Ambulante Versorgungsqualität im Kontext von Alter und Pflegebedürftigkeit – Ergebnisse einer Querschnittsanalyse von GKV-Routinedaten aus Deutschland

Abstract

Care-dependent community dwelling people are vulnerable to deficits in medical care provided by the German statutory health insurance (GKV). Quality of care indicators (QIs) contribute to the identification of deficits and of potential for the optimization of care. To investigate the discriminatory ability of QIs in a population of elderly people with and without care dependency and different age structures, insights into the feasibility of such QIs based on health claims data are of interest. The aim of this study is an explorative approach to health claims based QIs for the ambulatory medical care of care-dependent elderly which can be used to optimize health care processes. This cross-sectional study used anonymised health claims data of a sample of statutory health insurance members from all German federal states of the year 2016. The sample consisted of 5,934,986 insured persons aged 65 years or older, who were community dwelling with (n = 785,135) or without care-dependency (n = 4,799,369) or who were residents of a nursing home (n = 350,482). 47 QIs focusing on ambulatory care-sensitive conditions such as, asthma, chronic obstructive pulmonary disease, cardiovascular diseases, diabetes mellitus type 2 and depression were calculated on a quarterly basis and are reported descriptively as the arithmetic mean of four quarters stratified by place of residence and age group. The majority of QI values vary between the observed groups with an overarching trend to the disadvantage of older individuals. Even though care-dependent insured persons show higher prevalence rates of the underlying diagnoses of the QIs (except for asthma diagnoses), they score more detrimental QI values than those without care-dependency. This finding holds true after stratification by age group. This study describes differences in the quality of medical care for elderly people. Considering prior empirical evidence of deficits in medical care, factors that act as barriers or facilitators of guideline-oriented medical care need to be investigated. The contribution of patients' preferences, access to medical care or prioritisation by medical and nursing care providers when initiating diagnostic or therapeutic procedures remains unclear. Methodical limitations of this study notably derive from the selection process of the observed groups using two stratification variables. For the further development of QIs other influencing factors on both an individual and a population-related level as well as the providers' ability to influence these factors need to be taken into account and incorporated in a risk-adjusted description of QIs. Measurement of ambulatory medical care of an elderly population based on health claims data is feasible and shows differences in care processes of older and care-dependent individuals if place of residency and level of care-dependency are considered. Further development of the QIs explored should incorporate a thorough methodical foundation, particularly with regard to risk adjustment. In addition, the contribution of individual and contextual factors on QIs remains to be examined with a view to the community-dwelling care-dependent elderly and their ongoing residency in this setting.