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

authored by

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.

Organisation(s)

Center for Health Economics Research Hannover (CHERH)

External Organisation(s)

Hannover Medical School (MHH)
The TK Scientific Institute of Value and Efficiency in Healthcare (WINEG)

Type

Article

Journal

Gesundheitswesen, Supplement

Volume

78

Pages

e135-e144

ISSN

0949-7013

Publication date

09.2016

Publication status

Published

Peer reviewed

Yes

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Sustainable Development Goals

SDG 3 - Good Health and Well-being

Electronic version(s)

https://doi.org/10.1055/s-0042-100727 (Access: Open)