Werner de Cruppé

Universität Witten/Herdecke, Witten, North Rhine-Westphalia, Germany

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Publications (34)31.64 Total impact

  • Werner de Cruppé, Marc Malik, Max Geraedts
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    ABSTRACT: Legally mandated minimum hospital caseload requirements for certain invasive procedures, including pancreatectomy, esophagectomy, and some types of organ transplantation, have been in effect in Germany since 2004. The goal of such requirements is to improve patient care by ensuring that patients undergo certain procedures only in hospitals that have met the corresponding minimum caseload requirement. We used the case numbers published in legally mandated hospital quality control reports to determine whether the hospitals actually met the stipulated requirements.
    Deutsches Ärzteblatt International 08/2014; 111(33-34):549-55. · 3.54 Impact Factor
  • P Hermeling, W de Cruppé, M Geraedts
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    ABSTRACT: This study examines the quality criteria which, from the perspective of non-hospital based physicians, are relevant in order to give patients quality-oriented recommendations in the selection of a suitable hospital or specialist.A primary telephone survey of 300 physicians from 5 specialist groups collected relevance assessments of 59 quality criteria for hospitals, GPs and specialist practices. A descriptive bi- and multivariate analysis was performed using McNemar tests, correlation and regression analysis.Next to the personal experiences which the physician and his patients made with the hospital or non-hospital based colleague in the past, there is a general interest in vital structural and outcome parameters of hospitals and medical practices. Physicians deem the nature and scope of services offered by the hospitals and medical practices as less relevant. In 12 of the 59 examined quality criteria, the relevance assessments differ depending on whether the physician is dealing with an elective admission to hospital or a referral to a GP or specialist. In the analysis of possible correlations between preferences and factors which might be influencing the physician, gender, age and specialisation were found to have an effect.
    Das Gesundheitswesen 04/2013; · 0.94 Impact Factor
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    Silke Auras, Werner de Cruppé, Karl Blum, Max Geraedts
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    ABSTRACT: BACKGROUND: Public reporting of hospital quality is to enable providers, patients and the public to make comparisons regarding the quality of care and thus contribute to informed decisions. It stimulates quality improvement activities in hospitals and thus positively impacts treatment results. Hospitals often use publicly reported data for further internal or external purposes. As of 2005, German hospitals are obliged to publish structured quality reports (QR) every two years. This gives them the opportunity to demonstrate their performance by number, type and quality in a transparent way. However, it constitutes a major burden to hospitals to generate and publish data required, and it is yet unknown if hospitals feel adequately represented and at the same time consider the effort appropriate. This study assesses hospital leaders' judgement about the capability of QR to put legally defined aims effectively and efficiently into practice. It also explores the additional purposes hospitals use their QR for. METHODS: In a cross-sectional observational study, a representative random sample out of 2,064 German hospitals (N=748) was invited to assess QR via questionnaire; 333 hospitals participated. We recorded the suitability of QR for representing number, type and quality of services, the adequacy of cost and benefits (6-level Likert scales) and additional purposes QR are used for (free text question). For representation purposes, the net sample was weighted for hospital size and hospital ownership (direct standardization). Data was analyzed descriptively and using inferential statistics (chi-2 test) or for the purpose of generating hypotheses. RESULTS: German hospitals rated the QR as suitable to represent the number of services but less so for the type and quality of services. The cost-benefit ratio was seen as inadequate. There were no significant differences between hospitals of different size or ownership. Public hospitals additionally used their reports for mostly internal purposes (e.g. comparison with competitors, quality management) whereas private ones used them externally (e.g. communication, marketing) (p=0.024, chi-2 test, hypotheses-generating level). CONCLUSIONS: German hospitals consider the mandatory QR as only partially capable to put the legally defined aims effectively and efficiently into practice. In order for public reporting to achieve its potentially positive effects, the QR must be more closely aligned to the needs of hospitals.
