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Biomedical subjects

Markus Lüngen

Publications and source records attributed to Markus Lüngen.

4 recordsLinked to original sources
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↗
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↗