Petra Kaufmann-Kolle

University Medical Center Hamburg - Eppendorf, Hamburg, Hamburg, Germany

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Publications (20)20.91 Total impact

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    ABSTRACT: Objective: The time of transfer between discharge from inpatient mental health care and first contact to the outpatient sector is considered to be an indicator for continuity of care.Methods: This indicator is assessed using health care claims data of one of the mayor health insurances in Baden-Wurttemberg, Germany.Results: About 80 % of cases with the diagnosis of a defined mental disorder sought outpatient care at general or mental health practitioners within six months from discharge. 50 % of them did so within six days, 75 % within three weeks. The majority sought outpatient care at general practitioners. Cases that sought care in outpatient clinics specialized for severe mental illness (SMI) could not be considered in the data. However, considering them by estimation, the rate of cases with SMI seeking outpatient care at mental health practitioners within six months from discharge estimated to be at least 70 %.Conclusions: General practitioners are an important source for aftercare of mentally ill people discharged from inpatient care. Time of transfer as an indicator can be predominantly assessed by using health claims data in Germany.
    Psychiatrische Praxis 10/2013; · 1.64 Impact Factor
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    ABSTRACT: The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins. We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients >= 35 years who were counselled before and after the study period were analysed (each n > 75000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients' overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes). There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect. Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician's prescribing behaviour is affected by an established health care system, which is not easy to change.Trial registration: ISRCTN71348772.
    BMC Public Health 07/2013; 13(1):623. · 2.08 Impact Factor
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    ABSTRACT: The agreement on family-doctor centred care (Hausarztzentrierte Versorgung, "HzV") pursuant to Sect. 73b, Volume V of the German Social Security Code became effective in Baden-Wuerttemberg, Germany, on July 1(st), 2008. This complex intervention, which is voluntary for both family doctors and patients, aims to strengthen the coordinative function of family practices. As a result, this intervention is believed to increase the quality of medical health care for persons insured - in the medium to long-term - and thereby, ideally, to additionally save expenses. Working package 1 was one out of a total of four working packages and focused on the evaluation of potential intervention effects of the HzV intervention based on the analyses of AOK routine data in Baden-Wuerttemberg. A total of 1.44 million insured persons were eligible for the present analyses. Insured adults voluntarily participating in the family doctor-centred health care intervention (HzV insured persons: n=580,924 in the intervention group) of the AOK were compared to those not participating in this intervention (non-HzV insured persons: n=862,237 in the control group). For both HzV and non-HzV insured persons, a comparison of each outcome of interest (encounters with family doctors, encounters with specialists, rate of hospitalisations, duration of hospitalisations, rate of re-hospitalisations, costs of pharmacotherapy, rate of polypharmacy, rate of Me-Too pharmaceuticals) was conducted for quarters 3 and 4 of 2008 as well as for quarters 3 and 4 in 2010. Both groups of insured persons differed in that they either participated in the HzV intervention between January 1, 2009 and June 30, 2011 or not. Before January 1, 2009 individuals in both groups did not participate in the HzV intervention. This design allowed for both longitudinal and cross-sectional comparisons. Moreover, the design implicitly controlled for potential seasonal bias. In order to adjust for relevant covariates (insured persons' age, gender, nationality, insurance state, morbidity), multivariate multilevel regression models were developed and applied. On average, HzV insured persons were about 3 years older (56.2 ± 27.3 vs. 53.1 ± 18.4 years) and had higher levels of comorbidity (Charlson Comorbidity Index: 1.45 ± 1.86 vs. 1.19 ± 1.71). No significant differences in terms of rate and duration of hospitalisations were observed. The same applied to the number of rehospitalisations within 30 days. After adjustment for covariates, however, an increase in visits to the respective family doctor of 38% was found in the intervention group. Moreover, a decrease of encounters to specialists with and without referrals from family doctors could be observed (-29.8 % and -12.5%, respectively). Interestingly, even costs of pharmacotherapy, polypharmacy and prescriptions of Me-Too drugs were statistically significantly lower or less frequent, respectively, in the group of HzV insured persons. In conclusion, besides the observed associations in terms of pharmacotherapy, the HzV intervention appears to have advantageous effects in terms of family doctor centred health care.
    Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 01/2013; 107(6):372-8.
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    ABSTRACT: Family doctor centred health care (German abbreviation: HzV) agreements in Baden-Wuerttemberg provides that every year the strategies and results of at least two high-quality guidelines shall be discussed and worked on in quality circles. In this regard, the 'heart failure' guideline by the German Society of General Practice and Family Medicine (DEGAM) is especially important due to the high treatment costs and the continuously increasing prevalence of this medical condition. Another specified objective of the HzV agreements is to increase the DMP participation rate. The study addressed two questions: Is the medical care provided to patients with chronic heart failure who are being treated under HzV more compliant with guidelines than routine care? Does further improvement result from working on the guidelines in quality circles? Routine data were provided by the AOK Baden-Wuerttemberg statutory health insurance company. Patients with heart failure receiving treatment under an HzV agreement (HzV group) were compared with patients receiving routine care (control group) with regard to quality of care eight months before and eight months after working on the guideline on heart failure in quality circles. Primary endpoints were the prescription of ACE inhibitors, AT1 antagonists and beta blockers in accordance with guidelines. Adjustment for various covariates was done by means of multivariate multilevel regression. Data were available for 3,667 practices [1,295 HzV practices; 2,158 non-HzV practices]. After applying validated diagnosis criteria, 16,584 patients were included in the intervention group and 28,992 in the control group. The HzV group received significantly better care in terms of the primary endpoint "prescription of ACE inhibitors or AT1 antagonists" (73.1 % vs. 69.3 % of the patients received ACE inhibitors or AT1 antagonists at T0 (OR 1.40; 95% CI [1,25; 1,57]; p < .001). 54.2 % vs. 52.3 % of the patients received beta blockers at T0 (not significant after adjustment, p = .260). No further improvement could be demonstrated to result from working on guidelines in quality circles. The treatment of HzV patients with chronic heart failure is more compliant with guidelines than that of patients receiving routine care. Quality of care was already high at the beginning, and working on guidelines in quality circles had no noticeable effect. The increased DMP participation rate, which is one of the specified objectives of the HzV agreements, appears to have a mediation effect.
    Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 01/2013; 107(6):394-402.
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    ABSTRACT: A debate on the application of quality indicators (QIs) arose among the members of the German College of General Practitioners and Family Physicians (DEGAM) when two QI systems for ambulatory care (QISA and AQUIK) were published in a short time interval. A research question that emanated from this discussion was whether appropriate QI might be developed based on German general practice guidelines. In spring 2010, the DEGAM guideline committee (SLK) decided to conduct a project on guideline-based development of QIs using the DEGAM guidelines for dementia, neck pain and sore throat. All members of the SLK were invited to participate in the development process which comprised three face-to-face meetings and four paper-pencil ratings. Finally, 17 QIs for the three guidelines on dementia (n=8), neck pain (n=7) and sore throat (n=2) emerged. These QIs received different ratings in the dimensions relevance, practicability, and appropriateness for public reporting as well as for pay for performance. In this project, guideline authors themselves developed QIs based on German general practice guidelines for the first time ever. Not before practice administration systems facilitate the availability of data in the context of clinical documentation, the practicability of the new QIs can be proven in real every-day practice.
    Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 01/2013; 107(1):74-86.
