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[利用索赔数据进行医院护理的小区域分析与控制]

[Using claims data for small area analysis and controlling of hospital care].

作者信息

Swart E, Deh U, Robra B-P

机构信息

Otto-von-Guericke-Universität Magdeburg, Magdeburg, BRD.

出版信息

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Oct;51(10):1183-92. doi: 10.1007/s00103-008-0653-z.

Abstract

In Germany, only few data sources enable a small-area analysis of medical care. However, this is necessary for empirically based planning of future medical care. Here claims data of the statutory health insurance provide new insights into medical care by utilization analysis at district and postal zip code levels. Examples of small-area analysis of hospital care show manifold possibilities of using these data for purposes of health services research and planning. The most important result of these analyses is the considerable variation of hospital care utilization which is constant over time and regions. Claims data are updated regularly, complete, unbiased, and of high quality. They also have a clear reference to population and region. Limitations of using claims data arise from the absence of clinical information. For purposes of hospital planning the restriction to the hospital sector is more important. In the future this limitation will be overcome by using claims data from primary and hospital care together.

摘要

在德国,仅有少数数据源能够支持对医疗保健进行小区域分析。然而,这对于基于实证的未来医疗保健规划而言是必要的。在此,法定健康保险的理赔数据通过在地区和邮政编码层面进行利用分析,为医疗保健提供了新的见解。医院护理小区域分析的示例展示了将这些数据用于卫生服务研究和规划目的的多种可能性。这些分析的最重要结果是医院护理利用情况存在显著差异,且这种差异在时间和区域上保持稳定。理赔数据定期更新、完整、无偏差且质量很高。它们还与人口和地区有明确关联。使用理赔数据的局限性源于缺乏临床信息。对于医院规划而言,局限于医院部门更为重要。未来,通过同时使用初级保健和医院护理的理赔数据,这一局限性将被克服。

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