Ergebnisqualität und Kosten der allgemeinen und spezialisierten Palliativversorgung in Deutschland im regionalen Vergleich: eine GKV-Routinedatenstudie  <span class="so-article-trans-title" dir="auto"> Translated title: A regional comparison of outcomes quality and costs of general and specialized palliative care in Germany: a claims data analysis </span>

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Hintergrund

Wesentliche Rahmenbedingungen für Palliativversorgung (PV) werden auf regionaler Ebene gesetzt. Der Umfang zum Einsatz kommender Versorgungsformen (ambulant, stationär, allgemein, spezialisiert) variiert regional stark. Welche Ergebnisqualität zu welchen Kosten wird mit der in einer KV-Region (Kassenärztliche Vereinigung) angebotenen PV erreicht?

Methoden

Retrospektive Beobachtungsstudie mit BARMER-Routinedaten von 145.372 im Zeitraum 2016–2019 Verstorbenen mit PV im letzten Lebensjahr. Vergleich der KV-Regionen hinsichtlich folgender Outcomes: Anteil palliativ versorgter Menschen, die im Krankenhaus verstarben, potenziell belastende Versorgung in den letzten 30 Lebenstagen (Rettungsdiensteinsätze, [intensivmedizinische] Krankenhausaufenthalte, Chemotherapien, Anlage/Wechsel einer PEG-Sonde, parenterale Ernährung), Gesamtversorgungskosten der letzten 3 Lebensmonate, Kosten der PV(‑Formen) des letzten Lebensjahres, Kosten-Effektivitäts-Relationen sowie Patienten‑/Wohnkreismerkmals-adjustierte Kennzahlen.

Ergebnisse

Die KV-Regionen variierten hinsichtlich der Outcomes (auch adjustiert) der PV deutlich. Über alle Outcomes aggregiert wies Westfalen-Lippe bessere Ergebnisse auf. Die PV-Kosten variierten ebenfalls stark, am stärksten bei spezialisierter ambulanter PV (SAPV). Die günstigste Kosten-Effektivitäts-Relation von Gesamtversorgungskosten zur Sterberate in der Häuslichkeit wies Westfalen-Lippe auf.

Fazit

Regionen mit besserer Ergebnisqualität und günstigerer Kosten-Effektivität können Orientierung für andere Regionen bieten. Es sollte überprüft werden, inwieweit der neue SAPV-Bundesrahmenvertrag die empirischen Erkenntnisse aufgreifen kann. Patientenrelevanten Outcomes sollte stärkeres Gewicht gegeben werden als Parametern, die auf Versorgungsstrukturen abzielen.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-023-03746-9) enthalten.

Translated abstract

Background

The main framework conditions for palliative care are set at the regional level. The scope of the forms of care used (outpatient, inpatient, general, specialized) varies widely. What is the quality of outcomes achieved by the palliative care provided on a federal states level? What are the associated costs of care?

Method

Retrospective observational study using BARMER claims data from 145,372 individuals who died between 2016 and 2019 and had palliative care in the last year of life. Regional comparison with regard to the following outcomes: proportion of palliative care patients who died in the hospital, potentially burdensome care in the last 30 days of life (ambulance calls, [intensive care] hospitalizations, chemotherapy, feeding tubes, parenteral nutrition), total cost of care (last three months), cost of palliative care (last year), and cost-effectiveness ratios. Calculation of patient/resident characteristic adjusted rates, costs, and ratios.

Results

Federal states vary significantly with respect to the outcomes (also adjusted) of palliative care. Palliative care costs vary widely, most strongly for specialized outpatient palliative care (SAPV). Across all indicators and the cost-effectiveness ratio of total cost of care to at-home deaths, Westphalia-Lippe shows favorable results.

Conclusion

Regions with better quality and more favorable cost (ratios) can provide guidance for other regions. The extent to which the new federal SAPV agreement can incorporate the empirical findings should be reviewed. Patient-relevant outcome parameters should be given greater weight than parameters aiming at structures of care.

