T Rath

University of Cologne, Köln, North Rhine-Westphalia, Germany

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Publications (10)7.91 Total impact

  • Clinical neurology and neurosurgery 02/2012; 114(7):1057-8. · 1.30 Impact Factor
  • T. Rath, O. Sander, A. Rubbert
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    ABSTRACT: Rheumatoid arthritis (RA) is characterized by a symmetric polyarthritis of unknown etiology that, if untreated or unresponsive to therapy, typically leads to deformities and destruction of joints through the erosion of cartilage and bone. Currently available disease-modifying antirheumatic drugs (DMARDs) can control synovitis and may slow, or even stop, radiographic progression, improve function and quality of life, and normalize mortality rates. This review gives a brief overview on commonly used conventional DMARDs and their role in the current management of RA. Methotrexate is still considered the gold standard among the DMARDs, and is widely accepted as first-line treatment in the management of RA. Other DMARDs are less frequently used in monotherapy or as first-line agents but continue to have a role as antirheumatic agents in select patients. DMARD combination therapy may still represent a valuable therapeutic option in patients who fail to DMARD monotherapy or in whom combination therapy is considered initially. This review will focus on a better understanding of the critical importance of early DMARD treatment, the goal of remission and the need for tight control and adaptive modification in case of inadequate response or intolerance. Drug Dev Res 72:657–663, 2011. © 2011 Wiley Periodicals, Inc.
    Drug Development Research 12/2011; 72(8). · 0.87 Impact Factor
  • Markus Lüngen, Thomas Rath
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    ABSTRACT: Quality indicators are used world-wide to monitor the quality of health care. For these indicators to be effective they also have to meet certain quality criteria. The QUALIFY tool is used for assessing the quality criteria themselves against a scientific background. The present paper evaluates the QUALIFY tool and provides an indication of its further development. The evaluation of the QUALIFY tool was carried out using structured group interviews. Participants of the first focus group were involved in both the development of the tool and in its implementation. The second focus group exclusively consisted of QUALIFY users. There was no essential difference in the rating between the two focus groups. Up till now, QUALIFY has been used for the designation of quality indicators for the German Quality Record for Hospitals, for a pre-selection of indicators for the National Disease Management Guidelines, and for a pharmaceutical drug safety project of the Coalition for Patient Safety. Its wider distribution is hampered by the fact that the actual QUALIFY tool is far too complex and requires a lot of resources. Nevertheless, its cost-effectiveness was rated 'adequate' because the application of inappropriate quality indicators can be very expensive. Our ambition should be to define QUALIFY subsystems of various complexity for different purposes and to enforce anchoring of the tool at an international level. QUALIFY, and thus the assessment of quality indicators, has entered virgin territory. Since quality assessment will be gaining relevance the further evaluation and development of these tools is warranted. In this context group interviews could provide an applicable approach to evaluating acceptance and implementation problems.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2011; 105(1):38-43.
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    ABSTRACT: Zusammenfassung Hintergrund Die Wahl der Versorgungsform, stationär oder ambulant, unterliegt im deutschen Gesundheitswesen derzeit einem tiefgreifenden Wandel. Eine neue Qualität erhält die Öffnung der Krankenhäuser mit der Neufassung des § 116b SGB V. Die Studie untersucht die Frage, welches ambulante Potenzial sich aus bisher vollstationär behandelten Fällen in der Rheumatologie ergibt. Methode Die Auswertung basiert auf einem Datensatz für die Jahre 2004 bis 2008. Dieser enthält anonymisiert die Abrechnungsdaten von rund 23,6 Mio. GKV-Versicherten. Die Auswahl von Patienten mit rheumatologischen Erkrankungen erfolgte anhand der in § 116b SGB V angegebenen ICD-10-Diagnosen. Ergebnisse Im untersuchten Zeitraum wurde ein Anstieg der rheumatologischen Fälle um 13,9% beobachtet bei einem Rückgang der durchschnittlichen Verweildauer von 9,46 Tagen auf 8,08 Tage und der behandelnden Krankenhäuser um 3,1%. Der Anteil der rheumatologischen Fälle mit kurzer Verweildauer (≤2 Tage) nahm um 32,3% zu. Als „ambulantes Potenzial“ definieren wir den Anteil dieser Kurzlieger an der Gesamtzahl der vollstationären rheumatologischen Fälle, er stieg von 25,7% auf 29,9% Diskussion Nicht alle Kurzlieger können problemlos in eine ambulante Versorgung überführt werden; diese erfordert spezialisierte Strukturen und Personal. Eine Zentrenbildung findet bisher nicht statt. Die Studie erlaubt keine Aussagen zur Qualität der Versorgung in den betrachteten Krankenhäusern. Eine Verknüpfung von Versorgungsdaten mit Qualitätsdaten wäre sinnvoll.
