Impact of early death recording on international comparison of acute myocardial infarction mortality - administrative hospital data study using the example of Germany and the United States.

Background: In-hospital mortality from acute myocardial infarction (AMI) is widely used in international comparisons as an indicator of health system performance. Because of the high risk of early death after AMI, international comparisons may be biased by differences in the recording of early death cases in hospital inpatient data. This study examined whether differences in the recording of early deaths affect international comparisons of AMI in-hospital mortality by using the example of Germany and the United States, and explored approaches to address this issue.

In-hospital mortality and failure to rescue following hepatobiliary surgery in Germany - a nationwide analysis.

Background: Recent observational studies on volume-outcome associations in hepatobiliary surgery were not designed to account for the varying extent of hepatobiliary resections and the consequential risk of perioperative morbidity and mortality. Therefore, this study aimed to determine the risk-adjusted in-hospital mortality for minor and major hepatobiliary resections at the national level in Germany and to examine the effect of hospital volume on in-hospital mortality, and failure to rescue.

Methods: All inpatient cases of hepatobiliary surgery (n = 31,114) in Germany from 2009 to 2015 were studied using national hospital discharge data.

[Definition of Variables in Hospital Discharge Data: Pitfalls and Proposed Solutions].

In Germany, the Diagnosis-Related Group Statistics (DRG Statistics) supply full coverage of inpatient episodes in acute care hospitals. The Research Data Centres of the Federal Statistical Office and the Statistical Offices of the Federal States provide the microdata of the DRG Statistics, namely hospital discharge files of each inpatient case, for scientific research. Hospital discharge data are generated for administrative purposes.

Correction to: Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015.

In the original publication of this article [1], some numbers in the below sentence errors in the Results section of the Abstract.

[Health Care Provision and Volume-Outcome Relationship for Acute Myocardial Infarction: Long-Term Analysis of German Nationwide Hospital Discharge Data 2005-2015].

Background: Studies on acute myocardial infarction have reported that higher hospital volume is associated with better outcomes. In this context, changes of acute hospital care for myocardial infarction and of the volume-outcome relationship were analysed. The aim of this study was to assess developments of hospital care in order to derive approaches for improving care for acute myocardial infarction in German hospitals.

Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015.

Background: In international comparisons, rates of amputations of the lower limb are relatively high in Germany. This study aims to analyze trends in lower limb amputations over time, as well as outcomes of care concerning in-hospital mortality and reamputation rates during the same hospital stay which might indicate the quality of surgical and perioperative health care processes.

Methods: This work is an observational population-based study using complete national hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)) from 2005 to 2015.

Complex gastric surgery in Germany-is centralization beneficial? Observational study using national hospital discharge data.

Purpose: This observational study explored the association between hospital volume and short-term outcome following gastric resections for non-bariatric indication, aiming to contribute to the discussion on centralization of complex visceral surgery in Germany.

Methods: Based on complete national hospital discharge data from 2010 to 2015, the association between hospital volume and in-hospital mortality was evaluated according to volume quintiles and volume deciles. Case-mix differences regarding surgical indication, age, sex, and comorbidities were considered for risk adjustment.

[Volume Growth of Inpatient Treatments for Spinal Disease - Analysis of German Nationwide Hospital Discharge Data from 2005 to 2014].

Background: Marked volume growth of inpatient treatments for spinal disease has been observed since diagnosis related groups (DRG) were introduced as payment for inpatient services in Germany. This study aims to analyse this increase by population and stratified by types of treatment.

Material And Methods: Using German nationwide hospital discharge data (DRG statistics), inpatient treatments for spinal disease with or without surgery were identified.

Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014.

Objectives: To explore the existence and strength of a relationship between hospital volume and mortality, to estimate minimum volume thresholds and to assess the potential benefit of centralisation of services.

Design: Observational population-based study using complete German hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)).

Setting: All acute care hospitals in Germany.

Drug-eluting stents in clinical routine: a 1-year follow-up analysis based on German health insurance administrative data from 2008 to 2014.

Objectives: To describe the use of drug-eluting stents (DESs) in the largest population of statutory health insurance members in Germany, including newly developed bio-resorbable vascular scaffolds (BVSs), and to evaluate 1-year complication rates of DES as compared with bare metal stents (BMSs) in this cohort.

Design: Routine data analysis of statutory health insurance claims data from the years 2008 to 2014.

Setting: The German healthcare insurance Allgemeine Ortskrankenkasse covers approximately 30% of the German population and is the largest nationwide provider of statutory healthcare insurance in Germany.

Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany.

