Werner de Cruppé

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

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Publications (55)52.1 Total impact

  • W de Cruppé · M Geraedts

    No preview · Article · Sep 2015 · Das Gesundheitswesen
  • R A Kraska · W de Cruppe · M Geraedts
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    ABSTRACT: Background: Since 2005, German hospitals are required by law to publish structured quality reports (QRs). Because of the detailed data basis, the QRs are being increasingly used for secondary data analyses in health services research. Up until now, methodological difficulties that can cause distorted results of the analyses have essentially been overlooked. The aim of this study is to systematically list the methodological problems associated with using QR and to suggest solution strategies. Methods: The QRs from 2006-2012 form the basis of the analyses and were aggregated in a database using an individualized data linkage procedure. Thereafter, a correlation analysis between a quality indicator and the staffing of hospitals was conducted, serving as an example for both cross-sectional as well as longitudinal studies. The resulting methodological problems are described qualitatively and quantitatively, and potential solutions are derived from the statistical literature. Results: In each reporting year, 2-15% of the hospitals delivered no QR. In 2-16% of the QRs, it is not recognizable whether a report belongs to a hospital network or a single location. In addition, 6-66% of the location reports falsely contain data from the hospital network. 10% of the hospitals changed their institution code (IC), in 5% of the cases, the same "IC-location-number-combination" was used for different hospitals over the years. Therefore, 10-20% of the QRs cannot be linked with the IC as key variable. As a remedy for the linking of QR, the combination of the IC, the address and the number of beds represents a suitable solution. Using this solution, hospital network reports, location reports and missing reports can be identified and considered in an analysis. Conclusions: Secondary data analyses with quality reports provide a high potential for error due to the inconsistent data base and the problems of the data linkage procedure. These can distort calculated parameters and limit the validity of results. Only the unequivocal identification of the reporting hospitals guarantees meaningful results. © Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Aug 2015 · Das Gesundheitswesen
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    Werner de Cruppé · Marc Malik · Max Geraedts
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    ABSTRACT: Background Compliance with minimum volume standards for specific procedures serves as a criterion for high-quality patient care. International experiences report a centralization of the respective procedures. In Germany, minimum volume standards for hospitals were introduced in 2004 for 5 procedures (complex esophageal and pancreatic interventions; liver, kidney and stem cell transplantations), in 2006 total knee replacement was added. This study explores whether any centralization is discernible for these procedures in Germany. Methods A retrospective longitudinal analysis of secondary data serves to determine a possible centralization of procedures from the system perspective. Centralization means that over time, fewer hospitals perform the respective procedure, the case volume in high-volume hospitals increases together with their percentage of the annual total case volume, and the case volume in low-volume hospitals decreases together with their percentage of the annual total case volume. Using data from the mandatory hospital quality reports for the years 2006, 2008 and 2010 we performed Kruskal Wallis and chi-square tests to evaluate potential centralization effects. Results No centralization was found for any of the six types of interventions over the period from 2006 to 2010. The annual case volume and the number of hospitals performing interventions rose at differing rates over the 5-year period depending on the type of intervention. Seven percent of esophagectomies and 14 % of pancreatectomies are still performed in hospitals with less than 10 interventions per year. Conclusions For the purpose of further centralization of interventions it will be necessary to first analyze and then appropriately address the reasons for non-compliance from the hospital and patient perspective.
    Preview · Article · Jul 2015 · BMC Health Services Research
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    Full-text · Article · Apr 2015 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
  • W de Cruppé · M Geraedts
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    ABSTRACT: Background: The outcome volume relationship has been analysed for more than 30 years and debated ever since. For German hospitals minimum volume standards (MVS) have been introduced for some procedures in 2004. Hospitals have to report procedure volumes in their quality reports. This study analyses for the first time how constant hospitals comply with minimum volume standards over time. Materials and Methods: Data used are the reported volumes, which hospitals published in their quality reports in 2006, 2008, and 2010. The case volumes of complex oesophageal and pancreatic interventions, total knee replacements, and liver, kidney and stem cell transplantations (KTX, LTX, STX) are analysed in a retrospective, longitudinal study design. Results: More than 80 % of hospitals conducting LTX, KTX, and total knee replacements are complying with MVS constantly, in STX 57 % of hospitals comply, and with complex pancreatic and oesophageal interventions compliance is 44 and 28 %, respectively. Twenty-seven to 36 % of hospitals conducting the three last mentioned procedures vary in complying with the MVS over time. 3.5 % (total knee replacements) up to 26 % (pancreatic interventions) and 37 % (oesophageal interventions) of all hospitals constantly fail to comply with MVS. Hospitals constantly over the MVS treat more than 80 % of all patients, except in complex oesophageal interventions. Hospitals with varying compliance in oesophageal and pancreatic interventions are mainly hospitals with 100 to 599 beds. Only very few hospitals of these two procedure types stop conducting the interventions after failing to comply with MVS earlier, the other some 120 hospitals for each intervention type treat 2 cases on average per year. Conclusion: The MVS on KTX, LTX, STX, and total knee replacement are almost constantly complied with. A considerable number of hospitals conducting oesophageal and pancreatic interventions never or rarely meet the MVS without discontinuing this type of intervention. At least for hospitals that never comply with MVS on oesophageal and pancreatic interventions, requirements and possibilities for a regional patient transfer should be studied in depth. Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Feb 2015 · Zentralblatt fur Chirurgie, Supplement
  • Werner de Cruppé · Marc Malik · Max Geraedts
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    ABSTRACT: Background: 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. Method: We performed a secondary analysis of data supplied by hospitals in their quality control reports for the years 2004, 2006, 2008, and 2010 with respect to six procedures that have a minimum caseload requirement: complex interventions on the esophagus and pancreas, total knee replacement, and hepatic, renal, and stem-cell transplantation. Results: The total case numbers for these six different procedures rose from 22 064 (0.1% of all procedures) in 2004 to 170 801 (0.9% of all procedures) in 2010. From 2006 onward, procedures to which minimum caseload requirements apply have been carried out in half of all hospitals studied. These procedures account for 0.9% of all inpatient cases in Germany. The percentage of hospitals that continue to perform certain procedures despite not having met the minimum caseload requirement ranged from 5% to 45%, depending on the type of procedure, and the percentage of cases carried out in such hospitals ranged from 1% to 15%. These values remained nearly constant for each of the six minimum caseload requirements over the 4 reporting years for which data were examined. Conclusion: The establishment of minimum caseload requirements in Germany in 2004 did not lessen the number of cases performed in violation of these requirements over the period 2004 to 2010.
    No preview · Article · Aug 2014 · Deutsches Ärzteblatt International
  • S. Auras · W. de Cruppé · F. Diel · M. Geraedts