    Zeitschrift für Rheumatologie 01/2011; 70(1):56-63. · 0.45 Impact Factor
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    ABSTRACT: The choice between outpatient and inpatient care is currently undergoing major changes within the German health care system with the amendment of § 116b SGB V. This study investigates what proportion of hitherto inpatient rheumatologic care could potentially be given on an outpatient basis. The analysis is based on administrative inpatient data from 2004 to 2008 covering approximately 23.6 million private health insurance insurants. The selection of patients with rheumatological diseases was based on diagnosis according to ICD-10 of § 116b SGB V. From 2004 to 2008 the number of all rheumatologic cases increased by 13.9%, while the average length of hospital stay decreased from 9.46 days to 8.08 days and the number of attending hospitals declined by 3.1%. The number of rheumatologic cases with a short inpatient stay (≤2 days) increased by 32.3%. We define the ambulatory potential as the proportion of patients with a short length of stay to the total of inpatient rheumatologic cases; this increased from 25.7% to 29.9%. Not all patients with a short inpatient stay can be transferred problem-free to ambulatory care. No channeling of patients to specialized centres has taken place thus far in Germany. Quality of care at the hospitals studied has not been considered. Further data are needed to link administrative data with quality care data.
    Zeitschrift für Rheumatologie 11/2010; 70(1):56-63. · 0.45 Impact Factor
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    ABSTRACT: An increase in the convergence of medical services toward specialized hospitals with high case numbers as well as the effects on quality of care are often assumed to be the result of diagnosis-related groups (DRGs; case-based lump-sum reimbursement). Estimates of the extent to which these effects occur in emergency diagnoses are not available. Claims data relating to approximately 23.6 million insured within the period 2004-2007 (inclusive) were analyzed. All cases with the main diagnosis of stroke (ICD-10: I63 and I64) and myocardial infarction (ICD-10: I21) were included in the study. Increasing case numbers could be observed for all entities within the period studied (myocardial infarction: +12.71%; stroke: +1.73%). The absolute increase in case numbers seems to affect those hospitals with case numbers >100 per year, whereas case numbers of hospital groups including hospitals with low case numbers per year remain unchanged or grow slower. No absolute trend in mortality could be seen. However, a disproportionate rate of mortality in hospitals with low case numbers per year for both diagnoses was observed. The convergence of emergency treatment in a few specialized centers has not yet been accelerated by the implementation of DRGs. Essentially, relative changes can be seen due to case number increases in large centers rather than because of service cutbacks and shifts from smaller hospitals. The reason for this could be the need to maintain emergency care in rural regions, while specialized centers are increasingly built in urban areas.
    Herz 09/2010; 35(6):389-96. · 0.78 Impact Factor
  • T Rath, A Rubbert
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    ABSTRACT: MTX is still considered the anchor drug among the disease-modifying antirheumatic agents, and it is widely accepted as first line treatment in the management of rheumatoid arthritis (RA). The ultimate therapeutic goal in treatment of RA is remission or at least low disease activity and this goal may not always be achieved with MTX monotherapy. Over the last two decades drug combinations based on MTX have been used increasingly to treat patients with RA. Combination DMARD therapy may be used initially or in a step-up strategy after MTX monotherapy in patients with persistently active disease on monotherapy. Many different MTX based combination regimens have been studied. Frequently used combinations on an MTX background include leflunomide, cyclosporine, azathioprine, sulfasalazine, gold and hydroxychloroquine. In conclusion, the use of MTX in combination with other DMARDs may still represent a valuable therapeutic option in patients who fail to DMARD monotherapy or in whom combination therapy is considered initially. However, in patients at risk for rapid radiographic progression, the early use of biologics has to be considered.
