The rising numbers of alcohol intoxicated adolescents (AIA) treated in emergency care units in several European countries have drawn attention to this target group for prevention. To our knowledge, this is the first study to assess a... more
The rising numbers of alcohol intoxicated adolescents (AIA) treated in emergency care units in several European countries have drawn attention to this target group for prevention. To our knowledge, this is the first study to assess a broad array of developmental hazards and their stability in AIA and to compare their distribution with representative samples (RS). A multisite cohort study of AIA aged 13-17 years assessed, in the hospital (t0) and 6 months later (t1), (family) violence, cannabis and alcohol use, school problems, delinquency, homelessness, depression, and suicidality, using items from representative German surveys: Children and Adolescent Health Survey (KiGGS), Childhood Trauma Questionnaire and Communities That Care Youth Survey. We calculated the differences between AIA and RS and corresponding 95% confidence intervals. For AIA respondents who completed t0 and t1 information, we calculated prevalence/persistence/incidence of developmental hazards and corresponding 95% confidence interval. A total of 342 AIA participated at t0, 228 at t1 (67%). AIA had a significantly higher burden of concomitant risks regarding physical and emotional family abuse, (sexual) victimization, cannabis use, binge drinking, school expulsion, police arrest, gang membership, and being violent. Six months after hospitalization, emotional family abuse (34.1%), cannabis use (23.5%), depression (14.8%), and being violent (13.2%) were especially prevalent. Developmental hazards are up to six times more prevalent in AIA than in RS. Therefore, when assessing the risk profile of AIA, it is important to consider developmental hazards as well as detrimental alcohol use.
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In Anbetracht des wachsenden finanziellen Drucks auf die sozialen Sicherungssysteme drangt sich immer starker die Frage auf, ob sich in Zukunft die Errungenschaften der modernen Medizin im Rahmen einer allgemeinen Gesundheitsversorgung... more
In Anbetracht des wachsenden finanziellen Drucks auf die sozialen Sicherungssysteme drangt sich immer starker die Frage auf, ob sich in Zukunft die Errungenschaften der modernen Medizin im Rahmen einer allgemeinen Gesundheitsversorgung bei weitgehend stabilen Beitragssatzen zur gesetzlichen Krankenversicherung (GKV) uberhaupt noch finanzieren lassen. Die in den inzwischen zahlreich vorliegenden Untersuchungen formulierten Vorschlage fur Masnahmen zur Weiterentwicklung des Gesundheitssystems zielen uberwiegend darauf ab, einerseits die Kosten im Gesundheitssystem zu begrenzen und andererseits die Eigenverantwortung der Patienten und Versicherten im Hinblick auf eine gesundheitsbewusste Lebensfuhrung, individuelle Eigenvorsorge und Kostenbewusstsein zu starken. Die Auswirkungen derartiger Masnahmen auf die Versorgungssituation der Burger werden im Einzelnen in der Regel nicht untersucht bzw. als bekannt angenommen. Insbesondere deren Akzeptabilitat fur die Patienten und Versicherten u...
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Aims: In Germany, little is known about mortality of coronary revascularisation after discharge from hospital due to a lack of longitudinal population-based data. The availability of clinically relevant information in administrative... more
Aims: In Germany, little is known about mortality of coronary revascularisation after discharge from hospital due to a lack of longitudinal population-based data. The availability of clinically relevant information in administrative health-insurance data increased during the last years. We determined the one-year mortality after surgical and non-surgical approaches to coronary revascularisation based on administrative data and explored the effectiveness of the available information for adjustment for confounders.Methods/Results: We analysed the one-year mortality of all beneficiaries of a German health insurance who underwent coronary artery bypass grafting or percutaneous coronary interventions in the year 2005 with complete follow-up (n=3447). We report the observed and the confounder adjusted one-year mortality (logistic regression). Parameters for adjustment for confounders (i.e. age, sex, previous myocardial infarction) were derived from administrative claims data on outpatient...
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... Arno Schmidt-Trucksäss*, Markus Sandrock, Leoni Klatt, Elisabeth Siegmund-Schultze, Hans Dörning, Karl Winkler, Hans ... dabei Fragen zur Motivation der Probanden (Kurzversion PAREMO), zu Kontrollüberzeugungen, zum Ernährungsverhalten... more
... Arno Schmidt-Trucksäss*, Markus Sandrock, Leoni Klatt, Elisabeth Siegmund-Schultze, Hans Dörning, Karl Winkler, Hans ... dabei Fragen zur Motivation der Probanden (Kurzversion PAREMO), zu Kontrollüberzeugungen, zum Ernährungsverhalten (MONICA-Food-Frequency ...
