Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care–Sensitive Conditions in Germany

Pollmanns, Johannes; Romano, Patrick S.; Weyermann, Maria; Geraedts, Max; Drösler, Saskia E.

doi:10.1111/1475-6773.12680

Cited by 18 publications

(17 citation statements)

References 52 publications

(94 reference statements)

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“…Eight studies were excluded, because they used ICD codes only (Albrecht et al 2016 [14]; Fortin et al 2017 [15]; Schwarzkopf et al 2016 [16]), or because they only reported the study protocol (Josephs et al 2017 [17]), or because they did not differentiate between asthma and COPD (Marrie et al 2016 [18]; Oelsner et al 2016 [19]). One publication was excluded, because it duplicated another publication (Vozoris et al 2016 [20]), and one study was excluded, because it investigated a different disease (Pollmanns et al 2018 [21]). Finally, 38 studies were included in the review as one study was identified by hand search.…”

Section: Resultsmentioning

confidence: 99%

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

Gothe

Bukumirić²,

Vukicevic³

et al. 2019

BMC Health Serv Res

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BackgroundChronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence and disease burden through routine insurance data is challenging because of under-diagnosis and under-treatment, particularly for early stage disease in health care systems where outpatient International Classification of Diseases (ICD) diagnoses are not collected. This poses the question of which criteria are commonly applied to identify COPD patients in claims datasets in the absence of ICD diagnoses, and which information can be used as a substitute. The aim of this systematic review is to summarize previously reported methodological approaches for the identification of COPD patients through routine data and to compile potential criteria for the identification of COPD patients if ICD codes are not available.MethodsA systematic literature review was performed in Medline via PubMed and Google Scholar from January 2000 through October 2018, followed by a manual review of the included studies by at least two independent raters. Study characteristics and all identifying criteria used in the studies were systematically extracted from the publications, categorized, and compiled in evidence tables.ResultsIn total, the systematic search yielded 151 publications. After title and abstract screening, 38 publications were included into the systematic assessment. In these studies, the most frequently used (22/38) criteria set to identify COPD patients included ICD codes, hospitalization, and ambulatory visits. Only four out of 38 studies used methods other than ICD coding. In a significant proportion of studies, the age range of the target population (33/38) and hospitalization (30/38) were provided. Ambulatory data were included in 24, physician claims in 22, and pharmaceutical data in 18 studies. Only five studies used spirometry, two used surgery and one used oxygen therapy.ConclusionsA variety of different criteria is used for the identification of COPD from routine data. The most promising criteria set in data environments where ambulatory diagnosis codes are lacking is the consideration of additional illness-related information with special attention to pharmacotherapy data. Further health services research should focus on the application of more systematic internal and/or external validation approaches.

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Section: Resultsmentioning

confidence: 99%

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

Gothe

Bukumirić²,

Vukicevic³

et al. 2019

BMC Health Serv Res

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“…On the other hand, claims data are primarily collected for reimbursement purposes and not for morbidity estimation and are known to overestimate the true epidemiological prevalence, in particular, if a case definition is only based on a single diagnosis. Previous research on asthma and COPD based on routine data thus applies a more conservative case definition 21,22,[31][32][33] . Furthermore, per case definition (i.e., diagnoses in at least two different quarters), patients with concurrent asthma/COPD diagnoses have higher rates of health care contacts, in particular, if patients visit different physicians as compared to controls.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany

Akmatov¹,

Ermakova

Holstiege³

et al. 2020

Sci Rep

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The aim of this study was to estimate the prevalence of concurrent diagnoses of asthma/COPD and examine its full spectrum of comorbid disorders in Germany. We used nationwide outpatient claims data comprising diagnoses of all statutory health insurees (40+ years) in 2017 (N = 40,477,745). The ICD-10 codes J44 (COPD) and J45 (asthma) were used to identify patients. The odds of 1,060 comorbid disorders were examined in a case–control study design. Of all insurees, 4,632,295 (11%) were diagnosed with either asthma or COPD. Of them, 43% had asthma only, 44% COPD only and 13% both diseases. The prevalence of concurrent asthma/COPD was 1.5% with a slightly higher estimate among females than males (1.6% vs. 1.4%) and constant increase by age in both sexes. Comorbid disorders were very common among these patients. 31 disorders were associated with a strong effect size (odds ratio > 10), including other respiratory diseases, but also bacterial (e.g., mycobacteria, including tuberculosis) and fungal infections (e.g., sporotrichosis and aspergillosis). Patients with concurrent asthma/COPD suffer from comorbid disorders involving various body systems, which points to the need of a multidisciplinary care approach. Regular screening for common comorbid disorders may result in better clinical course and prognosis as well as improvement of patients’ quality of life.

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“…Fürsorgepersonen anzustreben, um der komplexen Kausalität der potenziellen ASK zu entsprechen [17]. Wird dagegen das ASK-Konzept als ein Monitoring-Instrument angesehen, besteht weiterer Forschungsbedarf, um die regionale Veränderung der ASK-Prävalenz zu erklären [8,15,28].…”

Section: Ansatzunclassified

Ambulant-sensitive Krankenhausfälle in Deutschland – Abgrenzung, Prävalenz und Kosten

Kurte¹,

Blankart²

2019

Gesundh ökon Qual manag

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Zusammenfassung Zielsetzung Ambulant-sensitive Krankenhausfälle (ASK) bezeichnen Hospitalisierungen, welche durch zugängliche und qualitativ hochwertige ambulante Maßnahmen vermeidbar wären. Ziel der Arbeit ist es, katalogbasierte Abgrenzungsansätze von ASK für Deutschland zu ermitteln sowie die Prävalenz und Kosten von ASK zu identifizieren. Methodik Eine systematische Literaturrecherche wurde im März 2018 in den Datenbanken MEDLINE und Web of Science durchgeführt. Publikationen wurden identifiziert, die einen Gesamtkatalog ambulant-sensitiver Diagnosen betrachten und Prävalenz oder Kosten von ASK ermitteln. Ergänzend wurde eine Vorwärts- und Rückwärtssuche identifizierter Studien durchgeführt. Ergebnisse Basierend auf 10 Publikationen wurden drei Abgrenzungsansätze identifiziert, bei deren Vergleich hohe Heterogenität in der ASK-Abgrenzung bezüglich eingeschlossener Diagnosen erkennbar wird. Das differenzierte Vorgehen bei der ASK-Kodierung spiegelt sich in hohen Spannweiten in Bezug auf die Prävalenz und den Kosten von ASK wider. Schlussfolgerung Die Heterogenität der Abgrenzungsansätze macht eine Überprüfung der Übertragbarkeit in den jeweiligen Versorgungskontext in Bezug auf die Auswahl ASK-relevanter Diagnosen, Vermeidbarkeit und Risikoadjustierung notwendig.

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Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care–Sensitive Conditions in Germany

Abstract: Unadjusted ACSH rates should be used with caution for high-stakes public reporting as differences in prevalence may have a marked impact. Prevalence adjustment should be considered in models analyzing ACSH.

Cited by 18 publications

References 52 publications

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review

Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany

Ambulant-sensitive Krankenhausfälle in Deutschland – Abgrenzung, Prävalenz und Kosten

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