PROM-based monitoring and alerts reduce post-surgery healthcare utilization of patients undergoing joint replacement: A secondary analysis of the PROMoting Quality RCT.

Objectives: Healthcare systems increasingly face shortages of medical professionals, and simultaneously experience a rise in demand for healthcare services. In this study, we investigated whether a digital PROM-based monitoring and alert system for hip and knee replacement patients post-surgery can support in decreasing healthcare expenditures and utilization.

Methods: We used data from the randomized controlled trial PROMoting Quality, focusing on 546 hip and 492 knee replacement patients from nine German hospitals between October 2019 and December 2020 with available claims data.

The PopGrouper as a tool for morbidity adjustment in regional comparisons of health care: an analytical framework.

Background: Analyzing regional variations can help improve equity, efficiency, and quality in health care provision. The PopGrouper is a population-based classification system which classifies persons with similar health care needs into distinct groups. It exhibits a high degree of morbidity differentiation.

Demographic and socioeconomic determinants of adherence in digital patient-reported outcomes among patients with chronic diseases.

Engaging patients in the digital collection of electronic patient-reported outcome measures (ePROMs) and experience measures (ePREMs) is desirable for equitable, patient-centred chronic disease management; however, adherence remain unclear. This study examined demographic and socioeconomic determinants of adherence using ePROMs and ePREMs collected from patients with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany. Of the 200,338 patients invited to complete digital surveys, 4657 consented (initiation; 2.

Primary endpoint acceptance and its association with benefit ratings and market access in German health technology assessments: a retrospective cohort study.

Background: In Germany, the Health Technology Assessment process, governed by the Federal Joint Committee (G-BA), evaluates relative efficacy and safety of newly European Medicines Agency (EMA)-approved drugs against the standard of care using patient-relevant endpoints. This study aimed to investigate the impact of the acceptance of the primary endpoint on the likelihood of an additional benefit and patient access in assessments that fulfilled criteria for study design and comparator for both authorities.

Methods: We examined whether the acceptance of the primary endpoint by G-BA resulted in a higher likelihood of a positive benefit rating and a reduced risk of market withdrawal by pharmaceutical companies of drugs that underwent a benefit assessment between 2011 and 2023, in which an RCT with an adequate comparator according to G-BA served as evidence base.

Hospital Volume and Outcome in the Treatment of Congenital Diaphragmatic Hernia in Germany - Observational Study Using National Hospital Discharge Data FROM 2016 to 2023.

Background: Congenital diaphragmatic hernia (CDH) is a critical malformation, with the neonatal period being particularly challenging and associated with high mortality. Data on the care structure and volume-outcome relationship in the treatment of children with CDH in Germany remain scarce.

Methods: This study determined case numbers and outcomes of treatment of children aged 0-17 years, with CDH in Germany between 2016 and 2023 through a query of the nationwide DRG database at the Research Data Center of the Federal Statistical Office.

Treatment decisions and surgery variables are predictors of better physical function after total hip and knee arthroplasty: a retrospective cohort study.

Background: Demographic factors are driving the further increase of total hip (THA) and total knee arthroplasty (TKA) volumes in the next decades. This will face the healthcare systems with new challenges. To find ways that optimize the utilization of the limited resources, it is important to understand which factors influence the outcomes at different points along the treatment pathway.

Health economic evaluation of a medication safety intervention in elderly care: identifying causal effects in a multi-center quasi-experimental study design.

The high prevalence of multimorbidity in the aging population necessitates complex medication regimens, increasing the risk of adverse drug events (ADEs) and hospital admissions. This paper evaluates an intervention aimed at improving medication safety for northeastern and western Germany under real-world conditions, thereby providing a pragmatic approach to the challenges of multi-center studies with staggered intervention starts and voluntary participation. The analysis utilizes iterative Propensity Score Matching (PSM) followed by a Difference-in-Differences (DiD) estimator to navigate the methodological complexities and assess the intervention's effectiveness and cost-effectiveness.

