PDF(Pubmed)
Abstract：
BACKGROUND: In 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed. Quality indicators (QIs) can serve to measure and transparently present the quality of evidence-based care. Comparing results in the form of audit and feedback has been shown to improve e.g. guideline-compliant ambulatory care. Existing QIs targeting the care of gon- and coxarthrosis mainly focus on discharge management after joint replacement surgery and/or require additional data collection. Therefore, as part of the MobilE-ARTH project, a set of QIs for ambulatory care prior to joint replacement surgery calculable based on routine data is being developed. The present study\'s aim is to evaluate the impact of this QI set in terms of providing feedback on the quality of care.
METHODS: The MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set\'s effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach.
CONCLUSIONS: Feedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments.
BACKGROUND: German Clinical Trials Register, number DRKS00027516 , Registered 25th January 2022 - Prospectively registered.
METHODS: The MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set\'s effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach.
CONCLUSIONS: Feedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments.
BACKGROUND: German Clinical Trials Register, number DRKS00027516 , Registered 25th January 2022 - Prospectively registered.
摘要：
背景：2019年，德国的髋关节置换手术率最高，在30多个经合组织国家中，膝关节置换手术率第四高。年龄标准化的比率估计为每100,000人174髋关节和137膝关节置换。在这种背景下,我们反复讨论了手术的经济激励措施和非手术治疗方案的缺失激励措施之间的对比.质量指标（QI）可以用来衡量和透明地呈现循证护理的质量。以审核和反馈的形式比较结果已被证明可以改善例如符合指南的动态护理。针对关节和髋关节病的现有QI主要集中在关节置换手术后的出院管理和/或需要额外的数据收集。因此,作为MobilE-ARTH项目的一部分,目前正在开发一套可根据常规数据计算的关节置换手术前门诊护理的QI.本研究的目的是评估该QI集在提供有关护理质量的反馈方面的影响。
方法：MobilE-ARTH项目包括（阶段1）按照RAND/UCLA适当性方法开发QI集，(第2阶段)在未来的德国法定健康保险(SHI)的既定医师网络中实施QI，非致盲,集群随机试点研究，和(阶段3)评估QI集的有效性。干预网络中的医生将（a）收到反馈报告，提供有关其关节和/或关节病患者的常规基于数据的QI的信息以及其网络的汇总结果，(b)被邀请参加两名自愿参加的活动，促进网络会议。在这些网络会议中，医师可以使用反馈报告中提供的信息来讨论针对关节和/或髋关节病患者的多专业护理途径.QI集的选定指标将作为主要和次要结果指标。将使用意向治疗方法在多级模型中分析常规数据。
结论：反馈报告有助于保持临床标准，缩小证据与医疗实践之间的差距，从而使医疗保健得到全面改善。为医生提供基于QI的护理质量信息可促进识别医学治疗中的优势和劣势。
背景：德国临床试验注册，编号DRKS00027516,2022年1月25日注册-前瞻性注册。
方法：MobilE-ARTH项目包括（阶段1）按照RAND/UCLA适当性方法开发QI集，(第2阶段)在未来的德国法定健康保险(SHI)的既定医师网络中实施QI，非致盲,集群随机试点研究，和(阶段3)评估QI集的有效性。干预网络中的医生将（a）收到反馈报告，提供有关其关节和/或关节病患者的常规基于数据的QI的信息以及其网络的汇总结果，(b)被邀请参加两名自愿参加的活动，促进网络会议。在这些网络会议中，医师可以使用反馈报告中提供的信息来讨论针对关节和/或髋关节病患者的多专业护理途径.QI集的选定指标将作为主要和次要结果指标。将使用意向治疗方法在多级模型中分析常规数据。
结论：反馈报告有助于保持临床标准，缩小证据与医疗实践之间的差距，从而使医疗保健得到全面改善。为医生提供基于QI的护理质量信息可促进识别医学治疗中的优势和劣势。
背景：德国临床试验注册，编号DRKS00027516,2022年1月25日注册-前瞻性注册。