    No preview · Article · May 2014 · Gesundheitsökonomie & Qualitätsmanagement
  • P Hermeling · W de Cruppé · M Geraedts
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    ABSTRACT: Background: 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. Methods: 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. Results: 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.
    No preview · Article · Apr 2013 · Das Gesundheitswesen
  • M. Geraedts · M. Malik · O. Jung · W. de Cruppé

    No preview · Article · Mar 2013 · Senologie - Zeitschrift für Mammadiagnostik und -therapie
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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.
    Preview · Article · Oct 2012 · BMC Health Services Research
  • M Geraedts · M Malik · O Jung · W de Cruppé
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    ABSTRACT: Background: 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. Methods: 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. Results: 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). Conclusion: 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.
    No preview · Article · Oct 2012 · Das Gesundheitswesen
  • S Auras · W de Cruppé · U Schmitt · F Diel · M Geraedts

    No preview · Article · Sep 2012 · DMW - Deutsche Medizinische Wochenschrift
  • G. Blumenstock · I. Fischer · W. de Cruppé · M. Geraedts · H. Selbmann

    No preview · Article · Aug 2012 · Gesundheitsökonomie & Qualitätsmanagement
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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.
    No preview · Article · Dec 2011 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
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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.
    No preview · Article · Dec 2011 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
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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.
    No preview · Article · Dec 2011 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen
  • 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.
    No preview · Article · Dec 2011 · Patient Education and Counseling

  • No preview · Article · Dec 2011 · Gesundheitsökonomie & Qualitätsmanagement
  • 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.
    No preview · Article · Aug 2011 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
  • W. de Cruppé · M. Geraedts
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    ABSTRACT: Background 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. Method 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. Results 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.
    No preview · Article · Aug 2011 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz

Publication Stats

185 Citations
52.10 Total Impact Points

Institutions

  • 2009-2015
    • Universität Witten/Herdecke
      • Faculty of Health
      Witten, North Rhine-Westphalia, Germany
  • 2011
    • Kassenärztliche Bundesvereinigung
      Berlín, Berlin, Germany
  • 2008
    • Deutsches Krankenhausinstitut
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2006-2008
    • Heinrich-Heine-Universität Düsseldorf
      • Institute of Medical Sociology
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2003-2005
    • Universität Heidelberg
      • Department of Internal Medicine II, General Internal Medicine and Psychosomatics
      Heidelburg, Baden-Württemberg, Germany