Eignung und Anwendung von GKV-Routinedaten zur Überprüfung von Versorgungsleitlinien am Beispiel der Indikation Linksherzinsuffizienz

verfasst von

S. Neubauer, J. Zeidler, T. Schilling, S. Engel, R. Linder, F. Verheyen, A. Haverich, J. M.G. Von Der Schulenburg

Abstract

Background: Guidelines have special importance in medicine, however, it is questionable to what extent these recommendations are applied in daily care, and under which conditions claims data can be used for verification of guideline adherence. Method: Advantages and limitations of claims data for verification of guidelines compliance in the therapeutic area as well as the guidelines themselves were analysed and critically assessed. To substantiate these results, claims data of a major German health insurance fund (Techniker Krankenkasse) were analysed. Results: 104 236 patients were identified. With certain limitations, claims data are useful for verifying guideline adherence; it could be shown that in pharmacotherapy the beta-adrenergic receptor blocker was used to the highest extent (70.5%). In contrast, only 56.4% of patients were treated with pure ACE inhibitors and ACE combined preparation. Conclusion: In order to validate guideline adherence by means of claims data analyses, a number of conditions relating to the database, the therapeutic area and the guidelines themselves have to be considered. Guideline recommendations, which, for example, are based on clinical data, cannot be reviewed by using claims data. Despite these limitations, claims data provide a suitable tool for reviewing selected guideline recommendations. They show that the current use of pharmacotherapy as well as clinical and diagnostic interventions might be increased in accordance with the guideline recommendations.

Organisationseinheit(en)

Center for Health Economics Research Hannover (CHERH)

Externe Organisation(en)

Medizinische Hochschule Hannover (MHH)
Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG)

Typ

Artikel

Journal

Gesundheitswesen, Supplement

Band

78

Seiten

e135-e144

ISSN

0949-7013

Publikationsdatum

09.2016

Publikationsstatus

Veröffentlicht

Peer-reviewed

Ja

ASJC Scopus Sachgebiete

Öffentliche Gesundheit, Umwelt- und Arbeitsmedizin

Ziele für nachhaltige Entwicklung

SDG 3 – Gute Gesundheit und Wohlergehen

Elektronische Version(en)

https://doi.org/10.1055/s-0042-100727 (Zugang: Offen)