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M Wildner

Publications and source records attributed to M Wildner.

At least 37 records · Page 2Linked to original sources
PubMed2001

Hip fracture incidence in east and west germany: reassessement ten years after unification.

The rising incidence of hip fractures is of world wide concern. In addition to the demographically aging populations world wide a secular trend of hip fracture incidence has been reported for various populations. The objective of the current study was to reassess hip fracture incidence ten years following German reunification and compare incidence rates in former East and West Germany. Data from the German hospital discharge diagnosis registry were used to compare rates in former East and West Germany. A reassessment of a secular trend was done with directly age-standardized rates of the population 60 years old and over. Significant differences were found between incidence rates in the East and West German states with higher rates in the West. Compared to earlier studies for East Germany, rate in East Germany have increased by on average annually 6% since reunification. This is a steep increase compared to the annual rise by about 3% between 1974 and 1989. Hip fracture incidence in East Germany thereby has doubled during the 25-year period from 1971 to 1996. Although the observed acceleration of a secular trend in East Germany probably has multiple causes, evidence suggests a significant influence of Western life style on hip fracture incidence.

Age Distribution↗
PubMed2000

[Evaluation of the appropriateness of hospital care in internal medicine. Reliability of a German adaptation of the procedure].

BACKGROUND AND OBJECTIVE: The evaluation of the appropriateness of hospital admissions and hospital stays has become an increasingly important issue in Germany. Evaluations by the German Physicians Review Organizations (MDS, MDK) demonstrated the need for a standardized, valid and reliable assessment tool for inappropriate hospital use. Objective of this study was to test the reliability of a German adaptation of the "Appropriateness Evaluation Protocol" (AEP). PATIENTS AND METHODS: From the 2317 admissions to medical wards of a teaching hospital in Hessia in 1997 we randomly selected 52 patients to test the inter-rater-reliability (54% female, mean age = 66 years +/- 18). Another 49 patients were randomly selected to test the intra-rater-reliability of the AEP (53% female, mean age = 61 years +/- 20). We estimated general agreement, specific agreement and Kappa statistics for the agreement of the evaluation of hospital admissions and hospital days. 95% confidence intervals were reported. RESULTS: The German adaptation of the AEP showed an inter-rater-agreement of 92% (88-96%) for hospital admissions and 76% (73-80%) for hospital days. Correspondingly, we observed an intra-rater-agreement of 96% (88-100%) for hospital admissions and 93% (91-95%) for hospital days. The high agreement was independent of the length of hospital stay and independent of the proportion of inappropriate hospital days. CONCLUSION: A standard instrument for the assessment of the appropriateness of hospital care with known metric properties may be useful for quality management in hospitals and provide competitive advantages in a consolidating health care market. The AEP could be such an instrument.

Aged↗
PubMed2000

[Validity and reliability of proband recall of fractures].

The validity and reliability of patient recall of diseases depends on the kind of disease. The validity and reliability of patients' recall of fractures was assessed among the 146 cases of a nested case-control study on independent living following fractures in the elderly. On declaration of a fracture a letter was sent to the general practitioner requesting medical information on the latest fracture receiving treatment. A total of 99 medical discharge letters (68%) could be collected for further evaluation. The information on fracture localisation which was obtained both during the patients interviews 1994/95 and 1998 and through the medical discharge letters were coded with reference to the AO (Arbeitsgemeinschaft für Osteosynthesefragen)-classification and compared. The Kappa-statistic for the reliability of patient information was 0.80-0.89, and 0.77-0.89 for the validity, depending on the degree of specified concordance. Obtaining information on fractures from patients appears as a valid and reliable source of epidemiologic data. Patients who generally are affected physically or had to stay in a hospital due to a fracture or its treatment seem to have a good recall of this event. It appears that it can be remembered years after the event with sufficient reliability and validity.

Aged↗
PubMed2000

[Health and human rights--development of a questionnaire for measuring perceived human rights status].

Health and human rights as interlinked concepts are a promising new avenue in public health. The aim of this study was the development of a reliable and valid instrument for the measurement of the human right status. The reliability and validity of this new questionnaire for human rights (HRS = human right scale) was measured within a group of Public Health students (n = 42) and the participants of the KORA-fracture-study. Test-retest-reliability was 0.73 (ICC: 0.69) and Cronbach's alpha was 0.66-0.79. The evaluation of the validity with the help of a factor analysis and a reconstruction study pointed out, that the perceived human rights status has to be treated as an interlinked and not divisible concept. Both study groups showed deficits for items in the dimension justice and participation.

Adult↗
PubMed2000

[Reproducibility of a German scale for assessing the need for inpatient treatment in surgery].

