Selecting and defining indicators for diabetes surveillance in Germany

Mainly because of the large number of people affected and associated significant health policy implications, the Robert Koch Institute (RKI) is developing a public health surveillance system using diabetes as an example. In a first step to ensure long-term and comparable data collection and establish efficient surveillance structures, the RKI has defined a set of relevant indicators for diabetes surveillance. An extensive review of the available literature followed by a structured process of consensus provided the basis for a harmonised set of 30 core and 10 supplementary indicators. They correspond to the following four fields of activity: (1) reducing diabetes risk, (2) improving diabetes early detection and treatment, (3) reducing diabetes complications, (4) reducing the disease burden and overall costs of the disease. In future, in addition to the primary data provided by RKI health monitoring diabetes surveillance needs to also consider the results from secondary data sources. Currently, barriers to accessing this data remain, which will have to be overcome, and gaps in the data closed. The RKI intentends to continuously update this set of indicators and at some point apply it also to further chronic diseases with high public health relevance

Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure

Abstract Background The rates of coronary angiograms (CA) and related procedures (percutaneous intervention [PCI]) are significantly higher in Germany than in other Organisation for Economic Co-ordination and Development (OECD) countries. The current guidelines recommend non-invasive diagnosis of coronary heart disease (CHD); CA should only have a limited role in choosing the appropriate revascularisation procedure. The aim of the present study was to explore whether improvements in guideline adherence can be achieved through the implementation of regional treatment pathways. We chose four regions of Germany with high utilisation of CAs for the study. Here we report the results of the concomitant qualitative study. Methods General practitioners and specialist physicians (cardiologists, hospital-based cardiologists, emergency physicians, radiologists and nuclear medicine specialists) caring for patients with suspected CHD were invited to develop regional treatment pathways. Four academic departments provided support for moderation, provision of materials, etc. The study team observed session discussions and took notes. After the development of the treatment pathways, 45 semi-structured interviews were conducted with the participating physicians. Interviews and field notes were transcribed verbatim and underwent qualitative content analysis. Results Pathway development received little support among the participants. Although consensus documents were produced, the results were unlikely to improve practice. The participants expressed very little commitment to change. Although this attempt clearly failed in all study regions, our experience provides relevant insights into the process of evidence appraisal and implementation. A lack of organisational skills, ignorance of current evidence and guidelines, and a lack of feedback regarding one’s own clinical behaviour proved to be insurmountable. CA was still seen as the diagnostic gold standard by most interviewees. Conclusions Oversupply and overutilisation can be assumed to be present in study regions but are not immediately perceived by clinicians. The problem is unlikely to be solved by regional collaborative initiatives; optimised resource planning within the health care system combined with appropriate economic incentives might best address these issues

Additional file 1 of Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure

Supplementary Material

Diabetes-Surveillance in Deutschland – Auswahl und Definition von Indikatoren

Vor dem Hintergrund einer hohen Anzahl Betroffener und der damit verbundenen gesundheitspolitischen Bedeutung wurde am Beispiel Diabetes mellitus mit dem Aufbau einer Public-Health-Surveillance am Robert Koch-Institut (RKI) begonnen. Für eine nachhaltige und vergleichbare Datenlage und zur Etablierung effizienter Surveillance- Strukturen wurde zunächst ein Set relevanter Indikatoren für die Diabetes-Surveillance definiert. Basierend auf umfangreichen Literaturrecherchen und anhand eines strukturierten Konsensusprozesses entstand ein abgestimmtes Indikatorenset, bestehend aus 30 Kern- und 10 Zusatzindikatoren. Diese können den folgenden vier Handlungsfeldern zugeordnet werden: (1) Diabetes-Risiko reduzieren, (2) Diabetes-Früherkennung und Behandlung verbessern, (3) Diabetes-Komplikationen reduzieren, (4) Krankheitslast und Krankheitskosten senken. Neben den Primärdaten des RKI-Gesundheitsmonitorings sollen zukünftig auch Ergebnisse aus verfügbaren Sekundärdatenquellen in die Diabetes-Surveillance mit einfließen. Hierzu müssen die teilweise noch existierenden Barrieren bei der Nutzung vorhandener Datenquellen abgebaut sowie bestehende Datenlücken geschlossen werden. Perspektivisch soll das Indikatorenset kontinuierlich angepasst und auf weitere chronische Erkrankungen mit hoher Public-Health-Relevanz übertragen werden