    Clinical and experimental rheumatology 01/2010; 28(5 Suppl 61):S52-7. · 2.66 Impact Factor
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    ABSTRACT: Background: Tocilizumab, a humanised monoclonal antibody targeting the IL-6 receptor, represents a potent new therapeutic principle for patients with active RA and intolerance or inadequate response to conventional DMARDs and/or TNF-blockers. Given the broad therapeutic armentarium of biologics that is available for RA patients today, predictive parameters before or during the early treatment period are urgently needed to optimize therapeutic strategies. Objectives: The current analysis was undertaken to evaluate whether an early response to tocilizumab is predictive for longterm outcome and whether the well characterized pharmakokinetic effects of blocking IL-6 on the course of CRP and neutrophils is associated with the clinical response. Methods: In our center, 36 patients with active RA were started on tocilizumab 8 mg/kg iv q4w and followed prospectively for 24 weeks. DAS 28 and laboratory parameters were obtained at baseline and every 4 weeks subsequently. Results: 36 patients (25% male, 75% female, mean baseline DAS28 6.09) were treated with tocilizumab 8mg/kg. 15/36 (42%) patients received tocilizumab as monotherapy and 21/36 (58%) with concomitant DMARD treatment. In 23/36 (64%) patients, tocilizumab was used as the first biological. After 24 weeks, 18 patients achieved low disease activity LDA (DAS 28 ≤ 3.2) and 12 were in remission (DAS<2,6). CRP, neutrophils or other clinical or laboratory parameters at baseline did not correlate to outcome at week 24. Patients with a DAS decrease of ≥ 1.2 at week 4 (early responders = ER) were compared to patients with a DAS difference of < 1.2 at week 4 (early non-responders = NR). 59.3% of the ER, but only 22% of NR achieved LDA in week 24 (n.s.). More impressively, 44% of the ER, but none of the NR achieved remission in week 24 (p=0.02). CRP levels normalized in all patients at week 4 and did not differ between ER and NR. Neutrophil counts at week 4 remained within normal limits in all patients. Of note, a decrease in neutrophil counts of ≥ 25% from baseline to week 4 was observed more frequently in ER (18/27) than in NR (2/9) (p = 0.05). More interestingly, a neutrophil decrease of ≥ 25% from baseline to week 4 was significantly associated with LDA and remission at week 24 (p=0,03) Conclusion: Patients who responded to tocilizumab with a DAS 28 decrease of ≥ 1.2 in week 4 (ER) achieved remission significantly more often in week 24 than patients who do not respond at week 4. Baseline CRP or normalization of CRP at week 4 did not correlate to ER/NR at week 4 or to LDA/remission at week 24. Of note, a decrease in neutrophil counts of ≥ 25% after a single infusion of tocilizumab (baseline to week 4) was highly predictive for achieving LDA/remission in week 24.
    Ann Rheum Dis 2010;69(Suppl3):499. 01/2010;
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    ABSTRACT: HintergrundAls Folge einer fallpauschalierten Vergütung über DRGs (Diagnosis-related Groups) werden oft die Konzentration der Leistungen auf spezialisierte Kliniken sowie Auswirkungen auf die Qualität der Versorgung vorausgesagt. Bisher existieren keine Abschätzungen, inwieweit diese Effekte auch bei Notfalldiagnosen auftreten werden. MethodikDie Autoren analysierten Abrechnungsdaten von rund 23,6Mio. Versicherten der Jahre 2004 bis einschließlich 2007. Einbezogen wurden anhand der Hauptdiagnosestellung alle Fälle in den Bereichen Schlaganfall (ICD-10: I63 und I64) und Myokardinfarkt (ICD-10: I21). ErgebnisseBei beiden Entitäten wurden steigende Fallzahlen von 2004 bis 2007 festgestellt (Myokardinfarkt: +12,71%; Schlaganfall: +1,73%). Die absolute Zunahme der Patientenfälle scheint sich am ehesten als Zunahme zugunsten der Krankenhausgruppen mit Fallzahlen >100Fälle pro Jahr auszuwirken, während Gruppen mit niedrigen Fallzahlen ihre Patientenzahlen konstant hielten oder nur in geringerem Maß ausweiteten. Die Entwicklung der Mortalität zeigte keine deutlich erkennbare Tendenz. Für beide Erkrankungen war jedoch ein überproportionaler Anteil der Mortalität in Krankenhäusern mit geringeren Fallzahlen pro Jahr festzustellen. SchlussfolgerungDie Konzentration der Leistungen auf wenige Zentren ist durch DRGs in der Notfallversorgung noch