During the past years, the assessment of the appropriateness of hospital utilization has become increasingly important in the German health care system. Previous evaluations by regional review organizations in several states demonstrated the need for a standardized, reliable, and valid instrument to evaluate the appropriateness of inpatient care. Objective of the study is to test the reliability of a German adaptation of the "Appropriateness Evaluation Protocol" (AEP). Among all 2672 admissions from the department of surgery of a regional medical center during one calendar year, 54 patients were randomly selected to evaluate the inter-rater reliability and 51 patients to test intra-rater reliability. Overall agreement, specific agreement and Kappa statistics were estimated for every hospital admissions and all consecutive hospital days. The German AEP showed an inter-rater agreement of 74% (62-86%) for hospital admissions (Kappa = 0.44) and 84% (79%-88%) for all hospital days (K = 0.55). Intra-rater reliability was 88% (79%-97%) for hospital admissions (K = 0.60) and 88% (85%-92%) for all hospital days (K = 0.70). The observed agreement is independent of length of hospital stay and proportion of appropriate days. A standardized instrument with known metric properties is essential for quality management in hospitals to prepare for an increasingly consolidating health care market in Germany. The German AEP is a reliable instrument, which will allow to identify inefficiencies in the management of surgical inpatients.

Adult↗
PubMed2000

Violence and fear of violence in East and West Germany.

The purpose of this research was to assess the effect of major social changes in Germany since 1989 on mortality due to intentional injury. Mechanisms and types of fatal intentional injury in East and West Germany between 1970 and 1995 were determined from death certificates and compared with judicial data on violent crime convictions and recent public survey data on citizen fear of crime. The number of homicides among East German males increased between 1989 and 1991, and the homicide rate remains high when compared with West German males (although lower than that of American males). Homicide among German females is less common, presently about equally likely in East and West. Violent crime in general has become more frequent in Germany, and citizen fear of crime has increased markedly, especially in the East. Non-citizens are convicted for an increasing number of homicides and assaults. Rates of suicide were declining in East and West before reunification, and these rates have continued to decline. Social changes in Europe since 1989 have led to noticeable increases in violence and homicide in Germany, which in turn have reduced feelings of security among German citizens, especially in the East. Suicide rates have not been affected.

Adult↗
PubMed2000

[Corroboration of concurrent assessment of inappropriate hospitalization with retrospective evaluation based on patient records].

BACKGROUND AND PURPOSE: Since the availability of a German adaptation of the "appropriateness Evaluation Protocol" (AEP) for hospital utilization review, physicians and health care managers were concerned about a potential overestimation of the extent of inappropriate hospital use in a retrospective assessment. The objective was to assess the agreement of concurrent and retrospective assessment of inappropriate hospital use. METHODS: The appropriateness of 42 admissions to surgical wards in a teaching hospital was tested concurrent to the admission. In 25 hospitalized patients the appropriateness of hospital days was assessed. Results were compared with the retrospective testing of the same patients after three months. RESULTS: Agreement between concurrent and retrospective assessment within the same reviewer was 86% of admissions (95% CI = 75%-96%) and 96% of hospital days (88%-100%). Kappa showed values of 0.85 and 0.78, which can be described as excellent. A comparison of two different reviewers, one testing concurrently, the other retrospectively showed agreements of 86% and 90%. The proportion of inappropriate days was the same in both designs. CONCLUSIONS: The results refute prior concerns that a retrospective assessment of the appropriateness of hospital use is impossible because in a retrospective design important clinical information would remain unconsidered or clinical information not yet available at that time would be used for the evaluation. The possibility of an incorrect assessment due to a retrospective design is within the variability inherent to the instrument. Despite the strong agreement, the small sample of surgical patient limits the generalizability of results.

Concurrent Review↗
PubMed2000

[Incidence of operations in Germany via telephone survey in 4 selected cities].

Considerable regional variation of surgical procedure rates has been reported for a number of countries. Influential variables that have been discussed are patient-related, physician-related and health care system-specific factors. A representative computer-assisted telephone survey was conducted in four selected regions for a study sponsored by the German Federal Ministry of Health. These regions were the townships of Aachen and Hamm in North Rhine-Westphalia and Chemnitz and Görlitz in Saxony. During the telephone survey 1897 persons were contacted and 1041 interviews completed. Multiple logistic regression showed a surgical procedure frequency which was by 40% higher in Aachen than in Hamm. During further analysis the regional localisation was replaced by region-specific structural health care information variables. During this analysis the regional frequency of medical specialists was significant at a 5% level (odds ratio: 1.07; 95% confidence interval: 1.02-1.12). This result can be interpreted as an increase in surgical procedures by 7% for each additional specialist per 10,000 persons. However, no definite conclusion can be reached based on the available data. Intensifying the presented survey-based health services research has the potential to identify regional over- or undersupply of medical services, to objectify and accompany informational, administrative or political action and thereby to support equity in access and health care in the sense of an optimized allocation of resources.