    BMC Health Services Research 10/2012; 12(1):378. · 1.77 Impact Factor
  • M Geraedts, M Malik, O Jung, W de Cruppé
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    ABSTRACT: To improve quality of breast cancer care, in 2004 the state of North Rhine-Westphalia (NRW), Germany, began to appoint 51 breast cancer centres. These centres comprise 91 hospitals performing breast cancer surgery which have - amongst other things - to fulfill minimum volume standards. The aim of our study was to analyse if the intended regionalisation of care from 252 hospitals performing breast cancer surgery formerly to the appointed hospitals had taken place by the year 2010.We used data for the years 2004-2010 from the agency for quality assurance in North Rhine-Westphalia concerning breast cancer care and analysed trends concerning the number of hospitals performing breast cancer surgery, case volumes, and achievement of minimum volume standards by performing descriptive and inferential statistics.Between 2004 and 2010 the number of breast cancer cases increased by 36.6% from 12 975 to 17 724 cases (p<0.001, Wilcoxon test). Simultaneously, the number of hospitals performing breast cancer surgery decreased from 252 to 208 whereby more than double the number of planned hospitals still performed breast cancer surgery. The case volumes of the 71 appointed hospitals for which we had individual data over the entire period of time increased by 49.4% from 8 103 cases in year 2004 to 12 105 cases in 2010. Assuming that case volume trends of those 20 appointed hospitals of which we did not have individual data developed uniformly to all other appointed hospitals, the proportion of cases that were operated in not appointed hospitals decreased from 20% in year 2004 to 12.5% in 2010 (p<0.001, χ2 test). Simultaneously, the proportion of cases that were operated in hospitals not achieving minimum volume standards decreased from 42.7% in year 2004 to 12.1% in 2010 (p<0.001, χ2 test).The establishment of breast cancer centres in NRW regionalised breast cancer surgery. In fact, in 2010 breast cancer surgery still took place in more than 100 not appointed hospitals. However, these hospitals were responsible for only a small proportion of breast cancer surgery.
    Das Gesundheitswesen 10/2012; · 0.94 Impact Factor
  • Max Geraedts, Peter Hermeling, Werner de Cruppé
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    ABSTRACT: Non-hospital based physicians usually counsel their patients which hospital to choose. Our aim was to determine which formats for presenting quality of care data are preferred by physicians. 300 randomly recruited non-hospital based physicians participated in a survey. We created eight presentation formats which varied in terms of information aggregation and usage of evaluative cues. Participants rated clarity, comprehensibility, information content, acceptance, and preference of the presentation formats. Additionally, we tested physicians' comprehension of the formats. Physicians' ratings of the formats differed significantly (p<0.001). Formats combining numeric information and evaluative cues performed best in terms of information content, comprehensibility and preference. Comprehension of presentation formats also differed (p<0.001). Even though physicians' accuracy of interpreting "Simple Star Rating" was best a majority of participants accepted only formats that contained detailed numerical information (p<0.001). In order to support physicians' use of quality of care information in counseling patients, report cards should depict indicator values in a format that combines actual indicator values with evaluative cues. If authors of comparative hospital quality reports apply the results of our study in designing reports, the results may increase physicians' use of comparative performance reports in their counseling of patients.
    Patient Education and Counseling 12/2011; 87(3):375-82. · 2.60 Impact Factor
  • W de Cruppé, M Geraedts
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    ABSTRACT: Patients want to decide on health care providers. Published quality reports are supposed to help but are rarely used. How patients manage choosing a hospital for elective surgery in Germany and whether they use the hospital quality reports was explored for the Federal Joint Committee. A cross-sectional survey asked 48 hospitalized patients from 5 specialties in 4 hospitals after elective surgery about their criteria and sources of information, and their use of the compulsory quality reports for choosing the hospital. Data were analyzed descriptively. To choose their hospital is very important for patients with elective surgery and they do so. Usually there is enough time to obtain information before admission. The three main criteria are own experience with a hospital, short distance from their homes, and the hospital's expertise. The main sources of information are relatives, contact with the hospital's outpatient departments, and patient's ambulatory health care provider. Written information is only used as supplementary information. The compulsory quality reports are not known and, hence, are not used.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 08/2011; 54(8):951-7. · 0.72 Impact Factor
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    ABSTRACT: Patient and physician attributes influence medical decisions as non-medical factors. The current study examines the influence of patient age and gender and physicians' gender and years of clinical experience on medical decision making in patients with undiagnosed diabetes type 2. A factorial experiment was conducted to estimate the influence of patient and physician attributes. An identical physician patient encounter with a patient presenting with diabetes symptoms was videotaped with varying patient attributes. Professional actors played the "patients". A sample of 64 randomly chosen and stratified (gender and years of experience) primary care physicians was interviewed about the presented videos. Results show few significant differences in diagnostic decisions: Younger patients were asked more frequently about psychosocial problems while with older patients a cancer diagnosis was more often taken into consideration. Female physicians made an earlier second appointment date compared to male physicians. Physicians with more years of professional experience considered more often diabetes as the diagnosis than physicians with less experience. Medical decision making in patients with diabetes type 2 is only marginally influenced by patients' and physicians' characteristics under study.