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    ABSTRACT: Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors. Within this context, this study describes the development of a set of quality indicators charting the whole pathway of CRC-care including data specifications that are necessary to operationalize these indicators before practice testing. Indicators were developed following a systematic 10 step modified 'RAND/UCLA Appropriateness Method' which involved a multidisciplinary panel of thirteen participants. For each indicator in the final set, data specifications relating to sources of quality information, data collection procedures, analysis and feedback were described. The final indicator set included 52 indicators covering diagnostic procedures (11 indicators), therapeutic management (28 indicators) and follow-up (6 indicators). In addition, 7 indicators represented patient perspectives. Primary surgical tumor resection and pre-operative radiation (rectum carcinoma only) were perceived as most useful tracer procedures initiating quality data collection. To assess the quality of CRC care across sectors, various data sources were identified: medical records, administrative inpatient and outpatient data, sickness-funds billing code systems and patient survey. In Germany, a set of 52 quality indicators, covering necessary aspects across the interfaces and pathways relevant to CRC-care has been developed. Combining different sectors and sources of health care in quality assessment is an innovative and challenging approach but reflects better the reality of the patient pathway and experience of CRC-care.
    PLoS ONE 01/2013; 8(5):e60947. · 3.53 Impact Factor
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    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 12/2012;
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    ABSTRACT: The hospital benchmarking system in Germany was originally introduced to detect unintended consequences of reimbursement based on diagnosis-related groups. The new nationwide SQG programme aims to provide information on quality and outcomes of health care provided in hospital, ambulatory specialist and primary care settings, including the healthcare delivery across different sectors. In 2010 the topics for indicator development were cataract surgery, cervical conization, colectoral cancer and percutaneous coronary interventions or coronary angiography. A systematic stepwise modified RAND/UCLA procedure is applied to develop quality indicators in each of these domains. A general framework for data collection is implemented. Benchmarking results are fed back to providers on a regular basis.
    International Journal for Quality in Health Care 04/2012; 24(2):101-4. · 1.79 Impact Factor
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    ABSTRACT: Evidence on the effectiveness of educational interventions on prescribing behaviour modification in prevention of cardiovascular disease is still insufficient. We evaluated the effects of a brief educational intervention on prescription of hydroxymethylglutaryl-CoA reductase inhibitors (statins), inhibitors of platelet aggregation (IPA), and antihypertensive agents (AH). Cluster randomised controlled trial with continuous medical education (CME) groups of general practitioners (GPs). Prescription of statins, IPA, and AH were verified prior to study start (BL), immediately after index consultation (IC), and at follow-up after 6 months (FU). Prescription in patients at high risk (>15% risk of a cardiovascular event in 10 years, based on the Framingham equation) and no prescription in low-risk patients (≤ 15%) were considered appropriate. An intervention effect on prescribing could only be found for IPA. Generally, changes in prescription over time were all directed towards higher prescription rates and persisted to FU, independent of risk status and group allocation. The active implementation of a brief evidence-based educational intervention on global risk in CVD did not lead directly to risk-adjusted changes in prescription. Investigations on an extended time scale would capture whether decision support of this kind would improve prescribing risk-adjusted sustainably.
    European journal of preventive cardiology. 03/2011; 19(3):322-9.
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    ABSTRACT: The purpose of this cluster-randomised controlled trial was to evaluate the efficacy of quality circles (QCs) working either with general data-based feedback or with an open benchmark within the field of asthma care and drug-drug interactions. Twelve QCs, involving 96 general practitioners from 85 practices, were randomised. Six QCs worked with traditional anonymous feedback and six with an open benchmark. Two QC meetings supported with feedback reports were held covering the topics "drug-drug interactions" and "asthma"; in both cases discussions were guided by a trained moderator. Outcome measures included health-related quality of life and patient satisfaction with treatment, asthma severity and number of potentially inappropriate drug combinations as well as the general practitioners' satisfaction in relation to the performance of the QC. A significant improvement in the treatment of asthma was observed in both trial arms. However, there was only a slight improvement regarding inappropriate drug combinations. There were no relevant differences between the group with open benchmark (B-QC) and traditional quality circles (T-QC). The physicians' satisfaction with the QC performance was significantly higher in the T-QCs. General practitioners seem to take a critical perspective about open benchmarking in quality circles. Caution should be used when implementing benchmarking in a quality circle as it did not improve healthcare when compared to the traditional procedure with anonymised comparisons.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(5):389-95.