nicht wesentlich beschleunigt worden. Im Wesentlichen gibt es Veränderungen der relativen Fallzahlen durch Fallzahlsteigerungen in großen Zentren, weniger durch Abbau und Verschiebung von Leistungen aus kleinen Standorten. Die Ursache kann in der Notwendigkeit der Aufrechterhaltung der Notfallversorgung in den ländlichen Regionen liegen, während sich in Ballungsgebieten zunehmend spezialisierte Zentren bilden. BackgroundAn increase in the convergence of medical services toward specialized hospitals with high case numbers as well as the effects on quality of care are often assumed to be the result of diagnosis-related groups (DRGs; case-based lump-sum reimbursement). Estimates of the extent to which these effects occur in emergency diagnoses are not available. MethodsClaims data relating to approximately 23.6million insured within the period 2004–2007 (inclusive) were analyzed. All cases with the main diagnosis of stroke (ICD-10: I63 and I64) and myocardial infarction (ICD-10: I21) were included in the study. ResultsIncreasing case numbers could be observed for all entities within the period studied (myocardial infarction: +12.71%; stroke: +1.73%). The absolute increase in case numbers seems to affect those hospitals with case numbers >100per year, whereas case numbers of hospital groups including hospitals with low case numbers per year remain unchanged or grow slower. No absolute trend in mortality could be seen. However, a disproportionate rate of mortality in hospitals with low case numbers per year for both diagnoses was observed. ConclusionThe convergence of emergency treatment in a few specialized centers has not yet been accelerated by the implementation of DRGs. Essentially, relative changes can be seen due to case number increases in large centers rather than because of service cutbacks and shifts from smaller hospitals. The reason for this could be the need to maintain emergency care in rural regions, while specialized centers are increasingly built in urban areas. SchlüsselwörterDiagnosis-related Groups-Datenanalyse-Qualitätssicherung-Myokardinfarkt-Schlaganfall KeywordsDiagnosis-related groups-Statistical analysis-Health care quality assurance-Myocardial infarction-Stroke
    Herz 01/2010; 35(6):389-396. · 0.78 Impact Factor
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    ABSTRACT: An increase of the convergence of medical services towards specialised hospitals with high case numbers is often assumed as a result of the implementation of diagnosis-related groups (DRG; case-based lump sum reimbursement). So far, estimates of the extent to which this effect occurs after the recent implementation of DRGs are not available in Germany. Claims data of about 23,600,000 insured within the inclusive period 2004-2007 were analysed. All cases with the main diagnosis of lung cancer, prostate cancer, and colorectal cancer were included in the study. Broken down by entities and years, graphical and statistical concentration measures as well as the percentages of different hospital size classes were calculated. Increasing case numbers could be observed for all entities within the period (lung cancer:+25.7%; prostate cancer:+12.5%; colorectal cancer:+8.1%). The concentration measures showed hardly any changes in the course of time. The absolute increase of case numbers seems to affect those hospitals with case numbers higher than 50 per year above average [lung cancer cases in a hospital group including hospitals with more than 50 cases 2004 (percentage): 78.1% and 2007: 81.6%; prostate cancer: 67.4% and 71.7%; colorectal: 72.5% and 75.9%], whereas case numbers of hospital groups including hospitals with case numbers less than 50 per year remain unchanged or grow more slowly. The convergence of oncological services towards a few specialised centres has not yet been accelerated by the implementation of DRG's. Fundamentally, relative changes can be noticed due to case number increases in large centres, not because of service cutbacks and shifts from smaller hospitals. Reasons for this could either be the inflexibility of capacity planning or control options of the statutory health insurance. Further research of convergence tendencies and its drivers is required to be able to draw any benefit from efficiency and quality potentials.
    Das Gesundheitswesen 06/2009; 71(12):809-15. · 0.62 Impact Factor