    DMW - Deutsche Medizinische Wochenschrift 02/2011; 136(8):359-64. · 0.65 Impact Factor
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    ABSTRACT: Nine out of ten demonstration projects on clinical benchmarking funded by the German Ministry of Health were evaluated. Project reports and interviews were uniformly analysed using a list of criteria and a scheme to categorize the realized benchmarking approach. At the end of the funding period four benchmarking networks had implemented all benchmarking steps, and six were continued after funding had expired. The improvement of outcome quality cannot yet be assessed. Factors promoting the introduction of benchmarking networks with regard to organisational and process aspects of benchmarking implementation were derived.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(5):339-42.
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    ABSTRACT: Zusammenfassung Hintergrund Bis Ende 2009 mussten die vertragsärztlichen Praxen in Deutschland ein einrichtungsinternes Qualitätsmanagement (QM) eingeführt haben. Die Untersuchung erhebt den Stand der Einführung in kinder- und jugendärztlichen Praxen zum Herbst 2008. Stichprobe 457 (75%) von 611 Kinder- und Jugendärzten einer zufallsgezogenen Stichprobe nahmen teil. Methode Mit einer querschnittlichen Beobachtungsstudie wurden per Fragebogen 50 Qualitätsmerkmale erhoben und varianzstatistisch mittels χ2-Tests analysiert. Ergebnisse 420 (92%) der Kinder- und Jugendärzte haben begonnen, ein QM einzuführen. Qualitätsmerkmale zur Praxissicherheit werden im Alltag bisher am häufigsten umgesetzt, am seltensten Qualitätsmerkmale zur Patientenorientierung. Praxisart und Niederlassungsdauer weisen einzelne, der Typ des QM-Systems nur geringe Unterschiede bei der Umsetzung der Qualitätsmerkmale auf. Praxen ohne QM zeigen bei fast der Hälfte der Qualitätsmerkmale signifikant niedrigere Umsetzungsgrade als Praxen mit bereits eingeführtem QM. Schlussfolgerung Kinder- und jugendärztliche Praxen führen QM ein. Es erhöht die Umsetzung prozessbezogener Qualitätsmerkmale.
    Monatsschrift Kinderheilkunde 01/2011; 159(2):145-151. · 0.19 Impact Factor
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    ABSTRACT: Development of a starter set of quality indicators for application by general practitioners and specialists in the outpatient care sector. The results of a systematic search for national and international quality indicators relevant to the outpatient care sector in Germany provided the basis for the indicator selection process. Outpatient care doctors rated the relevance and feasibility of the indicators according to the RAND/UCLA method. In a further step the indicators were tested in medical practices, focussing on data availability and accessibility. As a result, we established a set of 48 reliable, structurally developed and patient-oriented quality indicators which can be used for quality improvement in the outpatient care setting, both by specialists and general practitioners. The project provides important information with regard to the future development and use of quality indicators. Depending on the potential fields of application, the development of new indicators as well as a corresponding IT infrastructure is of high priority. Possible unintended effects of indicators will have to be considered.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(1):54-63.
  • W. de Cruppé, M. Geraedts
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    ABSTRACT: HintergrundPatienten wollen die Behandlerwahl (mit-)entscheiden. Veröffentlichte Qualitätsinformationen sollen hierbei helfen, werden aber selten genutzt. Wie Patienten bei der Krankenhauswahl vor elektiven operativen Eingriffen in Deutschland tatsächlich vorgehen und ob sie die Krankenhausqualitätsberichte nutzen, wurde für den Gemeinsamen Bundesausschuss untersucht. MethodeIn einer querschnittlichen Untersuchung wurden 48 stationäre Patienten aus fünf Fachgebieten nach elektivem Eingriff in vier Krankenhäusern zu ihren Wahlkriterien und Informationsquellen und der Verwendung der gesetzlichen Qualitätsberichte befragt. Die Daten wurden deskriptiv ausgewertet. ErgebnissePatienten ist bei elektivem Krankenhausaufenthalt die eigene Wahl sehr wichtig, und sie treffen sie auch überwiegend selber. Fast immer besteht ausreichend Zeit, sich vorab zu informieren. Die drei häufigsten Wahlkriterien sind die eigene Vorerfahrung mit dem Krankenhaus, die Wohnortnähe und die Kompetenz der Klinik. Die wichtigsten Informationsquellen sind Angehörige, Vorkontakt in der Krankenhausambulanz und die eigenen ambulanten Behandler; schriftliche Informationen werden nur ergänzend verwendet. Die gesetzlichen Qualitätsberichte sind nicht bekannt und werden nicht verwendet. BackgroundPatients want to decide on health care providers. Published quality reports are supposed to help but are rarely used. How patients manage choosing a hospital for elective surgery in Germany and whether they use the hospital quality reports was explored for the Federal Joint Committee. MethodA cross-sectional survey asked 48 hospitalized patients from 5 specialties in 4 hospitals after elective surgery about their criteria and sources of information, and their use of the compulsory quality reports for choosing the hospital. Data were analyzed descriptively. ResultsTo choose their hospital is very important for patients with elective surgery and they do so. Usually there is enough time to obtain information before admission. The three main criteria are own experience with a hospital, short distance from their homes, and the hospital’s expertise. The main sources of information are relatives, contact with the hospital’s outpatient departments, and patient’s ambulatory health care provider. Written information is only used as supplementary information. The compulsory quality reports are not known and, hence, are not used. SchlüsselwörterKrankenhauswahl–Patientenautonomie–Querschnittsuntersuchung–Deutsches Gesundheitssystem–Elektive operative Eingriffe KeywordsHospital choice–Patient autonomy–Cross-sectional survey–German health care system–Elective surgery