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    ABSTRACT: Objective The purpose of this cluster-randomised controlled trial was to evaluate the efficacy of quality circles (QCs) working either with general data-based feedback or with an open benchmark within the field of asthma care and drug-drug interactions.Methods Twelve QCs, involving 96 general practitioners from 85 practices, were randomised. Six QCs worked with traditional anonymous feedback and six with an open benchmark. Two QC meetings supported with feedback reports were held covering the topics “drug-drug interactions” and “asthma”; in both cases discussions were guided by a trained moderator. Outcome measures included health-related quality of life and patient satisfaction with treatment, asthma severity and number of potentially inappropriate drug combinations as well as the general practitioners’ satisfaction in relation to the performance of the QC.ResultsA significant improvement in the treatment of asthma was observed in both trial arms. However, there was only a slight improvement regarding inappropriate drug combinations. There were no relevant differences between the group with open benchmark (B-QC) and traditional quality circles (T-QC). The physicians’ satisfaction with the QC performance was significantly higher in the T-QCs.Conclusion General practitioners seem to take a critical perspective about open benchmarking in quality circles. Caution should be used when implementing benchmarking in a quality circle as it did not improve healthcare when compared to the traditional procedure with anonymised comparisons.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(5):389-395.
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    ABSTRACT: Various study approaches can be considered for the investigation of the efficiency of enrollment models, like GP-centred health-care contract or disease management programmes. As an active and independent enrollment into care models is effected by the insured (self-selection), a randomisation cannot be applied. The matched pairs design - in which for every insured a control insured with comparable morbidity is selected - presents an alternative investigation method. A precondition is a model that describes appropriately the morbidity on the basis of available routine data. The aim of this study was to develop a procedure that selects comparable insured persons on the basis of routine data of the statutory health-care funds. Apart from age, gender, care status, insured status, days of disability, region, health insurance and belonging to an enrollment model, also ambulant as well as stationary performance data for the year 2005 following the PCG/DCG procedure for morbidity-oriented matching design developed by Lamers and Vliet (2003) were applied. Thereby the consumption of certain medications prescribed is determining for the allocation of patients to pharmaceutical cost groups (PCG). Additionally a classification into diagnosis cost groups (DCG) according to stationary diagnoses was conducted. Within the scope of the enrollment models the formation of matched pairs following the PCG/DCG procedure represents an appropriate study design for the creation of a control group. In the first year of enrollment the insured of the interventional and those of the control group show a comparable morbidity. When applying 9 matching criteria a control insured person can be found for 87% of the enrolled individuals. There are various and complex possibilities to define morbidity. Variable parameters within the presented matched pairs design are the number of used matching criteria as well as minimum drug consumption limit relevant for the classification in PCGs. Alternative models are possible for morbidity definition considering, apart from the stationary diagnosis, also the ambulant diagnosis. When taking into account a higher number of morbidity criteria, the matched pairs design is confronted with dimensionality issues. The propensity score matching is discussed as approach to solve this problem.