Related collections

Most cited references 41

Record: found
Abstract: found
Article: not found

Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Bárbara Gomes, Natalia Calanzani, Vito Curiale … (2013)

Background Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. Objectives 1. To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarise the current evidence on cost-effectiveness. Search methods We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home). Main results We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), HIV/AIDS and multiple sclerosis (MS), among other conditions. Meta-analysis showed increased odds of dying at home (odds ratio (OR) 2.21, 95% CI 1.31 to 3.71; Z = 2.98, P value = 0.003; Chi2 = 20.57, degrees of freedom (df) = 6, P value = 0.002; I2 = 71%; NNTB 5, 95% CI 3 to 14 (seven trials with 1222 participants, three of high quality)). In addition, narrative synthesis showed evidence of small but statistically significant beneficial effects of home palliative care services compared to usual care on reducing symptom burden for patients (three trials, two of high quality, and one CBA with 2107 participants) and of no effect on caregiver grief (three RCTs, two of high quality, and one CBA with 2113 caregivers). Evidence on cost-effectiveness (six studies) is inconclusive. Authors' conclusions The results provide clear and reliable evidence that home palliative care increases the chance of dying at home and reduces symptom burden in particular for patients with cancer, without impacting on caregiver grief. This justifies providing home palliative care for patients who wish to die at home. More work is needed to study cost-effectiveness especially for people with non-malignant conditions, assessing place of death and appropriate outcomes that are sensitive to change and valid in these populations, and to compare different models of home palliative care, in powered studies. PLAIN LANGUAGE SUMMARY Effectiveness and cost-effectiveness of home-based palliative care services for adults with advanced illness and their caregivers When faced with the prospect of dying with an advanced illness, the majority of people prefer to die at home, yet in many countries around the world they are most likely to die in hospital. We reviewed all known studies that evaluated home palliative care services, i.e. experienced home care teams of health professionals specialised in the control of a wide range of problems associated with advanced illness – physical, psychological, social, spiritual. We wanted to see how much of a difference these services make to people's chances of dying at home, but also to other important aspects for patients towards the end of life, such as symptoms (e.g. pain) and family distress. We also compared the impact on the costs with care. On the basis of 23 studies including 37,561 patients and 4042 family caregivers, we found that when someone with an advanced illness gets home palliative care, their chances of dying at home more than double. Home palliative care services also help reduce the symptom burden people may experience as a result of advanced illness, without increasing grief for family caregivers after the patient dies. In these circumstances, patients who wish to die at home should be offered home palliative care. There is still scope to improve home palliative care services and increase the benefits for patients and families without raising costs.

0 comments Cited 205 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Estimating predicted probabilities from logistic regression: different methods correspond to different target populations.

Clemma J Muller, Richard F MacLehose (2014)

We review three common methods to estimate predicted probabilities following confounder-adjusted logistic regression: marginal standardization (predicted probabilities summed to a weighted average reflecting the confounder distribution in the target population); prediction at the modes (conditional predicted probabilities calculated by setting each confounder to its modal value); and prediction at the means (predicted probabilities calculated by setting each confounder to its mean value). That each method corresponds to a different target population is underappreciated in practice. Specifically, prediction at the means is often incorrectly interpreted as estimating average probabilities for the overall study population, and furthermore yields nonsensical estimates in the presence of dichotomous confounders. Default commands in popular statistical software packages often lead to inadvertent misapplication of prediction at the means. Using an applied example, we demonstrate discrepancies in predicted probabilities across these methods, discuss implications for interpretation and provide syntax for SAS and Stata. Marginal standardization allows inference to the total population from which data are drawn. Prediction at the modes or means allows inference only to the relevant stratum of observations. With dichotomous confounders, prediction at the means corresponds to a stratum that does not include any real-life observations. Marginal standardization is the appropriate method when making inference to the overall population. Other methods should be used with caution, and prediction at the means should not be used with binary confounders. Stata, but not SAS, incorporates simple methods for marginal standardization. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

0 comments Cited 202 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.

B. Gomes, I.J. Higginson, N Calanzani … (2012)

Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally. A telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying. Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal). At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.