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 01/2011; 54(8):951-957. · 0.72 Impact Factor
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    ABSTRACT: A survey among 232 German health care organisations addressed benchmarking projects in patient care. 53 projects were reported and analysed using a benchmarking development scheme and a list of criteria. None of the projects satisfied all the criteria. Rather, examples of best practice for single aspects have been identified.
    Earth and Planetary Science Letters - EARTH PLANET SCI LETT. 01/2011; 105(5):335-338.
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    ABSTRACT: Benchmarking as a tool of organisational development is directed towards improvement through learning from others. The German Ministry of Health funded 10 demonstration projects on clinical benchmarking in order to study the prerequisites to and the methods for its dissemination. The evaluation was carried out as an observational study in 2008. The evaluation tools used included a list of criteria to uniformly describe benchmarking networks and a scheme to categorize the realized benchmarking steps.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(5):331-4.
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    ABSTRACT: Aim Development of a starter set of quality indicators for application by general practitioners and specialists in the outpatient care sector. Methodology The results of a systematic search for national and international quality indicators relevant to the outpatient care sector in Germany provided the basis for the indicator selection process. Outpatient care doctors rated the relevance and feasibility of the indicators according to the RAND/UCLA method. In a further step the indicators were tested in medical practices, focussing on data availability and accessibility. Results As a result, we established a set of 48 reliable, structurally developed and patient-oriented quality indicators which can be used for quality improvement in the outpatient care setting, both by specialists and general practitioners. Discussion The project provides important information with regard to the future development and use of quality indicators. Depending on the potential fields of application, the development of new indicators as well as a corresponding IT infrastructure is of high priority. Possible unintended effects of indicators will have to be considered.
    Earth and Planetary Science Letters - EARTH PLANET SCI LETT. 01/2011; 105(1):54-63.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A survey among 232 German health care organisations addressed benchmarking projects in patient care. 53 projects were reported and analysed using a benchmarking development scheme and a list of criteria. None of the projects satisfied all the criteria. Rather, examples of best practice for single aspects have been identified.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(5):335-8.
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    ABSTRACT: This article examines the diagnosis and management of type-2 diabetes when exactly the same "patient" is encountered by 192 randomly selected primary care doctors in 3 different health care systems--the United States, United Kingdom, and Germany. We conducted a factorial experiment, employing 2 clinically authentic filmed scenarios, to examine country differences in the treatment of diabetes, while controlling the effects of selected characteristics of patients and physicians. The patient in the first scenario presented with (undiagnosed) signs and symptoms strongly suggestive of diabetes, while the second scenario presented an already diagnosed patient with an emerging foot neuropathy. Physicians were asked how they would diagnose and manage the patients after watching the video vignettes using a questionnaire with standardized and open-ended questions. Regarding the first (undiagnosed) case, US doctors would ask significantly more questions than physicians from the UK and Germany (P < 0.001). German physicians would give less advice but would want to see the patient again much sooner (P < 0.001). Regarding the diagnosed case with an emerging foot neuropathy, US physicians would be most active in terms of questioning, testing, prescribing, and advice giving. Again, physicians from Germany would be less active in terms of therapeutic strategies but they would like to see the patient again sooner (P = 0.005). Although physicians in the 3 countries encountered exactly the same patient, differences in diagnostic and management decisions were evident. The experimental design provides unconfounded estimates of health system differences while simultaneously controlling for the effects of selected patient attributes and physician characteristics.