Objective: We aimed to determine the effect of hospital volume on in-hospital mortality, and failure to rescue following major pancreatic resections using hospital discharge data of every inpatient case in Germany.

Summary Background Data: Several studies have found strong volume-outcome relationships in pancreatic surgery, with high mortality in low-volume facilities. However, their datasets were only based on portions of national populations.

[Continuity of hospital identifiers in hospital discharge data - Analysis of the nationwide German DRG Statistics from 2005 to 2013].

Background: In Germany, nationwide hospital discharge data (DRG statistics provided by the research data centers of the Federal Statistical Office and the Statistical Offices of the 'Länder') are increasingly used as data source for health services research. Within this data hospitals can be separated via their hospital identifier ([Institutionskennzeichen] IK). However, this hospital identifier primarily designates the invoicing unit and is not necessarily equivalent to one hospital location.

[Impact of quality measurement, transparency and peer review on in-hospital mortality - retrospective before-after study with 63 hospitals].

Background: In 2008 the 'Initiative Qualitätsmedizin' (initiative for quality in medical care, IQM) was established as a voluntary non-profit association of hospital providers of all kinds of ownership. Currently, about 350 hospitals from Germany and Switzerland participate in IQM. Member hospitals are committed to a quality strategy based on measuring outcome indicators using administrative data, peer review procedures to improve medical quality, and transparency by public reporting.

Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI-analysis of routine statutory health insurance data.

Objectives: We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy.

Design: Retrospective analysis of routine statutory health insurance data between 2010 and 2012.

Main Outcome Measures: Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year.

[Minimum Caseload Requirements and In-hospital Mortality: Observational Study using Nationwide Hospital Discharge Data from 2006 to 2013].

In order to improve hospital care, minimum caseload requirements for certain elective hospital treatments have been defined by law in Germany. This study analyses retrospectively if adherence to this regulation is associated with the outcome of hospital treatment. Differences in in-hospital mortality were analyzed for complex esophageal and pancreatic surgery, liver and kidney transplantation, stem cell transplantation and total knee replacement.

Nationwide In-hospital Mortality Following Pancreatic Surgery in Germany is Higher than Anticipated.

Objective: We aimed to determine the unbiased mortality rates for pancreatic surgery procedures at the national level through a comprehensive analysis of every inpatient case in Germany.

Summary Of Background Data: Several studies have proclaimed a general improvement of perioperative outcomes following pancreatic surgery. These results are challenged by recent analyses of large US databases that found strong volume-outcome relationships, with high mortality in low-volume facilities.

Improving outcomes using German Inpatient Quality Indicators in conjunction with peer review procedures.

Some hospital comparisons seem to generate confusion because different methods of outcome comparisons lead to different results in hospital rankings. This article questions the concept of overall comparisons of hospitals, which are multiproduct enterprises and may have specialties that provide good results in some areas despite having worse outcomes in others. Therefore, the authors argue for a disease specific view of outcome measurement.

[Hospital quality measurement—what matters?].

In Germany, the aims of hospital quality measurement have evolved from intra-professional quality assurance via organisational quality improvement to public reporting. Recently, quality-based purchasing is also discussed as a political option. These developments lead to new requirements for quality measurement which have gained little attention so far.

Achieving minimum caseload requirements--an analysis of hospital discharge data from 2005-2011.

Background: The German Federal Joint Committee (the highest decision-making body of physicians and health insurance funds in Germany) has established minimum caseload requirements with the goal of improving patient care. Such requirements have been in place for five types of surgical procedure since 2004 and were introduced for total knee endoprosthesis surgery in 2006 and for the care of low-birth-weight neonates (weighing less than 1250 g) in 2010.

Method: We analyzed data from German nationwide DRG statistics (DRG = diagnosis-related groups) for the years 2005-2011.

Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011.

Background: The number of hip and knee replacement operations is rising in many industrialized countries. To evaluate the current situation in Germany, we analyzed the frequency of procedures in Germany compared to the USA, with the aid of similar case definitions and taking demographic differences into account.

Methods: We used individual inpatient data from Germany (DRG statistics) and the USA (Nationwide Inpatient Sample) to study differences in the age- and sex-adjusted rates of hip and knee replacement surgery and the determinants of trends in case numbers over the years 2005 to 2011.

Stroke unit care and trends of in-hospital mortality for stroke in Germany 2005-2010.

Background: In Germany, the financing of stroke unit care was implemented into the hospital reimbursement system in 2006. Since then, many acute care hospitals newly implemented stroke units. Simultaneous, in-hospital mortality for stroke declined.