Clinical trial NCT03224078: Emergency Department Utilization in Germany
Official title: Utilization and Trans-sectoral Patterns of Care for Patients Admitted to Emergency Departments in Germany
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Emergencies
Lead sponsor: Charite University, Berlin, Germany
Sponsor class: OTHER
Collaborators: name: Zentralinstitut für die Kassenärztliche Versorgung in Deutschland
name: University of Magdeburg
name: Wissenschaftliches Institut der AOK (WIdO)
name: Technische Universität Berlin
name: Technologie- und Methodenplattform für die vernetzte medizinische Forschung (TMF)
name: OFFIS - Institut für Informatik
First posted: 2017-07-21
Enrollment: 680000
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All patients with public health insurance who attended one of the participating EDs in 2016 will be included in this research Project.

Brief summary: The overall aim of INDEED is to facilitate trans-sectoral and interdisciplinary health services research of emergency care in Germany.

Clinical hospital data from 15 to 20 emergency departments in Germany will be linked to routine ambulatory health care data provided by the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV). INDEED will identify health care gaps and inadequate resource allocation as well as develop strategies for adaptations of the health care system to existing demands.

Detailed description: B a c k g r o u n d:

Emergency departments nationally and internationally are challenged by a continuously increasing number and complexity of patients and consequent crowding. International studies showed that crowding is associated with unfavourable outcomes. Emergency departments are an important interface between the outpatient and inpatient health care sectors. Health care sectors in Germany are not organisationally cross-linked and data linkage for analysis of the health care system is not generally performed. Hence, there is a lack of data to trans-sectorally describe and monitor patients' pathways and patterns of care in the health care system.

RESEARCH AIMS:

The overall aim of INDEED is to facilitate trans-sectoral and interdisciplinary health services research of emergency care in Germany.

The primary objective of the project is to assess the trans-sectoral utilization of health care services of patients 2 years prior and 1 year after treatment in an emergency department. Patterns of adequate, inadequate and potentially avoidable care will be examined.

The secondary aim is to identify patient clusters with comparable needs of health care provision. Within clusters and for all patients combined INDEED will examine health care needs and gaps as well as factors that influence emergency department visits, disease progression, comorbidities and mortality.

METHODS:

Clinical hospital data from 15 to 20 emergency departments in Germany will be linked to routine ambulatory health care data provided by the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV).

A secondary data analysis of linked routinely collected hospital information system and health insurance data of all adult patients that were treated with any condition in one of the participating emergency departments in 2016 (n≈680.000 cases) will be performed. Data analysis will cover the pattern of utilization of health care, identification of subgroups with comparable need of health care provision, of factors that influence emergency department visits and factors for ambulatory care sensitive conditions (ACSC) or inpatient treatment. Study results will be evaluated considering age, multimorbidity and gender aspects as well as the health system and health economic perspective. Thereby INDEED will identify health care gaps and inadequate resource allocation as well as develop strategies for adaptations of the health care system to existing demands.

Eligibility criteria: Inclusion Criteria:

* adult ED patients who attended one of the participating EDs in 2016
* patients with public health insurance

Exclusion Criteria:

* no exclusion criteria are applied

Primary outcomes:
measure: Prevalence of adequate, inadequate and avoidable ED-visits
timeFrame: Baseline
Secondary outcomes:
measure: Characterization of health care resource utilization before and after an ED-visit
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
measure: influencing factors on avoidable ED-visits
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
measure: influencing factors on adequate ED-visits
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
measure: influencing factors on inadequate ED-visits
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
measure: Exploratory analysis of influencing factors on increased health care costs.
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
measure: Exploratory analysis of influencing factors on patient-related mortality
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
measure: Exploratory analysis of influencing factors on morbidity
timeFrame: from 2 years before until 1 year after ED-visit (2014-2017)
Other outcomes:
Locations:
city: Berlin
country: Germany
facility: Charité Universitätsmedizin - Berlin
Study officials:
affiliation: Charite University, Berlin, Germany
name: Martin Möckel, Prof. Dr.
role: PRINCIPAL_INVESTIGATOR
References: