Project Details

People in need of long-term care are often affected by multimorbidity, and self-determined access to statutory health insurance (SHI) services can be difficult for them. Measuring and ensuring the quality of ambulatory medical care for this group of people is therefore of particular importance. To date, there is no population-specific quality monitoring in Germany. SHI claims data, originally collected for billing purposes, represent a potential data source for monitoring the quality of ambulatory care for people in need of long-term care.

This cumulative dissertation examines the possibilities and limitations for monitoring the ambulatory medical quality of care of people in need of long-term care using routine SHI claims data in Germany. Based on a systematic review and two secondary analyses of SHI claims data of the AOK, it is shown that i) a broad selection of internationally tested quality indicators for the mapping of ambulatory care quality based on SHI claims data is available, ii) a population-specific mapping of selected quality aspects based on SHI claims data is feasible, iii) differences in care quality are to the disadvantage of older people when their place of living and care status are considered, and iv) that there are associations between the individual quality of care in multimorbid populations in need of long-term care and institutionalization. In addition, a status quo of the ambulatory quality of care of people in need of long-term care in Germany is described based on SHI claims data.

A theoretical framework for a population-specific monitoring is provided by the Chronic Care Model (CCM), which provides arguments for the beneficial integration of SHI claims data into information systems and the organization and design of health care.