Projektdetails
Avoiding admission to nursing home: Onset of long-term inpatient care and its predictors in care, housing and support situation - population-based cohort study
Dr. Dirk Peschke (Projektleitung);
Description
Research questions
1. what influence do health status, SHI care received, housing and support situation have on people in need of care remaining in their own homes?
2. what influence does the treatment quality of care communities have on people in need of care remaining in their own homes?
3. to what extent do the direct healthcare costs of SHI care that supports people to remain in their own homes differ from those of average care?
Research process
The study analyses data from the past ten years. Insured persons who received care services for the first time in 2006 and who lived in their own home at the beginning of their need for care are included.
The project analyses so-called routine data from the AOK from all over Germany. This billing data is routinely collected by all health insurance funds. To measure the quality of care, the study uses proven, disease-specific indicators. Further information, for example on the general state of health or the housing situation from MDK reports to determine the need for care, supplements the data material analysed.
Objectives
People in need of care whose outpatient care in their own four walls is covered by statutory health insurance often run the risk of having to switch to inpatient residential care.The "Avoiding institutionalisation" project aims to find out which quality features of the health care provided by statutory health insurance contribute to people with care needs being able to live at home for as long as possible. In addition, characteristics in the living and support situation of people in need of care are to be identified that promote living in one's own home for as long as possible. For this purpose, criteria that are already routinely collected by the Medical Service of the Health Insurance Funds (MDK) during the assessment are analysed.
Methods
A retrospective longitudinal study with an observation period of ten years and two analytical approaches (I and II) is being conducted. Analysis I has a personalised approach, in which the unit of analysis is the insured person.Analysis II has a population-based approach, in which the unit of analysis is the healthcare community, which is responsible for the treatment of disjoint populations of insured persons.
The study population consists of AOK-insured persons (age ≥ 65 years) who became in need of care in 2006 and receive outpatient services according to SGB XI (N=157,677). Anonymised health insurance routine data from the AOK from the whole of Germany is used. They provide a comprehensive, detailed and time-related picture of service utilisation and morbidity. This body of data is supplemented by anonymised MDK reports to determine the need for long-term care with detailed information on the living situation and functional state of health, among other things.
The data is analysed using descriptive presentations, univariate and multivariate evaluation methods, with a particular focus on time series analyses (Cox regressions, etc.).
Results
The following results are expected:
- Descriptive presentation of selected characteristics of the insured population, the MDK care assessments and the reconstructed care communities
- multivariate and person-level correlation measures between the time from the start of the need for long-term care to the start of any necessary inpatient long-term care and
the functional health status
the housing situation
the utilisation of existing rehabilitation potential
the illnesses justifying care and other existing illnesses
the quality of care
the continuity of care
illnesses that occur after the start of the need for care
multivariate, risk-adjusted correlation measures determined taking into account the care community between the time from the start of the need for long-term care to the start of any necessary long-term inpatient care and
structural characteristics in the care communities
characteristics of the care processes and outcomes in the care communities
the continuity of care
the treatment regimens
exploratively determined treatment characteristics that are not yet the subject of guideline recommendations
Treatment costs and their relationship to effectiveness in preventing admissions to nursing homes
Further information
