system thus may serve as an example for other countries that are planning to initiate social LTC insurance systems in other nations.

Aged↗
PubMed2000

[Conception and testing of a regional practice guideline using bronchial asthma as an example].

Frequently, there is a gap between publication and implementation of guidelines into clinical practice. To improve adherence with guidelines, experts recommend among other things local adaptation of guidelines. The goal of the present study was to conceptualize and test such an adaptation in the region of Neckar-Alb in Germany by using asthma guidelines as an example. We conceptualized a three-step approach for regional guideline adaptation: 1) Compilation of existing national and international asthma guidelines by regional experts to develop a draft for regional asthma guideline; 2) regional consensus conference to discuss the draft with local physicians; 3) modified Delphi procedure using regional physicians as "experts" to get consent for the regional asthma guideline. We defined consensus as reaching at least a 2/3 consent for each of the statements. As starting point for the process of guideline adaptation, the regional experts developed a first draft of the regional asthma guideline including 132 recommendations. 60 out of 500 regional general practitioners (GP), internists and asthma specialists participated in the consensus process. After the preparations of the regional experts and the regional consensus conference, only four recommendations had to be changed considerably during the Delphi procedure to reach the consensus criterion. If the recommendations remained unchanged, the whole guideline might be disapproved because they were considered to affect the role of GPs by shifting responsibilities from GPs to asthma specialists. As the result of the adaptation, the first regionally adapted asthma guideline for the Neckar-Alb region fosters the principal responsibility of regional GPs in asthma care, thereby surmounting resistance for implementation that former specialist-centered guidelines provoked. Hence, the new guideline meets the requirements for successfully implementing the recommendations into clinical practice.

Asthma↗
PubMed1997

Internal and external measures of quality assurance in gynecological surgery.

In the light of exploding costs in health care and increasing demands for public accountability, gynecological surgeons are forced to improve the effectiveness and efficiency of their care in order to increase the satisfaction of their 'clients'. To do so, the implementation of a structured quality management system in gynecological care units is strongly encouraged. Basic requirements for an efficient quality management system comprise developing appropriate structures for the system, training staff in management techniques and using tools to monitor the quality of care. An important part of a quality management system is structured data collection permitting regional benchmarking between hospitals. The study 'Quality assurance in gynecological surgery' of the German Society of Gynecology and Obstetrics is mentioned as an example of such an external measure. Profiles help gynecological care units to recognize problem areas of their care. A list of further structural characteristics of a quality-oriented gynecological care unit, such as second opinion techniques or the application of clinical practice guidelines, is given to enable the evaluation or certification of quality management systems in gynecological departments.

Accreditation↗
PubMed1997

[Experiences with external quality assurance in gynecologic surgery].

A project, 'Quality Management in Gynecological Surgery', was developed as an external means of quality management in gynecological surgery and tested in 44 clinics in 1994. The external comparison of clinics generally demonstrated the high quality of the services, but certain aspects of these services exhibited an extremely high variability, for instance as far as thrombosis prevention and the choice of the routes of access for defined interventions are concerned. The positive effects of the project were that the clinics used the comparative data provided by the project as a basis to modify the management processes and thus improved the quality of their services. On the other hand, the external comparisons uncovered the need for guidelines for the management of patients. It will now be the responsibility of the gynecological societies to establish such guidelines and communicate them to their members via the appropriate channels.

Female↗
PubMed1997

[Effects of quality assurance measures on surgical gynecology treatment].

Basing on the example of the project "Quality assurance in gynaecological surgery", we show which effects due to participation in an externally supported quality assurance measure can be reached short-term. 44 gynaecological clinics documented 42,433 operative procedures within the project in 1994. In 1995, seven participants continued the documentation (9,430 operations). We measured the quality of care over time, using 20 quality indicators that were formulated in the project. Quality improvements were achieved in the two-year study period particularly for indicators which focused on less complex processes of care (i.e. thromboprophylaxis with heparin). However, more complex processes of care, such as the indication for an operation, have not yet changed. Nevertheless, according to the results of structured interviews, we expect long-term quality improvements: due to the participation in the project, 26 clinics reported increasing attention to the quality of care, 12 clinics changed their organisation of the quality assurance system and 11 clinics began internal quality improvement projects on the basis of the study benchmarks.

Female↗
PubMed1997

[Quality assurance measures in surgical gynecology. Program development and routine introduction in Hessia].

Frequently, quality assurance measures fail during application in routine practice despite showing very promising results in the developmental stage. Using the project 'Quality assurance in gynecological surgery' as an example which has made the leap into routine practice, we describe the development of a successful quality assurance measure. We name some of the elements which have proved to be crucial for the assumption of a new quality assurance measure. First of all, decisive was the development of the measure by renowned experts of the scientific medical society together with methodologists. All current professional and legal demands on medical quality assurance were included as were methodological knowledge for the optimal formation of such a measure. The evaluation of the measure on approximately 50,000 gynecological surgical procedures showed that the new quality assurance measure is suitable in gynecological surgery as an instrument both for making transparent the quality of health care delivery as well as for supporting comprehensive internal and external assessments of performance, outcomes, and processes of care and comparisons with the "best" care provider ("benchmarking"). Secondly, a favorable point in time--here the introduction of a diagnosis related payment system--and the early and close cooperation on the part of the program developers with political decision-makers helped to ensure that the newly developed quality assurance measure in gynecological surgery was accepted for routine practice.

Benchmarking↗
PubMed1997

[Benchmarks for surgical gynecology: results of the German Society of Gynecology and Obstetrics Quality Assurance Study].

Profiling of performance and quality in gynecological surgery is discussed. Unfortunately, most report cards miss valid clinical benchmarks. Within the German study on quality assurance in gynecological surgery we explored whether indicators of quality were suitable as clinical benchmarks. Using a factor analytic approach, we reduced the number of indicators and obtained in a set of 13 indicators of clinical quality. On the basis of the study data on post operative infections we show that these indicators are suitable as clinical benchmarks: the clinical benchmarks are able to make health care quality transparent and demonstrate opportunities for improvement of the processes of gynecological care.

Benchmarking↗
PubMedDate not supplied

[The self-help groups' need for support as seen by the participants].

BACKGROUND: Since section 20(4) of the revised German Social Code Book V became effective in 2001, German statutory health insurance providers are obliged to support self-help groups (SHG) financially. Additionally, public health services in North Rhine-Westphalia have--according to the "Law for Public Health Services"--to establish district health conferences (DHC) designed to coordinate medical and social care. The DHC of the district of Wesel (population;500,000) decided to choose the "coordination of health-related SHG" as their first topic. In this framework the aim of the study was to quantify the need for development and promotion of health-related SHG from the perspective of SHG. METHODS: Collection of primary data in 120 SHG in the district of Wesel by a questionnaire with a return of 77 analysable answers (Rate 64 %). RESULTS: From the perspective of SHG in the district of Wesel a need for assistance/promotion exists primarily in: Training group leaders, chairman (55% of the entries), recruitment/placement of experts (53% of the entries, and public relation/"Advertisement" (52% of the entries. In the first place, a need for development is seen in an improvement of cooperation with the professional sector, especially with office-based physicians DISCUSSION/CONCLUSION: The results of this study quantify and specify SHGs' need for support on district level from the perspective of SHG. These results can be used for local public health policy and health planning.

Germany↗