Research Interests: Medicine and Gynecology
The recommendations aim to increase patient participation and health literacy by strengthening the role of patient education in medical rehabilitation. Research shows patient education to be effective and efficient; making the... more
The recommendations aim to increase patient participation and health literacy by strengthening the role of patient education in medical rehabilitation. Research shows patient education to be effective and efficient; making the implementation of high quality patient education a top priority. To strengthen the role of patient education it is important to address known obstacles, identify potential for improvement, and define future demands for rehabilitative care. Led by the German Society for Medical Rehabilitation (DEGEMED), the Centre for Patient Education at the Würzburg University, and the Institute for Quality Management and Clinical Audit in Medical Rehabilitation (IQEM) an inter- and multidisciplinary panel of 28 experts from research and practice developed recommendations to further patient education in medical rehabilitation. The recommendations address topics such as the implementation of legal requirements under book IX of the German Social Code, SGB 9, structural and organisational prerequisites to promote the importance of patient education in rehabilitation units, the incorporation of quality criteria for patient education in quality assurance, quality management, and certification, as well as networking between medical rehabilitation and other health care sectors. Providers of medical rehabilitation hold the power to strengthen patient education: by implementing patient education programmes that are well-evaluated, manual-based, and standardised, by providing sufficient resources within their institutions, and by placing patient education in the centre of their quality policy, i.e. by nomination of a patient education representative. Stakeholders need to acknowledge these activities by incorporating quality criteria for patient education in clinical audit, and last but not least by adequate funding of medical rehabilitation.
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AIM The study was conducted in co-operation with a German sickness fund to identify determinants of disease-specific health outcomes after hip surgery in routine health care. METHOD In September 1997 all beneficiaries (age 40-75 yrs.),... more
AIM The study was conducted in co-operation with a German sickness fund to identify determinants of disease-specific health outcomes after hip surgery in routine health care. METHOD In September 1997 all beneficiaries (age 40-75 yrs.), who were hospitalized for "osteoarthrosis" (ICD 9-715/820), were sent a disease-specific survey instrument on average 5.2 months (T1) after discharge. Survey content focused, among others, on pre- and postoperative symptoms and impairment (Lequesne index), postoperative complications, comorbidity (Katz Index) and health-related quality of life (SF-36). The response rate at T1 was 67.8%. Only patients undergoing hip surgery were sent a second survey instrument 17.2 months (T2) after discharge. After two mailings, data from 293 patients were available for analysis. Descriptive and multivariate analysis (GSK Model) were performed. RESULTS Patients (57.6% male) were on average 61 yrs. of age and 61.2% reported no comorbidity. 88.4% received total hip replacement. A third of patients reported at least one complication. Univariate, a substantial (and highly significant) improvement was found for the Lequesne Index over time: (recalled) preoperative: 14.2 points; postoperative T1: 5.6 pts.; postoperative T2: 4.4 pts. This result is confirmed by multivariate analyses (estimated values: pre = 13.8, T1 = 6.9; T2 = 5.7), although it is modified by an interaction effect between the variables "Lequesne index" and "complication". The Lequesne Index in patients with complications is estimated preoperative 12.9, at T1 = 7.3 and T2 = 6.2. The respective estimated values for patients without complications are: preoperative 14.7, T1 = 6.5, T2 = 5.2. CONCLUSION Patients with postoperative complications obtain lower scores on the Lequesne Index (higher burden of disease) before hip surgery. Their postoperative progress is slower in the short term (-5.6 pts. vs. -8.2 pts) and in the medium term (-6.7 pts. vs. -9.5 pts). Complications after hip surgery have a lasting negative effect on disease-specific health outcomes.
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EinleitungDie Versorgung mit künstlichen Hüft- und Kniegelenken ist eine Technologie, die v.a. bei Patienten mit fortgeschrittener Osteoarthrose des Hüft- bzw. Kniegelenks angewendet wird. Da die Osteoarthrose eine typische degenerative... more
EinleitungDie Versorgung mit künstlichen Hüft- und Kniegelenken ist eine Technologie, die v.a. bei Patienten mit fortgeschrittener Osteoarthrose des Hüft- bzw. Kniegelenks angewendet wird. Da die Osteoarthrose eine typische degenerative Erkrankung des Bewegungsapparates ist, nimmt die absolute Häufigkeit des Krankheitsbilds mit zunehmender Alterung der Bevölkerung zu und damit auch der Bedarf an endoprothetischer Versorgung. Von 2000 bis 2008 hat sich die Zahl der Krankenhausbehandlungsfälle mit der Diagnose Osteoarthrose mehr als verdoppelt.
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BACKGROUND: We conducted a retrospective survey on patient's evaluation of the outcomes of surgery for a deviated nasal septum. MATERIAL AND METHODS: In January 1995 all working members of a German health insurance plan who were... more
BACKGROUND: We conducted a retrospective survey on patient's evaluation of the outcomes of surgery for a deviated nasal septum. MATERIAL AND METHODS: In January 1995 all working members of a German health insurance plan who were hospitalized between March and September 1994 for ICD-470 (n = 392) were surveyed using a self-administered pretested questionnaire. The response rate was 85.2% (n = 334, 88.8% male; medium age: 35.2 years, average length of stay: 6.5 days). Descriptive and multivariate analysis (GSK model) were preformed. Relative alleviation of symptoms was taken as an indicator for clinical outcome. RESULTS: The most important reasons for undergoing septal surgery from the patient's point of view were nasal obstruction (52%), headache (8.7%) and snoring (7.8%). Ten point six percent of the study population reported complete disappearance of preoperative symptoms (100% relative improvement), whereas in 7.9% no symptom alleviation of nasal related symptoms was described. Postoperative complications were reported by 29.9% of the respondents (i.e., adhesions: 5.7%; perforations; 2.1%). Multivariate analysis revealed that the relative improvement of symptoms increases if no nasal packing is administered, if the patients report minor postoperative discomfort only, and if no postoperative complications appear. CONCLUSION: The clinical outcome of septal surgery is similar compared to that of other studies, but may be improved by not applying postoperative nasal packings. For some of the surgical complications we found higher rates than those that have been reported so far. The results may offer opportunities for clinical audit and quality management.
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Research Interests: Medicine, Patient reported outcome measures, Physical Therapy, Multivariate Analysis, Humans, and 15 moreHealth related Quality of Life, Female, Feasibility Studies, Male, Checklist, Patient Satisfaction, Middle Aged, Inguinal Hernia, Hernia Repair, General Linear Model, Abdominal Surgery, Hernia, Physical Function, Health Outcome, and Hernia inguinal
BACKGROUND The study was conducted in co-operation with a German health insurance fund (Gmunder Ersatzkasse, GEK) to identify determinants of outcomes of hip surgery from the patient's perspective. METHODS In September 1997 all... more
BACKGROUND The study was conducted in co-operation with a German health insurance fund (Gmunder Ersatzkasse, GEK) to identify determinants of outcomes of hip surgery from the patient's perspective. METHODS In September 1997 all beneficiaries (age 40-75 yrs.) who had been treated in hospital for osteoarthrosis of the hip (ICD-715/820) (n = 1352) were sent a questionnaire on average 5.2 months (T1) postoperatively. The standardized questionnaire contained, among others, items about pre- and postoperative subjective assessment of disease specific symptoms (Lequesne Index), complications, comorbidity (Katz-Index), health related quality of life (SF-36) and discharge (home or for inpatient rehabilitation). The response rate at T1 was 67.8%. Patients with hip surgery (n = 390) were sent a second questionnaire 17.2 months (T2) postoperatively. After the two mailings, data from 293 patients were available for analysis. Descriptive and multivariate analyses (GSK model) were performed to reveal determinants of disease specific symptom alleviation. RESULTS Patients (57.6% male) were 61 years of age on average, and 61.2% reported no comorbidity. 88.4% had undergone total hip replacement. A third of the patients reported at least one complication. 70.6% were discharged for inpatient rehabilitation. Univariately, a substantial (and statistically highly significant) decrease was observed in the Lequesne Index over time: (recalled) preoperative: 14.2 points; postoperative T1: 5.6 pts.; postoperative T2: 4.4 pts. This result is confirmed by multivariate analyses (estimated values: pre = 13.8; T1 = 6.9; T2 = 5.7) although it is modified by an interaction effect between the variables "Lequesne Index" and "Discharge". In patients discharged home, the preoperative Lequesne Index is an estimated 13.3, at T1 = 6.9 and T2 = 6.2. The respective estimated values for patients discharged for inpatient rehabilitation are: preoperative 14.3; T1 = 6.9; T2 = 5.2. CONCLUSIONS Patients receiving inpatient rehabilitation scored higher on the Lequesne Index (higher burden of disease) before hip surgery. In the short term, their improvements are higher than those of the patient group discharged home (-7.4 pts. versus -6.4 pts.) and continue to be higher in the medium term (-9.1 pts. versus -7.1 pts.). Inpatient rehabilitation after hip surgery leads to better disease specific health outcomes than direct discharge home.