0 comments Cited 201 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Antje Freytag: antje.freytag@med.uni-jena.de

Journal

Journal ID (nlm-ta): Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz

Journal ID (iso-abbrev): Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz

Title: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1436-9990

ISSN (Electronic): 1437-1588

Publication date (Electronic): 3 August 2023

Publication date PMC-release: 3 August 2023

Publication date (Print): 2023

Volume: 66

Issue: 10

Pages: 1135-1145

Affiliations

[1 ]Institut für Allgemeinmedizin, Universitätsklinikum Jena, ( https://ror.org/035rzkx15) Bachstr. 18, 07743 Jena, Deutschland

[2 ]Zentrum für Klinische Studien, Universitätsklinikum Jena, ( https://ror.org/035rzkx15) Jena, Deutschland

[3 ]Klinik für Palliativmedizin, Universitätsmedizin Göttingen, ( https://ror.org/021ft0n22) Göttingen, Deutschland

[4 ]BARMER Institut für Gesundheitssystemforschung, Wuppertal, Wuppertal, Deutschland

[5 ]Gesundheitsökonomie und -management, Rechts- und Wirtschaftswissenschaftliche Fakultät, Universität Bayreuth, ( https://ror.org/0234wmv40) Bayreuth, Deutschland

[6 ]Oberender AG, Bayreuth, Bayreuth, Deutschland

[7 ]Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, ( https://ror.org/00f2yqf98) Hannover, Deutschland

[8 ]Abteilung für Allgemeinmedizin (AM RUB), Medizinische Fakultät, Ruhr-Universität Bochum, ( https://ror.org/04tsk2644) Bochum, Deutschland

[9 ]Abteilung Palliativmedizin der Klinik für Innere Medizin II, Universitätsklinikum Jena, ( https://ror.org/035rzkx15) Jena, Deutschland

Article

Publisher ID: 3746

DOI: 10.1007/s00103-023-03746-9

PMC ID: 10539464

PubMed ID: 37535086

SO-VID: e74290cc-7935-4644-ba2f-a1bd2de58bab

License:

Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

Die in diesem Artikel enthaltenen Bilder und sonstiges Drittmaterial unterliegen ebenfalls der genannten Creative Commons Lizenz, sofern sich aus der Abbildungslegende nichts anderes ergibt. Sofern das betreffende Material nicht unter der genannten Creative Commons Lizenz steht und die betreffende Handlung nicht nach gesetzlichen Vorschriften erlaubt ist, ist für die oben aufgeführten Weiterverwendungen des Materials die Einwilligung des jeweiligen Rechteinhabers einzuholen.

Weitere Details zur Lizenz entnehmen Sie bitte der Lizenzinformation auf http://creativecommons.org/licenses/by/4.0/deed.de.

History

Date received : 23 February 2023

Date accepted : 23 June 2023

Funding

Funded by: Universitätsklinikum Jena (8979)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

Keywords: versorgung am lebensende,versorgungsqualität,kosten-effektivität,sekundärddaten,kleinräumige analysen,end-of-life care,quality of care,cost-effectiveness,secondary data,small-scale analysis

Data availability:

Keywords: versorgung am lebensende, versorgungsqualität, kosten-effektivität, sekundärddaten, kleinräumige analysen, end-of-life care, quality of care, cost-effectiveness, secondary data, small-scale analysis

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Ergebnisqualität und Kosten der allgemeinen und spezialisierten Palliativversorgung in Deutschland im regionalen Vergleich: eine GKV-Routinedatenstudie Translated title: A regional comparison of outcomes quality and costs of general and specialized palliative care in Germany: a claims data analysis

Read this article at

Abstract

Hintergrund

Methoden

Ergebnisse

Fazit

Zusatzmaterial online

Translated abstract

Related collections

HTWK Leipzig / OA-HVerlag

Most cited references 41

Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Estimating predicted probabilities from logistic regression: different methods correspond to different target populations.

Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain.

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 227

Cited by 3

Most referenced authors 677