[Requirements for the provision of healthcare to socially disadvantaged population groups: evaluation of 10 years of medical care provided to the homeless in Hanover].

In 2007, the German Federal Government introduced a general health insurance obligation, but there are still vulnerable groups such as poor and homeless people without access to medical care. Especially for social fringe groups, a visit to the doctor involves many obstacles. Ten years ago the project "Outreach medical care for homeless people and people threatened by homelessness in Hanover" was established in order to reduce those gaps in healthcare provision.

Maternal near-miss among women with a migrant background in Germany.

Objective: To examine the association between region of origin and severe illness bringing a mother close to death (near-miss).

Design: Retrospective cohort study.

Setting: Maternity units in Lower Saxony, Germany.

[State-wide follow-up of extremely preterm infants: a model of cross-sectoral quality analysis].

A long-term outcome project for the special high-risk group of extremely preterm (ELBW) infants has been established in the federal state of Lower Saxony, which is unique in Germany. All departments of neonatology and all divisions of paediatric neurology are participating. Since October 2004 children who were born at <28 weeks gestation are examined using a standardised concept at defined follow-up intervals (at the age of 6 months, 2, 5 and 10 years).

[Benchmarking to evaluate the care of patients with cystic fibrosis: an established tool to improve patient care].

Benchmarking, i.e. learning from the best, by means of appropriate and established quality indicators is one of the central management tools to improve patient care in the field of cystic fibrosis in Germany.

Benchmarking improves quality in cystic fibrosis care: a pilot project involving 12 centres.

Objective: Health care quality monitoring has been introduced in cystic fibrosis (CF) by a few groups and national registries. Based upon this, continuous quality improvement can be achieved by applying the benchmarking method which is focused on learning from best practice.

Setting: A group of 12 CF centres in Germany, treating a total of 1200 patients of all ages, enrolled in a nationwide pilot benchmarking project from 2004 to 2007.

Self-testing of vaginal pH to prevent preterm delivery: a controlled trial.

Background: From 2004 to 2006, in a model project carried out by four German health insurers, expectant mothers were offered self-testing of vaginal pH in order to prevent preterm delivery. They were given pH test gloves on request so that they could measure their vaginal pH twice a week from the 12(th) to the 32(nd) week of gestation. They were instructed to consult with a gynecologist after any positive result.

The impact of the time interval between two successive deliveries in an obstetric unit in terms of the mode of each delivery and the rate of perinatal mortality.

Objective: To analyze the relationship of the time interval between two deliveries, done by one obstetric team, on the delivery mode of the subsequent birth; to define the length of this interval; and to evaluate this time interval as a risk factor for increased perinatal mortality in a population-based cohort.

Methods: All singleton deliveries at ≥ 24 weeks' gestation in Lower Saxony, Germany, between 2001 and 2005 (a total of 317,663 deliveries including 402 cases of perinatal mortality) were analyzed. The mode of the previous and the subsequent delivery, the time interval between the two deliveries, the time of birth, the hospital volume, and the existence of an affiliated neonatal ward were investigated.

Head injury in Germany: A population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas.

Introduction: Little is known about the ratio of mild traumatic brain injury (TBI) to moderate and severe TBI, about the time that elapses until primary care is given, about the number of patients requiring immediate surgery and about the early outcome and the costs.

Method: In a prospective study two regions taken as model examples were investigated: the City of Hanover with its surrounding catchment area and Münster with its regions.

Results: From 1 March 2000 until 28 February 2001 all patients were recruited who were admitted to a hospital emergency department due to a TBI; 6783 patients (58.

[In-house team seminars: working together as a team--from data and statistics to quality development].

The concept of the "ZQ In-house Seminars" provided by external trainers/experts pursues the specific aim to enable all healthcare staff members of hospital departments to analyse statistical data--especially from external quality measurements--and to initiate in-hospital measures of quality improvement based on structured team work. The results of an evaluation in Lower Saxony for the period between 2004 and 2008 demonstrate a sustainable increase in outcome quality of care and a strengthening of team and process orientation in clinical care.

Does underutilization of prenatal care explain the excess risk for stillbirth among women with migration background in Germany?

Objective: To explore the role of utilization of prenatal care on the risk for stillbirth among women with migration background in Germany by comparing stillbirth rates of women from different origins characterized by adequate and inadequate utilization of prenatal care to German women with adequate utilization of care.

Design: Retrospective cohort study.

Setting: Lower Saxony, Germany.

Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents' first pregnancies.

Background: Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth.

Obstetrical volume and early neonatal mortality in preterm infants.

Objective: Regionalised perinatal care with antenatal transfer of high risk pregnancies to Level III centres is beneficial. However, levels of care are usually not linked to caseload requirements, which remain a point for discussion. We aimed to investigate the impact of annual delivery volume on early neonatal mortality among very preterm births.

Hospital volume and neonatal mortality among very low birth weight infants.

Background: Very low birth weight infants (< 1500 g) are at increased mortality risk. Data on the impact of NICU volume are sparse, in comparison with those on the level of care. We hypothesized that neonatal mortality would be higher in small NICUs (< 36 very low birth weight admissions per year) than in large NICUs, with adjustment for volume of the delivery unit.

The role of mediating factors in the association between social deprivation and low birth weight in Germany.

This study examines whether the association between social inequalities and low birth weight (LBW) (occurring in both pre- and full-term births) in Germany can be explained by several potentially confounding factors. These include maternal age, occupational status, marital status, nationality, employment status, smoking, prenatal care, psychosocial stress, obesity, short stature, short inter-pregnancy interval, chronic conditions, and several obstetrical risk factors such as pregnancy induced hypertension. We also examined how the risk for LBW varies over time within each socioeconomic group.

The German electronic doctor's license: the introduction of a health professional card.

The rapid increase of the use of electronic communication in the healthcare sector in the last decade made it more and more important to implement an appropriate general security infrastructure. Improved security is necessary for both patients and health professionals. One corner stone in all these concepts is the introduction of the so-called Health Professional Card as an important security tool.