Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Hessen, Germany
Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Hessen, Germany.
BMJ Open. 2023 Aug 24;13(8):e074259. doi: 10.1136/bmjopen-2023-074259.
The need of a regional healthcare monitoring in order to evaluate quality and utilisation of health services in smaller scale is internationally and in Germany well established. Little is known about variation in healthcare in rural German areas, especially for women's health. In particular, endometriosis is highly prevalent and known to be unsatisfactorily treated. Thus, this study aims to investigate utilisation and quality of care, the influence of structural determinants on quality and the patient's experiences on endometriosis healthcare in rural Hesse.
We will use a mixed methods approach to ensure reliable mapping of the care situation for endometriosis patients in seven counties in Central and Eastern Hesse. First, retrospective secondary utilisation data and quality indicators will be used to describe possible regional variation in the treatment of endometriosis in the outpatient and inpatient sector. Second, we compare structural determinants of regions with quality of care. Third, we conduct qualitative, semistructured interviews with endometriosis patients on their perspective and experiences in those chosen rural regions. Data will then be analysed using descriptive statistics, small area variation analyses and multifactorial analyses of variance (ANOVAs). The interview will be interpreted using the experience-focused phenomenological approach.
The study has been approved by the ethics committee of Philipps-University Marburg. Utilisation data and structural determinants are anonymised and partly aggregated. The interview will use tokens for pseudonymisation to prevent the collected data from being assigned to an individual person. Also, informed consent will be obtained from patients.The results of this study will be reported to the scientific community in peer-reviewed journals and at conferences. A summary of the key findings will be provided to the interviewed patients and the .
在国际上和德国，人们已经认识到需要进行区域性医疗保健监测，以评估较小规模的医疗服务质量和利用情况。关于德国农村地区医疗保健的差异，人们知之甚少，特别是在妇女健康方面。特别是子宫内膜异位症的患病率很高，而且治疗效果不佳。因此，本研究旨在调查农村黑森州子宫内膜异位症患者的利用情况和护理质量、结构决定因素对质量的影响以及患者对子宫内膜异位症护理的体验。
我们将使用混合方法来确保可靠地描绘出中东部黑森州七个县的子宫内膜异位症患者的护理情况。首先，将使用回顾性二次利用数据和质量指标来描述门诊和住院部门治疗子宫内膜异位症的可能区域差异。其次，我们将比较具有护理质量的地区的结构决定因素。第三，我们将对这些选定的农村地区的子宫内膜异位症患者进行定性、半结构化访谈，了解他们的观点和体验。然后，将使用描述性统计、小区域变化分析和多因素方差分析（ANOVA）来分析数据。访谈将使用以体验为重点的现象学方法进行解释。
该研究已获得马尔堡菲利普斯大学伦理委员会的批准。利用数据和结构决定因素是匿名的，部分是聚合的。访谈将使用化名令牌进行化名，以防止收集的数据被分配给个人。此外，将从患者处获得知情同意。该研究的结果将在同行评议的期刊和会议上报告给科学界。将向接受采访的患者和. 提供关键发现摘要。
