Evaluation of Participants Characteristics and Health Economic Aspects of Outpatient Disease Management Programs (DMP) for Chronic Heart Disease Patients in Germany
Notice bibliographique
Résumé
Background: In Germany, the first DMP for patients with chronic heart disease was introduced in 2005. Sickness funds are obligated by the Social Security Code to evaluate DMP. However, due to conditions of DMP in Germany high quality evaluations are hardly practicable. For example: the linkage of the DMP with the risk adjustment scheme forces the sickness funds to enrol any potential candidate for the DMP as fast as possible. Thus randomised comparisons of DMP vs. non-DMP are virtually impossible. Objective: The objective of this study is to investigate quality of care between DMP vs. non-DMP patients systematically. Furthermore, the size and sociodemographic characteristics of the inscription rate of people with chronic heart disease in DMP will be analysed. Methods: The database is the population-based KORA (Kooperative Gesundheitsforschung in der Region Augsburg) Myocardial Infarction Register, which registered all patients with an acute myocardial infarction (AMI) treated in hospital between 1985 and 2004. All 24-hours surviving AMI-patiens were interviewed while they were in hospital and after discharge in a concluding chart review treatment data were gathered. A follow up survey of all 4392 registered alive persons was performed by autumn 2006. The postal questionnaire included in particular information on sociodemographic characteristics (age, sex, education), medical condition (diabetes, state of health), process parameters (physician counselling for smoking, nutrition, physical activity and medication) and quality of life (EQ-5D). The data were analysed using a logistic regression model. Results: The response rate of the study was over 65%, which resulting in a sample size of 2950 individuals. At the time of the investigation about one third of the study population were inscribed in DMP. Our first findings suggest that there is a difference in quality of care between patients inscribed in DMP vs. standard treatment (non-DMP). The pysician counselling for smoking, nutrition and physical activity of DMP patients are significantly higher than for non-DMP patients. Furthermore, the investigation did show scarcely significant differences between DMP and non DMP-group with regard to age, sex and quality of life (EQ-5D). Conclusions: Based on this regional cross sectional survey, DMP seems to have positive effects according to quality of care. The inscription decision seems to be less related to basic socio-demographic characteristics, which points to a broad acceptance within the target population.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».