Einfluss von Struktur- und Prozessmerkmalen stationärer Einrichtungen auf die Qualität der Versorgung am Beispiel des akuten Schlaganfalls
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Philipps-Universität Marburg
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Abstract
Aim: The aim of this dissertation is to show the influence of structures and processes on the quality of inpatient care, with a focus on acute stroke care.
Material: The work is based on the quality reports of the German hospitals, the insurance data of the AOK health insurance company (provided by the WIdO, the scientific institute of the AOK) and the external quality assurance data of the Hessian Quality Assurance Office. Further data was collected or provided by respective authorities (participation in the German Registry Working Group; availability of stroke units; regions with mandatory external quality assurance). The observation period is from 2007 to 2017.
Method: The quality of care in German hospitals was examined univariate and with linear regression analyses. Structural analyses on the development of stroke care in Germany were tested using univariate and bivariate methods. The mortality risk under consideration of treatment with neurological complex treatments, in stroke units and under the conditions of external quality assurance measures was examined using the Kaplan-Meier method and Cox regression; univariate and bivariate models were also used. The statistical analysis was performed with the SPSS program in versions 25 and 28.
Results: The analyses showed the contra intuitive result that the quality of care is associated with better quality, particularly in small, privately run hospitals without a teaching contract. The amount of patients with acute stroke treated in specialized hospitals increased. The analyses showed that certain quality-enhancing structures and processes are associated with a lower mortality risk after stroke.
Discussion: The expansion and promotion of the described structures and processes is relevant and forward-looking for an increased quality of care. Many of the initiated processes are still in flux - in addition to future new therapeutic measures, these offer great opportunities that should be pursued centrally with government sup-port due to the favorable and extensive data situation to further increase the quality of stroke care. Future studies should initially also evaluate the effectiveness of the individual structural features separately - not exclusively in combination, as in the present partial studies.
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Created: 2024Issued: 2024-05-27Updated: 2024-05-27
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
DFG-subjects
externe QualitätssicherungSchlaganfall / Quality of careexternal quality assurancestrokeVersorgungsqualität
DDC-Numbers
610
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Ebbeler, Dijana: Einfluss von Struktur- und Prozessmerkmalen stationärer Einrichtungen auf die Qualität der Versorgung am Beispiel des akuten Schlaganfalls. : Philipps-Universität Marburg 2024-05-27. DOI: https://doi.org/10.17192/z2024.0184.
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This item has been published with the following license: In Copyright