Das Gesundheitswesen
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Das Gesundheitswesen · Oct 2012
[Is the needs-based planning mechanism effectively needs-based? An analysis of the regional distribution of outpatient care providers].
Since the 1990s licenses for opening a medical practice in Germany are granted based on a needs-based planning system which regulates the regional allocation of physicians in primary care. This study aims at an analysis of the distribution of physicians (and hence the effects of the planning system) with regard to the overarching objective of primary care supply: the safeguarding of "needs-based and evenly distributed health care provision" (Section 70 para 1 German Social Code V). ⋯ The initiated reforms of the planning mechanism should progress and be further deepened. Especially today's quota-based allocation of practice licenses requires fundamental changes taking into account the relevant factors approximating local health care needs, re-assessing the adequate spatial planning level and expanding opportunities for introducing innovative and more flexible health care services models.
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Das Gesundheitswesen · Oct 2012
[Hospital admission due to adverse drug events (ADE): an analysis of German routine hospital data of 2006].
In developed countries 1-5% of all hospital admissions are due to adverse drug events (ADE). An ADE is defined as an injury resulting from medical intervention related to a drug. The established reporting systems and study designs only capture selective data. The objective of the current analysis was to evaluate the rate, distribution and correlations of ADE related admissions by using German routine data. ⋯ Younger age, reduced hospital stay and lower mortality of ADE cases are contrary to findings in the relevant literature. The DRG-Statistics also comprise populations which often are excluded in established study designs, in particular, children and cases due to medication errors, overdose, poisoning and allergic reactions. As these cases respond easily to prevention and are of significant interest to pharmacovigilance, the use of routine data is valuable for more intense research of ADE.
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Das Gesundheitswesen · Oct 2012
[Strategies to prevent the transmission of multidrug-resistant pathogens and their practical implementation in oupatient care].
Multidrugresistant pathogens which are highly relevant for infection control in hospitals and other health-care facilities are a serious public health problem and a big challenge for all players in the health sector. In order to prevent the spread of multi-resistant pathogens the Commission for Hospital Hygiene of the Robert Koch-Institute (RKI) has published guidelines. These recommendations refer to the consequent implementation of an infection control management in all health care settings, including outpatient care. In Germany there are only few data available concerning infection control management and the implementation of preventive strategies in outpatient care. ⋯ Implementation of an infection control management concerning multidrug-resistant pathogens in outpatient care is problematic. Prevention strategies are commonly not known or not adequately implemented into daily practice. Actions to improve the situation should focus at the individual level (e.g., trainings in the context of the initiative "clean hands" ), the institutional level (improving networking, bonus schemes) and the social level (financial and legal support for outpatient care centres to bear the expenses of infection control management, "search and destroy").
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Das Gesundheitswesen · Oct 2012
[Quality assurance in coding expertise of hospital cases in the German DRG system. Evaluation of inter-rater reliability in MDK expertise].
The purpose of this study was to evaluate differences in the D-DRG results of a hospital case by 2 independently coding MKD raters. Calculation of the 2-inter-rater reliability was performed by examination of the coding of individual hospital cases. The reasons for the non-agreement of the expert evaluations and suggestions to improve the process are discussed. ⋯ The results of our study demonstrate an almost 70% agreement in the evaluation of hospital cost accounts by 2 independently operating MDK. This result leaves room for improvement. Optimisation potentials can be recognised on the basis of the results. Potential for improvement was established in combination with regular further training and the expansion of binding internal code recommendations as well as exchange of code-relevant information among experts in internal forums. The presented model is in principle suitable for cross-border examinations within the MDK system with the advantage that further trends could be uncovered by more variety and larger numbers of the randomly selected cases.
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Das Gesundheitswesen · Oct 2012
[Inequalities in health risks, morbidity and health care of children by health insurance of their parents (statutory vs. private health insurance): results of the German KiGGS study].
In Germany, differences in health risks, morbidity and health care between children whose parents are insured either in the statutory or in the private health insurance (in German: GKV or PKV respectively) have rarely been studied. Recent studies have shown that adults who are insured in the GKV tend to be less healthy and tend to seek primary health care more frequently than those who are insured in the PKV. The study presented here focuses on the hypothesis that similar inequalities also exist between their children. ⋯ Health risks are usually greater among GKV-insured children as compared with PKV-insured. Concerning morbidity, these differences can mainly be explained by differences in national origin and SES. Efforts aimed at reducing these health differences should therefore focus on risks associated with migration and low SES. In addition, differences concerning risk factors such as smoking could not be explained by differences in national origin and SES. Thus, there seems to be a general need for more preventive measures in the GKV (i.e., independent of national origin and SES).