[Definition of consolidated disease groups for a population-based system to classify morbidity-related healthcare needs: PopGroup].

Objective: In recent years there has been an increased demand for a morbidity-oriented approach in the planning of healthcare facilities in Germany. Population-based classification systems, which already exist in various countries, are crucial for assessing regional healthcare needs. The PopGroup project aims to develop such a classification system (PopGrouper) for the German healthcare system and to test various applications.

[Healthcare landscape in internal medicine in Germany: A trend analysis over 10 years for the German Society of Internal Medicine (DGIM)].

The aim of the project is to analyse the status of the inpatient and outpatient care landscape with regard to medical staff, care structures and performance developments for internal medicine and its specialities.Various data sources were used, including the German Medical Association, the National Association of Statutory Health Insurance Physicians, the Federal Statistical Office and structured hospital quality reports.According to the German Medical Association, 58000 internists were registered in 2020, 45% (n=26,400) of whom worked in the inpatient sector and 48% (n=28,000) in the outpatient sector.

From 'Sovereign Self-Proclaimed Experts' to 'Impressionable Sceptics'-Developing a Patient Typology to Distinguish Patients' Interactions With Healthcare: A Qualitative Study in Germany.

Background: Person-centredness in health systems puts patients and their preferences at the centre of healthcare. However, there is not an 'one size fits all' approach as patients are heterogenous and have varying interactions with and perceptions of healthcare, and assessments of the health system performance. This study aims to explore these patient differences by (1) identifying core attributes of patients that shape their general approach to and interactions with healthcare and (2) deriving specific patient types based on these core attributes.

[Hospital service groups and quality indicators - A cross-comparison for pneumonia, ischemic stroke, and colorectal resection for carcinoma].

In Germany, the Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz) will introduce service groups for hospital reserve financing. The hospital planning of the federal states is also intended to allocate care contracts to hospitals based on service groups in conjunction with structural quality criteria. This paper analyzes service group-specific differences in treatment case characteristics as well as differences in process and outcome quality indicators.

The introduction of maximum reimbursement prices for digital health applications in Germany in 2022: Current developments.

Germany serves as a pioneering example for the integration of digital health applications. Since October 2020, digital health applications that passed a benefit evaluation have been provisionally or permanently included in the benefit basket of the German statutory health insurance. However, free price setting by the manufacturers in the first year after the introduction in the benefit basket led to high prices.

Leveraging machine learning for duration of surgery prediction in knee and hip arthroplasty - a development and validation study.

Background: Duration of surgery (DOS) varies substantially for patients with hip and knee arthroplasty (HA/KA) and is a major risk factor for adverse events. We therefore aimed (1) to identify whether machine learning can predict DOS in HA/KA patients using retrospective data available before surgery with reasonable performance, (2) to compare whether machine learning is able to outperform multivariable regression in predictive performance and (3) to identify the most important predictor variables for DOS both in a multi- and single-hospital context.

Methods: eXtreme Gradient Boosting (XGBoost) and multivariable linear regression were used for predictions.

Selecting indicators for the measurement of low-value care using German claims data: A three-round modified Delphi panel.

By reducing healthcare services that offer little benefit or potential harm to patients (low-value care), resources can be redirected towards more adequate treatments, improving healthcare efficiency and patient outcomes. This study aimed to systematically incorporate clinical expertise across medical disciplines through a Delphi process to establish indicators for measuring low-value care, ensuring their acceptance by medical societies, the broader medical community, and patients. We developed two versions (one with higher sensitivity and one with higher specificity) for almost each of the 42 indicators identified as potentially measurable in a previous systematic review.

Implementation of the EU's Health Technology Assessment regulation: where does existing methods guidance require concretization and what are the relevant methodological options?

Objectives: The EUnetHTA Core Model is well-established in the HTA community. Some recommendations of corresponding guidance documents leave room for alternative methodological choices. Considering the new HTA regulation (HTAR), we aimed to identify needs for concretization (NCs) in EUnetHTA guidance and provide indicative methodological options.

