ObjectivesData on patient safety problems (PSPs) in ambulatory care are scarce. The aim of the study was to record the frequency, type, severity and point of origin of PSPs in ambulatory care in Germany.DesignRetrospective cross-sectional study.SettingComputer-assisted telephone interviews with randomly recruited citizens aged ≥40 years in Germany who were asked about their experiences with PSPs in ambulatory care.Participants10 037 citizens ≥40 years.MeasuresA new questionnaire was developed to record patient experiences with PSPs in ambulatory care. The study reported here targets patient experiences in the last 12 months. The questionnaire focuses on PSPs in seven areas of medical treatment: anamnesis/diagnostic procedures; medication; vaccination, injection, infusion; aftercare; outpatient surgery; office administration; other areas. For each PSP reported, detailed questions were asked about the specialist group concerned, and, on the most serious harm, the severity of the harm and its consequences. The target parameters are presented as proportions with 95% CIs.Results1422 of the respondents (14%) reported 2589 PSPs. The areas most frequently affected by PSPs were anamnesis/diagnostic procedures (61%) and medication (15%). General practitioners accounted for 44% of PSPs, orthopaedists for 15% and internists for 10%. 75% of PSPs were associated with harm, especially unnecessarily prolonged pain or deterioration of health; 35% of PSPs led to permanent harm. 804 PSPs (32%) prompted patients to see another doctor for additional treatment; 255 PSPs (10%) required inpatient treatment.ConclusionPSPs experienced by patients are widespread in ambulatory care in Germany. The study reveals in which areas of medical treatment efforts to prevent PSPs could make the greatest contribution to improving patient safety. It also demonstrates the valuable contribution of patient reports to the analysis of PSPs.
This paper investigates the area of the Metropole Ruhr in terms of spatial distributions of environmental factors that can prevent or cause a significantly lower or higher rate of respiratory diseases such as asthma. Environmental factors can have negative impact, like air pollution, and positive, like the access to urban green areas. In the second part of the analysis, the accessibility of pharmacies, hospitals, and medical facilities that offer a special treatment for people with respiratory diseases will be spatially analysed and associated to those detected urban areas of higher and lower prevalence. The results of both approaches are spatially blended with socioeconomic and socio-demographic values of the respective residents. With this it is possible to point out whether accessibility of health facilities is a suitable and equitable for all people diagnosed with asthma regardless of their educational or migration background, their employment rate, salary or age. Consequently, all values will be disaggregated from large spatial units, such as city districts municipalities or neighbourhoods, to small city blocks, to assess large-scale spatial variability. This provides the opportunity of a point-by-point investigation and statistical analysis with a high level of detail that significantly exceeds previous study results. In the sociological context of environmental justice this highly interdisciplinary study contributes to the assessment of fair health conditions for people in densely populated conurbations.
Background
In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Since then, MVRQs were implemented for seven hospital procedures. This study evaluates the effect of a system-wide intermission of MVRQ for total knee arthroplasty (TKA), demanding 50 annual cases per hospital.
Methods
An uncontrolled before–after study based on federal-level data including the number of hospitals performing TKA, and TKA cases from the external hospital quality assurance programme in Germany (2004–2017). Bi- and multivariate analyses based on hospital-level secondary data of TKA cases and TKA quality indicators extracted from hospital quality reports in Germany (2006–2014).
Results
The number of TKAs performed in Germany decreased by 11% after suspending the TKA-MVRQ in 2011, and rose by 13% after its reintroduction in 2015. The number of hospitals with less than 50 cases rose from 10 to 25% and their case share from 2 to 5.5% during suspension. Change in hospital volume after the suspension of TKA-MVRQ was not associated with hospital size, ownership, or region. All four evaluable quality indicators increased significantly in the year after their first public reporting. Compared to hospitals meeting the TKA-MVRQ, three indicators show slight but statistically significant better quality in hospitals below the TKA-MVRQ.
Conclusions
In Germany, TKA-MVRQs seem to induce in-hospital caseload adjustments rather than foster regional inter-hospital case transfers as intended.
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