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Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care
BACKGROUND: HSPA is a tool to monitor, evaluate, and improve health systems based on their achievements within different dimensions, e.g., access to care, quality, and population health. Next to the overall system, HSPA also allows to analyze its performance for specific groups across dimensions. In...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595796/ http://dx.doi.org/10.1093/eurpub/ckad160.306 |
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author | Hengel, P Haltaufderheide, M Blümel, M Achstetter, K Busse, R |
author_facet | Hengel, P Haltaufderheide, M Blümel, M Achstetter, K Busse, R |
author_sort | Hengel, P |
collection | PubMed |
description | BACKGROUND: HSPA is a tool to monitor, evaluate, and improve health systems based on their achievements within different dimensions, e.g., access to care, quality, and population health. Next to the overall system, HSPA also allows to analyze its performance for specific groups across dimensions. In a pilot for a German HSPA, a conceptual framework was developed, and indicators for every dimension were selected and analyzed. This presentation illustrates the results of the German HSPA pilot using the example of access to and quality of care for ischemic stroke. METHODS: Selected indicators include stroke unit (SU) density, availability of a SU within 30 minutes by car, share of inpatient cases treated in a hospital with a SU, and inpatient mortality from 2014 to 2020, respectively. Indicators were analyzed based on nation-wide hospital discharge data. Travel time was computed and provided by the Federal Institute for Research on Building, Urban Affairs and Spatial Development. RESULTS: About 475 SU were identified in hospital data (2014: 463), compared to 350 certified SU in Germany. In 75% of Germany's 11,000 municipalities, 100% of the population could reach a SU within 30 minutes by car. Number of inpatient ischemic stroke cases was about 250,000 per year. Of the 215,000 cases without transfer from another hospital, 93% were treated in a hospital with a SU in 2020 (2014: 88%). Inpatient mortality was about 6,4% for all ischemic stroke cases and 6,1% for cases without transfer, varying only slightly over time. SU treatment showed large, and inpatient mortality minor regional variation. CONCLUSIONS: Access to and quality of inpatient stroke care seems comparatively good in Germany, as SU density is high and mortality low in the European context. However, regional variation should be further tackled. The example shows how HSPA can be used to assess different strands of care by connecting health system dimensions, to produce actionable evidence for policy. KEY MESSAGES: • Health system performance assessment (HSPA) is a tool for the evaluation and improvement of the overall system but also of the care for specific groups or diseases across health system dimensions. • The results of the German HSPA pilot show a good access and quality for the case of inpatient stroke care. Regional variations might be further reduced via improvements in hospital planning. |
format | Online Article Text |
id | pubmed-10595796 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-105957962023-10-25 Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care Hengel, P Haltaufderheide, M Blümel, M Achstetter, K Busse, R Eur J Public Health Parallel Programme BACKGROUND: HSPA is a tool to monitor, evaluate, and improve health systems based on their achievements within different dimensions, e.g., access to care, quality, and population health. Next to the overall system, HSPA also allows to analyze its performance for specific groups across dimensions. In a pilot for a German HSPA, a conceptual framework was developed, and indicators for every dimension were selected and analyzed. This presentation illustrates the results of the German HSPA pilot using the example of access to and quality of care for ischemic stroke. METHODS: Selected indicators include stroke unit (SU) density, availability of a SU within 30 minutes by car, share of inpatient cases treated in a hospital with a SU, and inpatient mortality from 2014 to 2020, respectively. Indicators were analyzed based on nation-wide hospital discharge data. Travel time was computed and provided by the Federal Institute for Research on Building, Urban Affairs and Spatial Development. RESULTS: About 475 SU were identified in hospital data (2014: 463), compared to 350 certified SU in Germany. In 75% of Germany's 11,000 municipalities, 100% of the population could reach a SU within 30 minutes by car. Number of inpatient ischemic stroke cases was about 250,000 per year. Of the 215,000 cases without transfer from another hospital, 93% were treated in a hospital with a SU in 2020 (2014: 88%). Inpatient mortality was about 6,4% for all ischemic stroke cases and 6,1% for cases without transfer, varying only slightly over time. SU treatment showed large, and inpatient mortality minor regional variation. CONCLUSIONS: Access to and quality of inpatient stroke care seems comparatively good in Germany, as SU density is high and mortality low in the European context. However, regional variation should be further tackled. The example shows how HSPA can be used to assess different strands of care by connecting health system dimensions, to produce actionable evidence for policy. KEY MESSAGES: • Health system performance assessment (HSPA) is a tool for the evaluation and improvement of the overall system but also of the care for specific groups or diseases across health system dimensions. • The results of the German HSPA pilot show a good access and quality for the case of inpatient stroke care. Regional variations might be further reduced via improvements in hospital planning. Oxford University Press 2023-10-24 /pmc/articles/PMC10595796/ http://dx.doi.org/10.1093/eurpub/ckad160.306 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Parallel Programme Hengel, P Haltaufderheide, M Blümel, M Achstetter, K Busse, R Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care |
title | Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care |
title_full | Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care |
title_fullStr | Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care |
title_full_unstemmed | Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care |
title_short | Results of Germany's health system performance assessment (HSPA) pilot: the example of stroke care |
title_sort | results of germany's health system performance assessment (hspa) pilot: the example of stroke care |
topic | Parallel Programme |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595796/ http://dx.doi.org/10.1093/eurpub/ckad160.306 |
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