    Das Gesundheitswesen 06/2010; 72(6):363-70. · 0.94 Impact Factor
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    ABSTRACT: To determine the effectiveness of quality circles on prescribing patterns of primary care physicians in Germany and to explore the influence of specific factors on changes. Three large non-randomised comparative studies were performed in primary care in Germany, with baseline measurements in 2001 and follow-up measurements in 2003. 1090 physicians were in intervention groups and 2090 physicians in control groups. For each physician, data on 444 patients and 1201 prescriptions were available, on average, at each measurement moment. Quality circles comprising of a series of small group moderated meetings of physicians, provision of evidence-based information and repeated written feedback on individual prescribing patterns. Compared to the control groups, physicians in the intervention groups reduced mean prescription cost per patient per 3-month period by 1.87 euro (95%CI 0.51 to 3.22), increased generic drugs of all potentially generic prescriptions by 0.75% (95%CI 0.40 to 1.10), increased prescription of recommended lipid lowering drugs by 4.24% (95%CI 2.40 to 6.10), increased the prescription of recommended antibiotics by 1.72% (95%CI 0.33 to 3.10). Groups with more positive views of performance feedback, evidence-based indicators and price comparisons showed more change of prescribing. Quality circles had a modest effect on prescribing quality and costs. If widely implemented, they could have nationwide impact on the quality and costs of prescribing in primary care.
    Pharmacoepidemiology and Drug Safety 06/2009; 18(9):763-9. · 2.90 Impact Factor
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    ABSTRACT: Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark. Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty-three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs. A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow-up 1 year later. Use of inhaled steroids at baseline was high (69%) and self-management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07-0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5-34.3) and emergency visits (OR 4.9; 95% CI 1.6-14.7). There was no difference between traditional and benchmarking QCs. Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self-management of asthma patients.
    Journal of Evaluation in Clinical Practice 05/2008; 14(2):185-90. · 1.51 Impact Factor
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    ABSTRACT: The reason why many patients seem to tolerate suffering from sub-optimal treated asthma remains unclear. The aim was to evaluate the guideline adherence combined with quality of life of patients with moderate to severe asthma. 256 asthma patients from 43 primary care practices in Saxony-Anhalt filled in a questionnaire including the Asthma Quality of Life Questionnaire (AQLQ), the Patient Health Questionnaire (PHQ-D) and questions evaluating the asthma severity, medication and self-management. 43.4% suffered from moderate to severe asthma. Drug treatment accorded with guidelines in 36.9%, drug dosage of inhaled steroids was too low in 34.3%, and 21.5% were not treated according to guidelines. A total of 7.3% of the patients received end-of-dose therapy. AQLQ declined and depression rose with asthma severity and guideline non-adherence (P < 0.001). Only 29.1% received asthma education. However, 64.5% of the patients without education did not want to receive education. They had a higher quality of life, lower depression (P < 0.001) and lower use of steroids (P = 0.016). Higher depression scores where related with hospital admission (OR 3.29; 95% CI 1.57-6.87 for each quartile of PHQ-D) and unscheduled home visits or ambulatory care (OR 1.58; 1.07-2.33). There is a large variation of asthma severity which can partly be explained by the guideline adherence of medication and deficits of patients' management. The perceived burden of illness plays a more important role for education and self-management than the real severity of disease. Therefore, target-oriented interventions are needed to identify and motivate patients at risk.
    Journal of Evaluation in Clinical Practice 01/2008; 13(6):846-52. · 1.51 Impact Factor
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    ABSTRACT: We assessed the frequency and determinants of tablet splitting in primary care in Germany and evaluated the quality of information on divisibility in the Summary of Product Characteristics (SPCs) and in the Package Leaflet (PL) as legal sources of information for health care providers and patients. We performed a cross-sectional questionnaire survey among patients of 59 general practitioners in the German Federal State Saxony-Anhalt in 2005 in order to collect detailed information on all drugs of patients maintained on more than three drugs. The response rate was 82.1% (n=905) and 3,158 drugs (tablets and dragées) were included in the analyses. Of all drugs, 24.1% were split (762 of 3,158): 8.7% of all split tablets were unscored (66 of 762) and 3.8% of all split tablets were not allowed to be split (29 of 762). Tablets of the higher price categories and higher strengths were twice as likely to be split. Only 22.5% of the SPCs (9 of 40) of the split unscored tablet brands contained explicit information on divisibility and only 36.4% of the PLs (8 of 22) of the split brands that were not allowed to be split stated that splitting was not appropriate. The splitting of tablets in primary care is a frequent habit likely driven by medical and economic considerations. Almost 1% of all tablets are split that must not be fragmented. However, the SPC and PL provide only limited information on divisibility stressing the need to improve this information promptly to avoid medication errors.
