Seibert Kathrin, Stiefler Susanne, Domhoff Dominik, Wolf-Ostermann Karin, Peschke Dirk
Universität Bremen, Fachbereich 11: Human- und Gesundheitswissenschaften, Institut für Public Health und Pflegeforschung, Bremen, Deutschland; Universität Bremen, Wissenschaftsschwerpunkt Gesundheitswissenschaften, Bremen, Germany.
Universität Bremen, Fachbereich 11: Human- und Gesundheitswissenschaften, Institut für Public Health und Pflegeforschung, Bremen, Deutschland; Universität Bremen, Wissenschaftsschwerpunkt Gesundheitswissenschaften, Bremen, Germany.
Z Evid Fortbild Qual Gesundhwes. 2019 Aug;144-145:7-23. doi: 10.1016/j.zefq.2019.06.004. Epub 2019 Jul 19.
Provider networks in healthcare can emerge as either formal or informal networks. For sector-encompassing population-based quality measurement in informal networks, which allows for conclusions about the cost-effectiveness of care for home-dwelling persons in need of care, a comprehensive review on suitable quality indicators that can be derived from German social health insurance claims data is still lacking.
Primary review questions: Which population-based indicators of quality of care in formal and informal provider networks are described in the international literature? Which of these indicators are used as outcome parameters in health economic evaluations, and what are the methodological approaches in these evaluations? Rating approaches and methods for establishing thresholds as well as the validity and suitability of quality indicators to predict quality of care as well as the potential for the calculation of quality indicators based on German social health insurance claims data are included in the secondary review questions.
Databases searched in May 2017 and July 2018 included PubMed, The Cochrane Library und NHS EED, CINAHL, GeroLit and EconLit. In addition, we hand-searched references of the studies identified and screened the project database Health Services Research Germany.
Quantitative design, German or English language. Any kind of formal or informal network for which distinct members regarding single providers are named and population-based quality indicators for adults (18 years or older) are described.
Two authors (Cohen's Kappa = 0.64) independently screened titles, abstracts and full texts. A third independent reviewer was consulted in cases of uncertainty regarding the inclusion of studies. Critical appraisal was conducted using AMSTAR, the Cochrane Risk-of-Bias Tool, the Newcastle-Ottawa Scale (NOS), the Appraisal Tool for Cross-Sectional Studies (AXIS) and the criteria of the Drummond Checklist.
137 studies were included, five of which evaluated informal provider networks and applied indicators for medical conditions such as diabetes mellitus or heart failure or events like ambulatory care-sensitive hospitalisations, which were also utilized for formal networks. Five out of 14 health economic evaluations also assessed associations between costs and quality of care. The majority of studies did not include evidence on rating approaches and/or thresholds. Even though the validity and reliability of the used data in single studies is frequently discussed, only one in four of the included studies undertook a discussion of the suitability of the applied indicators. 121 studies explored indicators that can, in whole or in part, potentially be calculated on the basis of German social health insurance claims data and that target medical conditions such as osteoarthritis, asthma, chronic pain, chronic obstructive pulmonary disease, cardiovascular disease, dementia, diabetes mellitus, osteoporosis or mental health disorders as well as ambulatory care-sensitive events, appropriate medication of the elderly and polypharmacy, preventive care and continuity of care.
AUTHORS' CONCLUSIONS: This systematic review identified quality indicators that were predominantly used in formal provider networks and, with sufficient testing and further development, include the possibility of being used for measuring the quality of care in informal networks. The need for further research on suitable approaches to measure the interactions of quality of care and costs and on the validity, reliability and predictive suitability of single indicators as well as the finding that quality indicators especially developed for the German ambulatory sector were rarely used in the included studies constitute promising starting points for both an intensified methodological debate and the critical discussion of issues concerning population-based, sector-encompassing measurement of quality of care in health services research.
医疗保健中的供应商网络可以呈现为正式网络或非正式网络。对于非正式网络中涵盖部门的基于人群的质量测量（这有助于得出关于居家护理需求者护理成本效益的结论），仍然缺乏对可从德国社会医疗保险理赔数据中得出的合适质量指标的全面综述。
主要综述问题：国际文献中描述了正式和非正式供应商网络中哪些基于人群的护理质量指标？这些指标中哪些被用作卫生经济评估的结果参数，以及这些评估中的方法学方法是什么？二级综述问题包括评级方法和确定阈值的方法，以及质量指标预测护理质量的有效性和适用性，以及基于德国社会医疗保险理赔数据计算质量指标的可能性。
2017年5月和2018年7月搜索的数据库包括PubMed、Cochrane图书馆、NHS EED、CINAHL、GeroLit和EconLit。此外，我们手工搜索了已识别研究的参考文献，并筛选了德国卫生服务研究项目数据库。
定量设计，德语或英语。描述了任何一种正式或非正式网络，其中提及了单个供应商的不同成员，并描述了针对成年人（18岁及以上）的基于人群的质量指标。
两位作者（科恩卡方系数=0.64）独立筛选标题、摘要和全文。在研究纳入存在不确定性的情况下，会咨询第三位独立评审员。使用AMSTAR、Cochrane偏倚风险工具、纽卡斯尔-渥太华量表（NOS）、横断面研究评估工具（AXIS）和德拉蒙德清单标准进行批判性评价。
纳入了137项研究，其中5项评估了非正式供应商网络，并应用了糖尿病或心力衰竭等医疗状况的指标或非卧床护理敏感住院等事件的指标，这些指标也用于正式网络。14项卫生经济评估中有5项也评估了成本与护理质量之间的关联。大多数研究没有包括关于评级方法和/或阈值的证据。尽管单个研究中使用数据的有效性和可靠性经常被讨论，但纳入的研究中只有四分之一讨论了所应用指标的适用性。121项研究探索了可以全部或部分基于德国社会医疗保险理赔数据计算的指标，这些指标针对骨关节炎、哮喘、慢性疼痛、慢性阻塞性肺疾病、心血管疾病、痴呆、糖尿病、骨质疏松症或精神健康障碍等医疗状况，以及非卧床护理敏感事件、老年人的合理用药和多重用药、预防保健和护理连续性。
本系统综述确定了主要用于正式供应商网络的质量指标，经过充分测试和进一步开发，包括可用于测量非正式网络中护理质量的可能性。需要进一步研究测量护理质量与成本相互作用的合适方法，以及单个指标的有效性、可靠性和预测适用性，并且在所纳入的研究中很少使用专门为德国门诊部门开发的质量指标这一发现，构成了加强方法学辩论以及对卫生服务研究中基于人群、涵盖部门的护理质量测量相关问题进行批判性讨论的有前景的起点。