Journal article refereed
Seibert, K.; Stiefler, S.; Domhoff, D.; Wolf-Ostermann, K.; Peschke, D., 2022: The influence of primary care quality on nursing home admissions in a multimorbid population with and without dementia in Germany: a retrospective cohort study using health insurance claims data, in: BMC Geriatrics, 22 (52), doi:10.1186/s12877-021-02731-8, 14.01.2022, Link (Status: 10.02.2022)
Domhoff, D.; Seibert, K.; Stiefler, S.; Wolf-Ostermann, K.; Peschke, D., 2022: Associations between quality of care in informal provider networks and nursing home admissions in Germany: results of a retrospective cohort study using German health claims data, in: Applied Network Science, 7 (25), doi:10.1007/s41109-022-00462-2, 04.05.2022, Link (as at: 17.05.2022)
Stiefler, S.; Seibert, K.; Domhoff, D.; Wolf-Ostermann, K.; Peschke, D., 2022: Predictors for entry into a nursing home with existing need for long-term care - A secondary data analysis in longitudinal design, in: Das Gesundheitswesen, 84 (2), S. 139 - 153, doi:10.1055/a-1276-0525, 01.04.2021
Domhoff, D.; Seibert, K.; Stiefler, S.; Wolf-Ostermann, K.; Peschke, D., 2021: Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care, in: BMC Health Services Research, 21 (190), doi:10.1186/s12913-021-06196-8, Link (as of 18 March 2021)
Stiefler, S.; Seibert, K.; Domhoff, D.; Peschke, D., 2021: Präventionspotenziale bei älteren pflegebedürftigen Menschen im häuslichen Setting, in: Public Health Forum, 29 (3), S. 194 - 197, doi:10.1515/pubhef-2021-0053, 04.09.2021, Link (Status: 15.06.2022)
Seibert, K.; Stiefler, S.; Domhoff, D.; Wolf-Ostermann, K.; Peschke, D., 2020: Ambulante Versorgungsqualität im Kontext von Alter und Pflegebedürftigkeit - Ergebnisse einer Querschnittsanalyse von GKV-Routinedaten aus Deutschland, in: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen (155), S. 17 - 28, doi:10.1016/j.zefq.2020.06.0, 05.10.2020, Link (as of: 05.10.2020)
Stiefler, S.; Seibert, K.; Domhoff, D.; Görres, S.; Wolf-Ostermann, K.; Peschke, D., 2020: Factors influencing entry into a nursing home with existing need for care - a systematic review, in: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitsweesen, 153-154, S. 60 - 75, doi:10.1016/j.zefq.2020.05.0, 13.06.2020, Link (Status: 05.10.2020)
Seibert, K.; Stiefler, S.; Domhoff, D.; Wolf-Ostermann, K.; Peschke, D., 2019: Systematic literature review on population-based indicators of quality of care in formal and informal care networks and their use in health economic evaluations, in: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, (forthcoming), doi:10.1016/j.zefq.2019.06.004
Journal articleSeibert, K.; Stiefler, S.; Domhoff, D.; Peschke, D., 2017: A systematic review on population-based indicators of quality of care (QoC) in provider networks and their application in health economic evaluations, in: PROSPERO: International prospective register of systematic reviews, 2017 (CRD4201706), 10.05.2017, Link (Status: 12.06.2017)Stiefler, S.; Domhoff, D.; Seibert, K.; Peschke, D., 2017:Influencing factors on ongoing residency at home despite need of care: a systematic review, in: PROSPERO: International prospective register of systematic reviews, Link (as of 31/08/2017)
Presentation / Poster
Peschke, D.; Stiefler, S.; Seibert, K.; Domhoff, D.; Wolf-Ostermann, K., 2020: Physiotherapeutic care for people with urinary incontinence in Germany, German Congress for Health Services Research 2020, Berlin, Germany, 30 September 2020
Seibert, K.; Domhoff, D.; Stiefler, S.; Wolf-Ostermann, K.; Peschke, D., 2020: Relationships between characteristics of outpatient care quality and nursing home admission - results of a retrospective cohort study based on SHI routine data, German Congress for Health Services Research 2020, Berlin, Germany, 01 October 2020
Domhoff, D.; Seibert, K.; Stiefler, S.; Peschke, D., 2019: Identification of service provider clusters in SHI routine data through patient sharing networks, AGENS MethodenWorkshop 2019, Magdeburg, Germany, 28/02/2019
Domhoff, D.; Peschke, D., 2019: Regional differences in functionally defined networks of healthcare providers, Annual Conference 2019 of the German Society for Demography , Bamberg, Germany, 14 March 2019
Peschke, D.; Stiefler, S.; Domhoff, D.; Seibert, K.; Kimmel, A.; Günster, C.; Wolf-Ostermann, K., 2016: Record Linkage im Projekt "Heimeintritt vermeiden", German Congress for Health Services Research, Berlin, United Kingdom, 05 October 2017