    Medical care 04/2010; 48(4):321-6. · 3.24 Impact Factor
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    ABSTRACT: Objectives: This article examines the diagnosis and management of type-2 diabetes when exactly the same “patient” is encountered by 192 randomly selected primary care doctors in 3 different health care systems—the United States, United Kingdom, and Germany. Methods: We conducted a factorial experiment, employing 2 clinically authentic filmed scenarios, to examine country differences in the treatment of diabetes, while controlling the effects of selected characteristics of patients and physicians. The patient in the first scenario presented with (undiagnosed) signs and symptoms strongly suggestive of diabetes, while the second scenario presented an already diagnosed patient with an emerging foot neuropathy. Physicians were asked how they would diagnose and manage the patients after watching the video vignettes using a questionnaire with standardized and open-ended questions. Results: Regarding the first (undiagnosed) case, US doctors would ask significantly more questions than physicians from the UK and Germany (P < 0.001). German physicians would give less advice but would want to see the patient again much sooner (P < 0.001). Regarding the diagnosed case with an emerging foot neuropathy, US physicians would be most active in terms of questioning, testing, prescribing, and advice giving. Again, physicians from Germany would be less active in terms of therapeutic strategies but they would like to see the patient again sooner (P = 0.005). Conclusions: Although physicians in the 3 countries encountered exactly the same patient, differences in diagnostic and management decisions were evident. The experimental design provides unconfounded estimates of health system differences while simultaneously controlling for the effects of selected patient attributes and physician characteristics.
    Medical Care 03/2010; 48(4):321-326. · 3.23 Impact Factor
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    ABSTRACT: Several studies have demonstrated positive relationships between high hospital volume and improved outcome following total knee replacement. To our knowledge, it has not been demonstrated whether improved outcomes are causally determined by selective referral to high-volume hospitals. We therefore evaluated the effect of a national regulation regarding minimum hospital volume for total knee replacement on two short-term outcome parameters. We performed a comparison of the years before (2004, 2005) and after (2006) the implementation of a national regulation on minimum hospital volume for total knee replacement through a secondary analysis of a national database on the quality of inpatient care in Germany as reflected by the number of cases per hospital and the postoperative rates of wound infection and wound hematoma or secondary hemorrhage. We analyzed 110,349 cases from 2004, 118,922 cases from 2005, and 125,322 cases from 2006. Implementation of the regulation had a significant effect on the number of cases per hospital. Of the hospitals that had performed one to forty-nine cases in 2005, 35.6% moved to higher-volume categories and 21.2% dropped out in 2006. Multiple logistic regression analysis adjusting for patient characteristics demonstrated risk reductions of 22.5% (odds ratio, 0.775; 95% confidence interval, 0.700 to 0.857) for postoperative wound infection and of 44% (odds ratio, 0.562; 95% confidence interval, 0.531 to 0.596) for wound hematoma or secondary hemorrhage from 2005 to 2006. For wound infection, approximately half of the improvement was attributable to the effects of the minimum-volume regulation. For wound hematoma and secondary hemorrhage, the improvement could not be explained by the minimum-volume regulation. Implementation of the minimum-volume regulation for total knee replacement resulted in more patients being managed at higher-volume hospitals than expected. Following the implementation of a minimum-volume regulation, effects on two short-term outcome parameters were observed, but definite conclusions could only be made regarding wound infection, with the minimum-volume regulation resulting in a decreased rate of infection.
    The Journal of Bone and Joint Surgery 03/2010; 92(3):629-38. · 3.23 Impact Factor
  • M. Geraedts, W. de Cruppé, K. Blum, C. Ohmann
    Gesundheitswesen. 01/2010; 72(05):271-278.
  • P Hermeling, W de Cruppé, M Geraedts
    Gesundheitswesen. 01/2010; 72.

Publication Stats

46 Citations
31.64 Total Impact Points

Institutions

  • 2009–2013
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany
  • 2011
    • Kassenärztliche Bundesvereinigung
      Berlín, Berlin, Germany
  • 2006–2010
    • Heinrich-Heine-Universität Düsseldorf
      • Koordinierungszentrum für Klinische Studien (KKS)
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2008
    • Deutsches Krankenhausinstitut
      Düsseldorf, North Rhine-Westphalia, Germany