    European Journal of Clinical Pharmacology 01/2007; 62(12):1065-73. · 2.74 Impact Factor
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    R Quinzler, C Gasse, A Schneider, P Kaufmann-Kolle …
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    ABSTRACT: Abstract Introduction We assessed the frequency and determinants of tablet splitting in primary care in Germany and evaluated the quality of information on divisibility in the Summary of Product Characteristics (SPCs) and in the
    01/2006;
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    ABSTRACT: Diabetes model projects in different regions of Germany including interventions such as quality circles, patient education and documentation of medical findings have shown improvements of HbA1c levels, blood pressure and occurrence of hypoglycaemia in before-after studies (without control group). In 2002 the German Ministry of Health defined legal regulations for the introduction of nationwide disease management programs (DMP) to improve the quality of care in chronically ill patients. In April 2003 the first DMP for patients with type 2 diabetes was accredited. The evaluation of the DMP is essential and has been made obligatory in Germany by the Fifth Book of Social Code. The aim of the study is to assess the effectiveness of DMP by example of type 2 diabetes in the primary care setting of two German federal states (Rheinland-Pfalz and Sachsen-Anhalt). The study is three-armed: a prospective cluster-randomized comparison of two interventions (DMP 1 and DMP 2) against routine care without DMP as control group. In the DMP group 1 the patients are treated according to the current situation within the German-Diabetes-DMP. The DMP group 2 represents diabetic care within ideally implemented DMP providing additional interventions (e.g. quality circles, outreach visits). According to a sample size calculation a sample size of 200 GPs (each GP including 20 patients) will be required for the comparison of DMP 1 and DMP 2 considering possible drop-outs. For the comparison with routine care 4000 patients identified by diabetic tracer medication and age (> 50 years) will be analyzed. This study will evaluate the effectiveness of the German Diabetes-DMP compared to a Diabetes-DMP providing additional interventions and routine care in the primary care setting of two different German federal states.
    BMC Public Health 01/2005; 5:99. · 2.08 Impact Factor
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    ABSTRACT: A debate on the application of quality indicators (QIs) arose among the members of the German College of General Practitioners and Family Physicians (DEGAM) when two QI systems for ambulatory care (QISA and AQUIK) were published in a short time interval. A research question that emanated from this discussion was whether appropriate QI might be developed based on German general practice guidelines. In spring 2010, the DEGAM guideline committee (SLK) decided to conduct a project on guideline-based development of QIs using the DEGAM guidelines for dementia, neck pain and sore throat. All members of the SLK were invited to participate in the development process which comprised three face-to-face meetings and four paper-pencil ratings. Finally, 17 QIs for the three guidelines on dementia (n = 8), neck pain (n = 7) and sore throat (n = 2) emerged. These QIs received different ratings in the dimensions relevance, practicability, and appropriateness for public reporting as well as for pay for performance. In this project, guideline authors themselves developed QIs based on German general practice guidelines for the first time ever. Not before practice administration systems facilitate the availability of data in the context of clinical documentation, the practicability of the new QIs can be proven in real every-day practice.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 107(1):74–86.

Publication Stats

100 Citations
20.91 Total Impact Points

Institutions

  • 2013
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2005–2013
    • Universität Heidelberg
      • Department of General Medicine and Health Services Research
      Heidelberg, Baden-Wuerttemberg, Germany
    • Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)
      Köln, North Rhine-Westphalia, Germany
  • 2012
    • Universität Bremen
      Bremen, Bremen, Germany
  • 2008–2011
    • Institut für Angewandte Qualitätsförderung und Forschung im Gesundheitswesen
      Göttingen, Lower Saxony, Germany
  • 2009
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands