Osmanski-Zenk Katrin, Klinder Annett, Malzahn Jürgen, Haas Holger, von Lewinski Gabriela, Kladny Bernd, Mittelmeier Wolfram
Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland.
AOK-Bundesverband, Rosenthaler Str. 31, 10178, Berlin, Deutschland.
Orthopadie (Heidelb). 2023 Apr;52(4):320-331. doi: 10.1007/s00132-023-04360-y. Epub 2023 Mar 14.
The EndoCert initiative does not yet allow a long-term assessment of outcome quality. The assessment cannot be achieved without cooperation with the German arthroplasty registry (EPRD) and other quality assurance infrastructure, such as the quality assurance system of the nationwide healthcare insurance data for inpatient hospital treatment (QSR) by the German local healthcare fund (AOK). Therefore, the quality of care of all certified centres for joint replacement (EPZ) after primary hip and knee arthroplasty was to be examined for the first time. These data were subsequently compared to the data of the EPRD.
In EPZ that provided care to at least one AOK-insured patient in 2016, the risk-adjusted 3‑year revision rate and the SMR-value (standardised mortality or morbidity ratio), which is the quotient of the observed and expected revision rate, were analysed as markers for the quality of care. Annual hospital volume, type of centre and audit results were examined as possible influencing factors.
In the group comparison, significant differences (p = 0.042) for the SMR value of the 3‑year revision rate were demonstrated for hip arthroplasty with regard to the EPZ type. The annual number of primary hip arthroplasties, however, did not influence the 3‑year revision rate. For knee arthroplasties, no effect of the defined categories on the 3‑year revision rate and its SMR value was observed. The comparison of our 3‑year revision rates with those of the EPRD showed similar results for the hip but indicated significant differences for the knee.
We did not observe a correlation between quality of care and annual hospital volume in certified EPZ. However, different quality assurance procedures can lead to different results with respect to the outcome quality. Therefore, a considerably improved interaction of the German quality systems must be achieved. Participation in the EPRD is not sufficient for this. Rather, a complete report of all arthroplasties must be required, at least with the achievement of a minimum reporting rate per participating hospital. Uniform inclusion and exclusion criteria should be defined.
EndoCert计划目前尚无法对结果质量进行长期评估。若不与德国关节置换登记处（EPRD）及其他质量保证基础设施合作，如德国地方医疗保险基金（AOK）提供的全国住院医院治疗医疗保险数据质量保证系统（QSR），则无法实现评估。因此，首次对所有经认证的初次髋膝关节置换联合置换中心（EPZ）的护理质量进行了检查。随后将这些数据与EPRD的数据进行了比较。
在2016年为至少一名AOK参保患者提供护理的EPZ中，分析风险调整后的3年翻修率和标准化死亡率或发病率比值（SMR值，即观察到的翻修率与预期翻修率的商），作为护理质量的指标。将年度医院手术量、中心类型和审核结果作为可能的影响因素进行了研究。
在组间比较中，髋置换术的3年翻修率SMR值在EPZ类型方面存在显著差异（p = 0.042）。然而，初次髋置换术的年度手术量并未影响3年翻修率。对于膝关节置换术，未观察到所定义类别对3年翻修率及其SMR值有影响。将我们的3年翻修率与EPRD的翻修率进行比较，结果显示髋部情况相似，但膝关节情况存在显著差异。
我们未观察到经认证的EPZ中护理质量与年度医院手术量之间存在相关性。然而，不同的质量保证程序在结果质量方面可能会导致不同的结果。因此，必须大幅改善德国质量体系之间的相互作用。仅参与EPRD是不够的。相反，必须要求提供所有关节置换术的完整报告，至少要达到每个参与医院的最低报告率。应定义统一的纳入和排除标准。