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The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy. In two centers for short-stay surgery, patients referred for laparoscopic... more
The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy. In two centers for short-stay surgery, patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and Jan 2002. Patients reported on health-related quality of life (SF-36), symptoms (gallstone symptom checklist, GSCL) and other indicators preoperatively (T0), 14 days (T1) and 6 months postoperatively (T2). The SF-36 subscales physical functioning, bodily pain, and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes. The main outcomes were analyzed by generalized linear models with regard to predictors. At T0 a total of 205 patients were included. The response rate at T2 was 63.4% (74.6% females, 53.6 years of age). The GSCL score at T0 (29.4% preoperatively) fell slightly to 27.9% at T1 and decreased to 14.8% at T2 (T0-T2: p < 0.001). The SF-36 subscales showed a different course over time (decrease of health-related quality of life at T1 and large increase at T2). The level of satisfaction with the outcome of cholecystectomy was 82.3%. The patient-reported outcomes were mainly influenced by the preoperative level, age and self-reported postoperative complaints. The low response rate was mainly due to nondelivery of questionnaires at T1 during the regular postoperative visit by the operating physician. Though nonresponse occurs under conditions of routine care, meaningful information was gained, which should be used for quality improvement activities. Because the preoperative level is a major determinant of the postoperative health outcomes, the prospective pre-post measurement should be preferred if institutional comparisons are intended.
Research Interests: Medicine, Patient reported outcome measures, General Surgery, Multivariate Analysis, Humans, and 15 moreHealth related Quality of Life, Female, Feasibility Studies, Male, Patient Satisfaction, Length of Stay, Clinical Sciences, Middle Aged, General Linear Model, Cholecystectomy, Physical Function, Health Outcome, Laparoscopic Cholecystectomy, Cholecystitis, and hospital units
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Zusammenfassung In Kooperation mit der Gmünder Ersatzkasse (GEK) wurden Determinanten der gesundheitsbezogenen Lebensqualität nach Hüftgelenkoperationen in der Routineversorgung untersucht. In 9/97 wurden alle Versicherten der GEK (Alter:... more
Zusammenfassung In Kooperation mit der Gmünder Ersatzkasse (GEK) wurden Determinanten der gesundheitsbezogenen Lebensqualität nach Hüftgelenkoperationen in der Routineversorgung untersucht. In 9/97 wurden alle Versicherten der GEK (Alter: 40–75 Jahre), die sich in stationärer Behandlung mit der Hauptdiagnose “Osteoarthrose” (n=1352) befanden, im Mittel 5,2 Monate (t1) und 17,2 Monate (t2) postoperativ schriftlich u.a. zu folgenden Aspekten befragt: prä- und postoperative Einschätzung des Beschwerdegrades (Lequesne-Index), Komplikationen, gesundheitsbezogene Lebensqualität (SF-36). Der Rücklauf zu t1 betrug 67,8%. Berücksichtigt wurden Patienten, die am Hüftgelenk operiert wurden (n=390). Zu t2 liegen auswertbare Fragebögen von 293 Patienten vor. Die Patienten (57,6% Männer) sind im Durchschnitt 61 Jahre alt. 61,2% sind frei von Begleiterkrankungen, 88,4% erhielten ein künstliches Hüftgelenk, 30,3% berichten über Komplikationen. In sechs der insgesamt acht Dimensionen des SF-36 weisen die Befragten im Vergleich zur Normalbevölkerung zu t1 und t2 statistisch signifikant schlechtere Lebensqualitätswerte auf. Zwischen t1 und t2 sind substantielle Verbesserungen in den Subskalen körperliche Funktionsfähigkeit, körperliche Rollenfunktion und Schmerz zu verzeichnen. Zentrale Determinanten von Verbesserungen der Lebensqualität sind Begleiterkrankungen (bei Vorliegen: geringere Verbesserungen) und der Umstand, ob die Patienten postoperativ in einer Rehabilitationseinrichtung weiterbehandelt wurden (wenn ja: grössere Verbesserungen). In der Routineversorgung sind Patientencharakteristika und Aspekte der Nachbehandlung zentrale Determinanten der Lebensqualität, wobei trotz substantieller Verbesserungen (noch) nicht das Niveau der Normalbevölkerung erreicht wird.
