Hauskrankenpflege, Hauspflege in Berlin

UuStB Koeln(38)-8306724 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Qualitaetssicherung der psychosozialen Versorgung in der ambulanten kinderaerztlichen Praxis auf Basis von Routinedaten der gesetzlichen Krankenversicherung

UuStB Koeln(38)-920109053 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Analyse typischer Situationen der Indikationsstellung zu Untersuchungen mit bildgebenden Verfahren Abschlussbericht

Imaging techniques in medical diagnostics improved rapidly during the last 25 years. This improvements lead to easier application of the techniques and better imaging of organs. At the same time the figures for use of and expenditures for diagnostic imaging in ambulatory care in Germany went up massively. Between 1988 and 1995 the use of ultrasonography (US) and computertomography (CT) in Germany increased by 156%/139%. The advantages of the new techniques could be counteracted by excessive and uncritical use with the result of consecutive costs for further examinations due to false positive results, as well as the possible unnecessary risk for the patient due to the methods. Negative consequences can be expected if the use of imaging techniques is inappropriate regarding their diagnostic capacity and value. This study granted by the BMBF as Public Health Project C6 in Berlin examined the decision process for the application of ultrasound technique in patients with problems of the abdomen and the urinary tract as well as cerebral computertomography (CT) and cerebral magnetic resonance imaging (MRI) for cerebral processes. The study was based on routine data of a representative sample of 1.500 patients on whom one of the diagnostic procedures was performed in 1994. The sample was drawn from routine data of the statutory health insurance. The results of the analysis show, that in the majority of the cases the application of the modern imaging techniques was in accordance with the medical state of the art. There were only few exceptions: In six percent of the considered abdominal ultrasounds, the criteria for indication seemed dubious. Ultrasound examinations of the urinary tract were repeated within short intervals in 20% of the examined cases. Physicians, using their own ultrasound equipment, seem to repeat ultrasonography more willingly. Strategies for the application of CT and MRI vary between different specialists, General Practitioners seemed to be uncertain to differentiate the appropriate application of CT or MRI according to the specific diagnostic question. The diagnostic procedures and their application in different stages of diagnosis should be emphasised within medical training and quality assurance. Guidelines for the diagnosis of different diseases and conditions will reduce uncritical applications and repetitions of diagnostic imaging and lead to standards for the selective application of CT and MRI. (orig.)Available from TIB Hannover: RR 7890(97-39) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Umverteilung und Wettbewerb in der gesetzlichen Krankenversicherung

SIGLEUuStB Koeln(38)-3Z4014 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Perspektiven fuer das Gesundheitswesen im Sozialstaat

UuStB Koeln(38)-21A7399 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman