scholarly journals The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: a retrospective cohort study using health insurance claims data

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathrin Seibert ◽  
Susanne Stiefler ◽  
Dominik Domhoff ◽  
Karin Wolf-Ostermann ◽  
Dirk Peschke
Keyword(s):  
Primary Care ◽  
Retrospective Cohort ◽  
Claims Data ◽  
Care Quality ◽  
Primary Care Quality ◽  
Quality Of Primary Care ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Health Insurance Claims

Abstract Background Multimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA. Methods We conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007–2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariable Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD. Results Among 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 9.6 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one’s own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one’s home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99–3.60 PWD; HR = 2.81, 95% CI 2.28–3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78–5.55 PWD; HR = 2.81, 95% CI 1.94–4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA. Conclusions The quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed.

scholarly journals The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: A retrospective cohort study using health insurance claims data

2021 ◽  
Author(s):  
Kathrin Seibert ◽  
Susanne Stiefler ◽  
Dominik Domhoff ◽  
Karin Wolf-Ostermann ◽  
Dirk Peschke
Keyword(s):  
Primary Care ◽  
Retrospective Cohort ◽  
Claims Data ◽  
Care Quality ◽  
Primary Care Quality ◽  
Quality Of Primary Care ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Health Insurance Claims

Abstract Background Multimorbidity poses a challenge for high quality primary care provision for nursing care-dependent people with (PWD) and without (PWOD) dementia. Evidence on the association of primary care quality of multimorbid PWD and PWOD with the event of a nursing home admission (NHA) is missing. This study aimed to investigate the contribution of individual quality of primary care for chronic diseases in multimorbid care-dependent PWD and PWOD on the duration of ongoing residence at home before the occurrence of NHA. Methods We conducted a retrospective cohort study among elderly care-dependent PWD and PWOD in Germany for six combinations of chronic diseases using statutory health insurance claims data (2007–2016). Primary care quality was measured by 21 process and outcome indicators for hypertension, diabetes, depression, chronic obstructive pulmonary disease and heart failure. The primary outcome was time to NHA after initial onset of care-dependency. Multivariate Cox proportional hazard models were used to compare the time-to-event between PWD and PWOD. Results Among 5876 PWD and 12,837 PWOD 5130 NHA occurred. With the highest proportion of NHA for PWD with hypertension and depression and for PWOD with hypertension, diabetes and depression. Average duration until NHA ranged from 6.5 to 8.9 quarters for PWD and from 8.1 to 13.5 quarters for PWOD. Adjusted analyses show consistent associations of the quality of diabetes care with the duration of remaining in one's own home regardless of the presence of dementia. Process indicators assessing guideline-fidelity are associated with remaining in one's home longer, while indicators assessing complications, such as emergency inpatient treatment (HR = 2.67, 95% CI 1.99–3.60 PWD; HR = 2.81, 95% CI 2.28–3.47 PWOD) or lower-limb amputation (HR = 3.10, 95% CI 1.78–5.55 PWD; HR = 2.81, 95% CI 1.94–4.08 PWOD) in PWD and PWOD with hypertension and diabetes, increase the risk of NHA. Conclusions The quality of primary care provided to care-dependent multimorbid PWD and POWD, influences the time individuals spend living in their own homes after onset of care-dependency before a NHA. Health care professionals should consider possibilities and barriers of guideline-based, coordinated care for multimorbid care-dependent people. Further research on quality indicator sets that acknowledge the complexity of care for multimorbid elderly populations is needed.

scholarly journals A háziorvosok teljesítményének minőségi értékelése. Mi a probléma a háziorvosi indikátorokkal?