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Background Measuring change is fundamental to evaluations, health services research and quality management. To date, the Gold-Standard is the prospective assessment of pre- to postoperative change. However, this is not always possible... more
Background Measuring change is fundamental to evaluations, health services research and quality management. To date, the Gold-Standard is the prospective assessment of pre- to postoperative change. However, this is not always possible (e.g. in emergencies). Instead a retrospective approach to the measurement of change is one alternative of potential validity. In this study, the Gold-Standard 'conventional' method was compared with two variations of the retrospective approach: a perceived-change design (model A) and a design that featured observed follow-up minus baseline recall (model B). Methods In a prospective longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients (T0: 7-8 days pre-operative; T1: 14 days post-operative and T2: 6 months post-operative) changes in symptoms (Hernia: 9 Items, Cholecystectomy: 8 Items) were assessed at the three time points by patients and the conventional method was compared to the two alternativ...
Research Interests: Health Services Research, Herniorrhaphy, Medicine, Observation, Humans, and 15 moreOral Health Related Quality of Life, Female, Male, Patient Satisfaction, Middle Aged, Gold Standard, Longitudinal Studies, Missing Values, B Method, Cholecystectomy, Observational Study, Preoperative Period, Laparoscopic Cholecystectomy, Design Model, and Postoperative Period
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Background Patient surveys constitute a valuable source of information in patient-focused health care. The objective of this study was to develop and validate a standardized, patient centered, quantitative instrument to assess parent... more
Background Patient surveys constitute a valuable source of information in patient-focused health care. The objective of this study was to develop and validate a standardized, patient centered, quantitative instrument to assess parent satisfaction in ambulatory pediatric care to be used in quality management and benchmarking activities, the Child-ZAP. Methods A preliminary version of the survey (38 items) was conducted in n = 19 pediatric practices. After psychometric testing a modified Child-ZAP was tested in a second survey (n = 20 new pediatric practices). Data from n = 979 patients were available for analysis. Results The final version of the Child-ZAP contains eight dimensions, three "Child-Scales" and five "Parent-Scales". Confirmatory factor analysis confirms the three hypothesized child dimensions as well as the five parent dimensions. The factorial structure is confirmed in subgroups of younger and older children. Conclusions With satisfactory to good res...
Research Interests: Health Informatics, Family Medicine, Health Administration, Benchmarking, Medicine, and 15 moreGermany, Nursing Research, Library and Information Studies, Humans, Child, Female, Confirmatory factor analysis, Male, Middle Aged, Parents, Adult, Health surveys, Patient Centered Care, Ambulatory Care, and Child preschool
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... 1999. [24.5.2007] Vestergaard H, Wohlfahrt J, Westergaard T et al. Incidence of tonsillectomy in Denmark, 1980 to 2001. Pediatr.Infect.Dis.J 2007; 26 (12): 1117–1121. Zolotor AJ, Randolph GD, Johnson JK et al. Effectiveness ...
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ZusammenfassungDas Deutsche Netzwerk Versorgungsforschung e.V. (DNVF) fördert seit Jahren die methodische Qualität von Versorgungsforschungsstudien auf der Basis von Memoranden und anderen Initiativen. Die Qualitäts- und... more
ZusammenfassungDas Deutsche Netzwerk Versorgungsforschung e.V. (DNVF) fördert seit Jahren die methodische Qualität von Versorgungsforschungsstudien auf der Basis von Memoranden und anderen Initiativen. Die Qualitäts- und Patientensicherheitsforschung (QPSF) gilt als Kerngebiet der Gesundheitsversorgungsforschung. Das vorliegende Memorandum erläutert wesentliche etablierte Fragestellungen und Methoden der QPSF. Vor dem Hintergrund der besonderen gesundheitspolitischen Bedeutung des Themas werden Methoden der Messgrößenentwicklung und -prüfung, die Risikoadjustierung, Methoden zur Erhebung von Patientensicherheitsdaten, Instrumente zur Analyse sicherheitsrelevanter Ereignisse und Methoden zur Evaluation der meist multiplen und komplexen QPSF-Interventionen behandelt. Zudem werden vordringliche Forschungsthemen benannt.