Health Economics

Project: OptiStruk – Optimal allocation of patients to specialist departments in hospitals according to structural quality

Project Duration

06/2018 - 11/2020 (current)

Commissioned by

Innovationsausschuss beim Gemeinsamen Bundesausschuss

Project Team (RWI)

Prof. Dr. Boris Augurzky (Chief), Alexander Haering , Christiane Wuckel, Prof. Dr. Ansgar Wübker (Chief)

Cooperation

BKK Dachverband, Hochschule Anhalt, Zentralinstitut für die Kassenärztliche Versorgung in Deutschland

Leader of Consortium

RWI

Summary

German health policy aims to improve the quality of inpatient care and reduce overcapacity in the hospital market. In order to achieve this goal, health policy increasingly taking quality indicators into account in hospital planning and hospital remuneration. In this paper we develop a quality indicator aiming at measuring whether patients are being treated in the "right" department. In a first step, using the Delphi method, we develop an algorithm that detects whether or not a patient was assigned to the most suitable hospital department conditional on specific symptoms. The primary and secondary diagnosis of the ICD?10 classification and the operation and procedure code (OPS) form the basis for the assignment rules. We focus on two highly relevant and medically clearly distinguishable ICD?groups, I20?I25 (Ischemic Heart Disease) and I64 (Cerebral Infarction). In a second step, using administrative data of one of the largest German public health insurer for the years 2013 to 2019, we evaluate the patient outcome. Preliminary analyses show that there are large differences in quality between German hospitals and that there is considerable scope for structural improvements. The quality indicator might be used to identify misoccupations of hospitals/specialist departments and could guide patient hospital choice.

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