2016 ◽  
Vol 157 (9) ◽  
pp. 328-335 ◽  
Author(s):  
László Róbert Kolozsvári ◽  
Imre Rurik
Keyword(s):  
Primary Care ◽  
Family Physicians ◽  
Indicator System ◽  
Care Quality ◽  
Proper Solution ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Quality ◽  
Quality Of Primary Care

The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary. Orv. Hetil., 2016, 157(9), 328–335.

scholarly journals Evidence-based indicators for the measurement of quality of primary care using health insurance claims data in Switzerland: update of the SQUIPRICA working group

2021 ◽  
Author(s):  
Eva Blozik ◽  
Renato Farcher ◽  
Sereina Graber ◽  
Carola Huber
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Claims Data ◽  
Evidence Based ◽  
Insurance Claims ◽  
Quality Of Primary Care ◽  
Swiss Health ◽  
Health Insurance Claims ◽  
General Aspects

Abstract Background The level of quality of care of ambulatory services in Switzerland is almost completely unknown. Since health insurance claims are the only nationwide applicable and available data source for this purpose, a set of 24 quality indicators (QI) for the measurement of quality of primary care has been previously developed and implemented. The present paper reports on an evidence-based update and extension of the initial QI set. Methods Established pragmatic 6-step process based on informal consensus and potential QI extracted from international medical practice guidelines and pre-existing QI for primary care. Experts rated potential QI based on strength of evidence, relevance for Swiss public health, and controllability in the Swiss primary care context. Feasibility of a preliminary set of potential new QI was tested using claims data of persons with basic mandatory health insurance at one of the largest Swiss health insurers. This test built the basis for expert consensus on the final set of new QI. Additionally, two diabetes indicators included in the previous QI set were re-evaluated. Results Of 23 potential new indicators, 19 of them were selected for feasibility testing. The expert group consented a final set of 9 additional QI covering the domains general aspects/efficiency (2 QI), diagnostic measures (1 QI), geriatric care (2 QI), osteoarthritis (1 QI), and drug safety (3 QI). Two pre-existing diabetes indicators were updated. Conclusions Additional QI relating to overuse and intersectoral care aspects extend the options of measuring quality of primary care in Switzerland based on claims data and complement the initial QI set.

scholarly journals Regional variation of care dependency after hip fracture in Germany: A retrospective cohort study using health insurance claims data

PLoS ONE ◽  
2020 ◽  
Vol 15 (3) ◽  
pp. e0230648
Author(s):  
Claudia Schulz ◽  
Gisela Büchele ◽  
Raphael Simon Peter ◽  
Dietrich Rothenbacher ◽  
Patrick Roigk ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Hip Fracture ◽  
Retrospective Cohort Study ◽  
Regional Variation ◽  
Retrospective Cohort ◽  
Claims Data ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Health Insurance Claims

scholarly journals Effect of Family Practice Contract Services on the Perceived Quality of Primary Care among Patients with Multimorbidity: A Cross-Sectional Study in Guangdong, China

2021 ◽  
Vol 19 (1) ◽  
pp. 157
Author(s):  
Jingyi Liao ◽  
Mengping Zhou ◽  
Chenwen Zhong ◽  
Cuiying Liang ◽  
Nan Hu ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Practice ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Care Quality ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primary Care Quality ◽  
Quality Of Primary Care

Family practice contract services, an important primary-care reform policy for improving primary healthcare quality in China, incorporate patients with multiple chronic conditions into the priority coverage groups and focus on their management. This study aims to explore the family practice contract services’ effectiveness in improving the quality of primary care experienced by this population. A cross-sectional study using a three-stage sampling was conducted from January to March 2019 in Guangdong, China. A multivariable linear regression, including interaction terms, was applied to examine the associations between the contract services and primary care quality among people with different chronic conditions. The process quality of primary care was measured in six dimensions using the validated assessment survey of primary care (ASPC) scale. People with contract services scored higher in terms of quality of primary care than those without contract services. Contract services moderated the association between chronic condition status and primary care quality. Significantly positive interactions were observed in the patient-centred care dimension and negative interactions were reflected in the accessibility dimension. Our findings suggest that family practice contract services play a crucial role in improving patient-perceived primary care quality and provide emerging evidence that patients with multimorbidity tend to benefit more from the services, especially in patient-centred care.

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