Adult↗
PubMed2000

Injury mortality in East Germany.

OBJECTIVES: This study determined the effects of social changes in East Germany since 1989 on patterns of injury mortality. METHODS: Death certificate data regarding injuries from 1980 through 1995 and police data regarding traffic injuries in East Germany from 1980 through 1998 were compared with similar data from West Germany. RESULTS: The number of motor vehicle-related injuries and deaths in East Germany increased dramatically between 1989 and 1991, whereas those in West Germany declined slightly. The increased mortality in the more rural East has especially involved young men driving automobiles on rural roads and has persisted since reunification of East and West Germany. Falls, other accidents, and suicides have shown no such effect. Homicide among East German men has increased but remains uncommon. CONCLUSIONS: Recent social changes in East Germany, including increased access to motor vehicles and decreased restrictions on personal freedom, have been associated with increased motor vehicle crashes and mortality, especially among young men and on rural roads.

Accidental Falls↗
PubMed1999

An indirect method for the estimation of osteoporotic fractures from injury and fracture profiles.

Study objective was to develop a valid epidemiological method for the estimation of osteoporotic fracture risk, using administrative databases and accounting for variable baseline risks of injury. Design is the secondary analysis of inpatient and outpatient utilization data. A baseline injury risk was estimated by the incidence of primary utilization of medical services for soft tissue injuries (ICD-9 diagnostic codes 910-929), and the risk profile was compared after normalization with the overall primary utilization rate for fractures (ICD-9 diagnostic codes 800-829). The setting is a county with approximately 100,000 inhabitants in the former East Germany. Participants were all inhabitants of the county who had a physician contact (inpatient or outpatient) during 1987-1988, as well as hospital inpatients for all of Germany in 1989. The number of fractures increased with age, especially in women, when compared to the number of fractures expected from the incidence of soft tissue injury. Similar patterns were identified in hospitalization data from East and West Germany. Estimating the prevalence of osteoporosis directly from certain "osteoporotic" fracture types associated with higher age is potentially biased, since it neglects the underlying risk of injury. Our model distinguished the osteoporotic fracture risk as the excess risk over an expected injury-related fracture risk for a given age and sex, and may allow a more valid quantification of osteoporotic fractures in different populations.

Adolescent↗
PubMed1999

A secular trend in hip fracture incidence in East Germany.

The central Inpatient Register of the former German Democratic Republic was used to study the population-based epidemiology of hip fractures among 16.5 million East Germans. Incidence rates for hospital discharges for proximal femoral fractures for the age group 60 years and over were calculated for the years 1971 to 1989, the year before unification. Incidence rates for 1989 are similar to figures reported from the UK and The Netherlands, but lower than Scandinavian rates. A decrease in the admission rate was noted from 1971 to 1974 of 4.5% each year on average, and an increase from 1974 onwards of 4.4% on average. This change was observed to a different extent in all age groups. The female:male ratio of the standardized discharge incidence was stable at 2.3:1 and the female:male ratio of manifest cases increases from 4.1:1 in 1971 to 5.1:1 in 1989. An exponential increase in the incidence rates was observed with age. This apparent rate overestimated both the rate for true incident cases (by about 25-30%, if adjustments are made for readmissions and transfers) and their trend. Adjusted estimates for incident fractures show an increase of 2% annually. Cohort effects due to changed selective forces appear to be one reasonable causal explanation.

Aged↗
PubMed1999

[Examples and proposed solutions for methodological problems in hospital appropriateness assessment].

Inappropriate hospital care has become a recurring theme since the publication of the results of the model project on the appropriateness of hospital care (Section 275 a SGB V) by the medical service of the National Associations of Health Insurers (MDS) in Spring 1997. Nationwide, an increased number of appropriateness assessments have since been conducted by the medical service of the health insurers (MDK). The basis for an objective assessment of the appropriateness of hospital care is a diligent, comprehensive, and methodologically valid examination of the actual situation. At first, it was unknown to what extent current methods in Germany conformed to international scientific standards in Epidemiology, Biometry, and Health Services Research. Following a thorough scientific examination of several typical methodologies, it became clear that current methods are insufficient, and hence do not allow valid conclusions regarding inappropriate hospital admissions or hospital days. This statement does not deny that inappropriate hospital use is very likely, but our current assessment tools do not permit further conclusions to be drawn. The purpose of this article is to identify typical mistakes in the fundamental aspects of a valid assessment based on selected examples. Proposals are made regarding methodology and the presentation of results that follow from this critical examination.

Germany↗