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Retrospective cohort study to investigate the adherence to the process indicators for pain management, sedation management and management of delirium on outcome indicators and cost/revenues in individual patients and subcohorts.
The evaluation of quality-related process indicators (in this case, Quality Indicator II of the Intensive Care Quality Indicators of the DIVI*: Management of Analgesia, Sedation and Delirium) will be correlated with economic parameters of the treatment from economic data (DRG revenue, case costs). Data from clinical routine care from the Charite hospital systems will be used with further analysis of outcome indicators from routine data (e.g. 30-day readmission rate, mortality, infection rate, length of stay). The aim of the study is to identify and evaluate incentive mechanisms for the implementation of quality-relevant care processes using the example of adherence to a quality indicator regarding management of analgesia, sedation and delirium) on detailed cost shares and case proceeds. In addition, further routine data, which may represent influencing factors like comorbidities (Charlson Comorbitity Index) are calculated using the ICD-10 coding. Also procedures using the OPS system are evaluated.
In this retrospective cohort study, patient records from the clinical information systems from 2012 to 2021 will be analyzed.. The analysis is also intended to analyze whether alternatively, cross-treatment outcome indicators can be defined, which would demonstrate not only positive patient-oriented results but also positive economic results as a potential incentive for health care service providers.
(* DIVI: Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin = German Interdisciplinary Association for Intensive Care and Emergency Medicine)
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| Measure | Description | Time Frame |
|---|---|---|
| Influence of compliance to a quality indicator (Monitoring sedation, analgesia, delirium) | Influence of compliance to a quality indicator (Quality Indicator II of the DIVI; Management of Analgesia, Sedation and Delirium) and the relationship to case specific revenues and case costs according to case-specific analysis based on hospital financial data | 01.01.2012- 31.12.2021 |
| Measure | Description | Time Frame |
|---|---|---|
| Comorbidity scores | (Comorbidity scores are assessed according to Charlson comorbidity index (CCI) employing routine data, like icd-10 codes. | 01.01.2012- 31.12.2021 |
| Outcome indicators | Outcome indicators from routine data are e. g. 30-day readmission rate, mortality, infection rate, length of stay, etc. ) |
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Inclusion Criteria:
Exclusion Criteria:
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Electronically documented anesthesiological or intensive care treatment in the HIS (Hospital Information System) and PDMS (Patient Data Management System) of the Charité (Dep. for Anesthesiology with focus on operative intensive care, CCM/CVK) from 01.01.2012- 31.12.2021
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| Name | Affiliation | Role |
|---|---|---|
| Claudia Spies, MD, Prof. | Charite University, Berlin, Germany | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Charité - University Medicine Berlin | Berlin | 13353 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39146321 | Result | Zuber A, Rubarth K, Forster F, Balzer F, Spies C, Furstenau D, Kumpf O. The impact of adhering to a quality indicator for sedation, analgesia, and delirium management on costs, revenues, and clinical outcomes in intensive care in Germany: A retrospective observational study. PLoS One. 2024 Aug 15;19(8):e0308948. doi: 10.1371/journal.pone.0308948. eCollection 2024. |
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| 01.01.2012- 31.12.2021 |
| ID | Term |
|---|---|
| D003693 | Delirium |
| D010146 | Pain |
| ID | Term |
|---|---|
| D003221 | Confusion |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
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