The Potential for Providing Treatment on an Outpatient Rather Than Inpatient Basis: A Nationwide Analysis of Hospital Discharge Data in Germany for the Year 2022.

Background: In an expert analysis by the IGES Institute, it was examined which inpatient hospital treatments could also be carried out on an outpatient basis. A method of determining the feasibility of performing any particular treatment in the outpatient setting based on routine documentation was proposed in the report. A new version of the German catalogue of operations that can be per - formed on an outpatient basis and other outpatient procedures (the AOP catalogue) was issued accordingly.

Satisfied with the worst health outcomes or unsatisfied with the best: explaining the divergence between good patient-reported outcomes and low satisfaction and vice versa among knee arthroplasty patients - a retrospective cohort study.

Objectives: Total knee arthroplasty (TKA) is an effective treatment for patients with end-stage knee osteoarthritis but some patients exhibit a discrepancy between patient-reported outcomes (PROs) and patient satisfaction (PS). This study aims to identify predictors for patients reporting unfavorable PROs but high PS and vice versa.

Materials And Methods: This retrospective cohort study categorized patients from nine German hospitals into four groups based on (i) whether they achieved a minimal clinically important difference (MCID) in knee functionality, measured with a joint-specific PRO from admission to 12-month post-surgery; and (ii) whether they were satisfied at 12 months post-surgery.

The impact of COVID-19 on health service utilization in sub-Saharan Africa-a scoping review.

Background: Despite comparatively low rates of COVID-19 admissions and recorded deaths in sub-Saharan Africa (SSA), the pandemic still had significant impact on health service utilization (HSU). The aim of this scoping review is to synthesize the available evidence of HSU in SSA during the pandemic, focusing on types of studies, changes in HSU compared with the pre-pandemic period, and changes among specific patient groups.

Methods: The scoping review was guided by the methodological framework for conducting scoping reviews developed by Arksey and O'Malley.

Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial.

Background: While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement.

Methods And Findings: The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals.

Treatment of Esophageal Atresia in Germany: Analysis of National Hospital Discharge Data From 2016 to 2022.

Background: Esophageal atresia (EA) is a complex malformation. Multidisciplinary management is necessary, with the operative repair being the most challenging step in the treatment algorithm. The complete care structure for children with EA in Germany has not been analyzed yet.

[Descriptive analysis of the steering potential in the internal medicine in Germany based on an international comparison].

Background: Healthcare in Germany is not always needs-based and has considerable potential for optimization. Internal medicine (IM) plays a special role in the German healthcare system due to its long tradition. Against this background, a look at the optimization potential to achieve better quality and higher efficiency care seems particularly relevant.

Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol.

Background: Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management.

[Value-based healthcare as an opportunity for patient management at the individual and system level].

Background: Value-based healthcare (VBHC) aims to increase patient outcomes in relation to the costs incurred, with a focus on measuring these outcomes using patient-reported outcome measures (PROMs). The German healthcare system faces the challenge of quality disparities in care amidst rising costs, making VBHC of interest.

Objectives: This paper aims to illustrate how VBHC principles are currently being implemented in the field of internal medicine in Germany and to identify the potential that can be derived from VBHC pioneering examples from the Netherlands.

In-hospital mortality, comorbidities, and costs of one million mechanically ventilated patients in Germany: a nationwide observational study before, during, and after the COVID-19 pandemic.

Background: Even more than hospital care in general, intensive care and mechanical ventilation capacities and its utilization in terms of rates, indications, ventilation types and outcomes vary largely among countries. We analyzed complete and nationwide data for Germany, a country with a large intensive care sector, before, during and after the COVID-19 pandemic.

Methods: Analysis of administrative claims data, provided by the German health insurance, from all hospitals for all individual patients who were mechanically ventilated between 2019 and 2022.