Werner de Cruppé

Publications (10)11.82 Total impact

• Article: Mandatory quality reports in Germany from the hospitals' point of view: a cross-sectional observational study.

  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. · 1.66 Impact Factor
• Article: Communicating quality of care information to physicians: a study of eight presentation formats.

  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. · 2.31 Impact Factor
• Article: [Benchmarking projects examining patient care in Germany: methods of analysis, survey results, and best practice].

  Gunnar Blumenstock, Imma Fischer, Werner de Cruppé, Max Geraedts, Hans-Konrad Selbmann
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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.
  Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(5):335-8.
• Article: [AQUIK®: starter set of ambulatory quality indicators developed by the German National Association of Statutory Health Insurance Physicians].

  Susanne Kleudgen, Franziska Diel, Friederike Burgdorf, Ingrid Quasdorf, Werner de Cruppé, Max Geraedts
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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.
• Article: [Evaluation of benchmarking networks in Germany: background and methodology].

  Werner de Cruppé, Gunnar Blumenstock, Imma Fischer, Hans-Konrad Selbmann, Max Geraedts
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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.
• Article: [Results of the evaluation of German benchmarking networks funded by the Ministry of Health].

  Werner de Cruppé, Gunnar Blumenstock, Imma Fischer, Hans-Konrad Selbmann, Max Geraedts
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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.
• Article: Two short-term outcomes after instituting a national regulation regarding minimum procedural volumes for total knee replacement.

  Christian Ohmann, Pablo Emilio Verde, Karl Blum, Burkhard Fischer, Werner de Cruppé, Max Geraedts
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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. · 3.27 Impact Factor
• Article: Implementation and effects of Germany's minimum volume regulations: results of the accompanying research.

  Max Geraedts, Werner de Cruppé, Karl Blum, Christian Ohmann
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  ABSTRACT: Since 2004, Germany has had legal minimum volumes for five surgical interventions (kidney, liver, and stem cell transplantations and complex pancreatic and esophageal interventions). In 2006, minimum volumes for total knee replacement were added. On behalf of the Federal Joint Committee we evaluated the implementation of the minimum volumes and their effects on health service structure, hospitals, and outcome quality. We analyzed hospital surveys and secondary data from quality reports for 2004, the Institute for the Hospital Remuneration System, and the Federal Agency for Quality Assurance. In 2006, the minimum volume regulations affected about half of all acute-care hospitals and about 146 000 hospital cases. Depending on the intervention, 10% to 60% of the hospitals with 1% to 31% of the patients performed the procedures yet failed to attain the minimum volumes. The number of hospitals providing the services did not change between 2004 and 2006, so nationwide coverage remained virtually unchanged. Regarding outcomes, only data for total knee replacement were available. One of three analyzed indicators of outcome, wound infections, showed the introduction of the minimum volumes to be associated with better results for higher numbers of cases. To date, the minimum volumes have affected health care only marginally. Further monitoring of the effects of the minimum volumes requires prospective definition of essential indicators of outcome and access.
  01/2009; 105(51-52):890-6. · 2.92 Impact Factor
• Source

  Available from: PubMed Central

  Article: Evaluating compulsory minimum volume standards in Germany: how many hospitals were compliant in 2004?

  Werner de Cruppé, Christian Ohmann, Karl Blum, Max Geraedts
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  ABSTRACT: Minimum hospital procedure volumes are discussed as an instrument for quality assurance. In 2004 Germany introduced such annual minimum volumes nationwide on five surgical procedures: kidney, liver, stem cell transplantation, complex oesophageal, and pancreatic interventions. The present investigation is the first part of a study evaluating the effects of these minimum volumes on health care provision. Research questions address how many hospitals and cases were affected by minimum volume regulations in 2004, how affected hospitals were distributed according to minimum volumes, and how many hospitals within the 16 German states complied with the standards set for 2004. The evaluation is based on the mandatory hospital quality reports for 2004. In the reports, all hospitals are statutorily obliged to state the number of procedures performed for each minimum volume. The data were analyzed descriptively. In 2004, 485 out of 1710 German hospitals providing acute care and approximately 0.14% of all hospital cases were affected by minimum volume regulations. Liver, kidney, and stem cell transplantation affected from 23 to hospitals; complex oesophageal and pancreatic interventions affected from 297 to 455 hospitals. The inter-state comparison of the average hospital care area demonstrates large differences between city states and large area states and the eastern and western German states ranging from a minimum 51 km2 up to a maximum 23.200 km2, varying according to each procedure. A range of 9% - 16% of the transplantation hospitals did not comply with the standards affecting 1% - 2% of the patients whereas 29% and 18% of the hospitals treating complex oesophageal and pancreatic interventions failed the standards affecting 2% - 5% of the prevailing cases. In 2004, the newly introduced minimum volume regulations affected only up to a quarter of German acute care hospitals and few cases. However, excluding the hospitals not meeting the minimum volume standards from providing the respective procedures deserves considering two aspects: the hospital health care provision concepts by the German states as being responsible and from a patient perspective the geographically equal access to hospital care.
  BMC Health Services Research 02/2007; 7:165. · 1.66 Impact Factor
• Article: [Controversial study results in relation to minimum volume standards].

  Max Geraedts, Werner de Cruppé
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  ABSTRACT: Multiple studies have demonstrated positive associations between volume and treatment outcome, especially in complex procedures. However, using these results in determining volume standards in Germany keeps being problematic: often, there is a lack of specific German data on the volume and outcome of healthcare providers making the modeling of potential effects almost impossible. In addition, recent publications focusing on the methods that are typically used in analyzing these associations indicate that the significance of positive volume-outcome associations is limited. The methodological quality of most studies is rather low, and there is a high heterogeneity among them concerning study populations, case mix, study designs and analytical methods. Results on the single-hospital level show a high variation of outcome parameters. There are both good hospitals with low volumes and bad hospitals with high volumes. Using the "best guideline-based current procedures" seems to be of high importance for the good outcomes of small and big hospitals. Furthermore, studies have demonstrated that data on historical outcomes are a better predictor for good outcomes than hospital procedural volumes. Furthermore in some studies negative outcomes were shown to be related to high volumes at facilities with a high case load per staff member. These results suggest that a more sophisticated consideration of the methods and results of volume-outcome studies is required. Therefore, volume standards should continue to be cautiously applied and obligatorily accompanied by health services research.
  Zeitschrift für ärztliche Fortbildung und Qualitätssicherung. 02/2006; 100(2):87-91.