Emergency Department Utilization in Germany (INDEED)

Utilization and Trans-sectoral Patterns of Care for Patients Admitted to Emergency Departments in Germany

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.

Study Overview

• Status: Unknown
• Conditions: Emergencies
• Intervention / Treatment: Other: data extraction

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.

• Study Type: Observational
• Enrollment (Anticipated): 680000

Contacts and Locations

• Study Contact: Name: Martin Möckel, Prof. Dr.; Phone Number: 0049 30 450 550472; Email: martin.moeckel@charite.de
• Study Contact Backup: Name: Anna Slagman, Dr., MSc; Phone Number: 004930450553037; Email: anna.slagman@charite.de

Study Locations

• Germany
  • Berlin, Germany, 13353
    • Recruiting
    • Charité Universitätsmedizin - Berlin
    • Contact: Martin Möckel, Prof. Dr.; Phone Number: 0049 30 553472; Email: martin.moeckel@charite.de
    • Contact: Anna Slagman, Dr. MSc.; Phone Number: 004930450553037; Email: anna.slagman@charite.de

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• 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.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
adult Emergency Department Patients; adult patients that were treated with any condition in one of the participating emergency departments in 2016 (n≈680.000 cases)	Other: data extraction; No Special interventions except from data extraction form the respective routine data sources are planned .

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of adequate, inadequate and avoidable ED-visits	Prevalence of adequate, inadequate and avoidable ED-visits will be operationalized by a) patients with low utilization of primary health care, b) low urgency, c) preventable conditions, d) chronic diseases that could have been adequately controlled, e) frequent-users, f) patients without contact to a physician in the ED ("left without being seen").	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Characterization of health care resource utilization before and after an ED-visit	Descriptive analysis of number of visits to primary care physicians before and after the ED visit. The utilization of primary health care will be assessed two years before and one year after the year of the ED visit. ED-visits will be analyzed for the year 2016, this outcome measure will be analyzed for the years 2014-2017.	from 2 years before until 1 year after ED-visit (2014-2017)
influencing factors on avoidable ED-visits	influencing factors: sex, age, number of contacts to primary care physician, day and time of ED-admission, diagnoses, medication, admission mode, urgency.	from 2 years before until 1 year after ED-visit (2014-2017)
influencing factors on adequate ED-visits	influencing factors: sex, age, number of contacts to primary care physician, day and time of ED-admission, diagnoses, medication, admission mode, urgency.	from 2 years before until 1 year after ED-visit (2014-2017)
influencing factors on inadequate ED-visits	influencing factors: sex, age, number of contacts to primary care physician, day and time of ED-admission, diagnoses, medication, admission mode, urgency.	from 2 years before until 1 year after ED-visit (2014-2017)
Exploratory analysis of influencing factors on increased health care costs.	influencing factors: sex, age, number of contacts to primary care physician, day and time of ED-admission, diagnoses, medication, admission mode, urgency. Outcome will be treatment costs in the ambulatory sector as well as in-hospital diagnosis related group (DRG) for hospitalized patients	from 2 years before until 1 year after ED-visit (2014-2017)
Exploratory analysis of influencing factors on patient-related mortality	influencing factors: sex, age, number of contacts to primary care physician, day and time of ED-admission, diagnoses, medication, admission mode, urgency. Outcome measure: mortality two years after the year of the ED-visit.	from 2 years before until 1 year after ED-visit (2014-2017)
Exploratory analysis of influencing factors on morbidity	influencing factors: sex, age, number of contacts to primary care physician, day and time of ED-admission, diagnoses, medication, admission mode, urgency. Outcome measure: morbidity two years after the year of the ED-visit.	from 2 years before until 1 year after ED-visit (2014-2017)

Collaborators and Investigators

• Sponsor: Charite University, Berlin, Germany
• Collaborators: Technische Universität Berlin; University of Magdeburg; Wissenschaftliches Institut der AOK (WIdO); Zentralinstitut für die Kassenärztliche Versorgung in Deutschland; Technologie- und Methodenplattform für die vernetzte medizinische Forschung (TMF); OFFIS - Institut für Informatik
• Investigators: Principal Investigator: Martin Möckel, Prof. Dr., Charite University, Berlin, Germany

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 1, 2017
• Primary Completion (ANTICIPATED): April 30, 2020
• Study Completion (ANTICIPATED): April 30, 2020

Study Registration Dates

• First Submitted: June 23, 2017
• First Submitted That Met QC Criteria: July 19, 2017
• First Posted (ACTUAL): July 21, 2017

Study Record Updates

• Last Update Posted (ACTUAL): July 21, 2017
• Last Update Submitted That Met QC Criteria: July 19, 2017
• Last Verified: July 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: EA4/086/17

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data could be made available to other researchers on reasonable request and if data protection requirements are met.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No