Development of indicators to assess quality and patient pathways in interdisciplinary care for patients with 14 ambulatory-care-sensitive conditions in Germany

Background In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients. Methods Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients. Results The process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure. Conclusion Our set of indicators provides useful information on patients’ health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08327-1.

Patients with heart failure D2-5 V Rate of patients in the disease group with at least one billing contact with a specialist in general medicine / general practitioner (family doctor) / family internal medicine / internist / internal medicine / cardiology / nephrology / psychosomatic medicine and psychotherapy / radiology / physical and rehabilitative medicine within the observation year Patients for whom at least one billing item was billed by a specialist in the respective specialty group Patients with heart failure Development of Indicators to Assess Quality and Patient Pathways in Interdisciplinary Care for Patients with 14 Ambulatory-Care-Sensitive Conditions in Germany Group Ind. No.
Cate gory* Name of the indicator(s) Numerator Denominator D2-6 V Rate of patients in the disease group with at least one billing contact with two different specialists in the above-mentioned disciplines (each per discipline) within the year of observation Patients for whom at least one billing item was billed by two different specialists in the respective specialty with different facility identities and with the type of physician utilization "original" in the observation year Patients with heart failure D2-7 V Rate of patients in the disease group with at least one billing contact to each of the above specialist groups with referral within the observation year.
Rate of patients with at least one billing contact to each of the above specialist groups with referral within the observation year.
Patients with heart failure D2-8 V Proportion of patients with billing contact in at least a) one, b) two, c) three d) four of four quarters for above-mentioned physician groups Proportion of patients with billing contact in at least a) one, b) two, c) three d) four of four quarters for abovementioned physician groups Patients with heart failure D2-9 V Rate of heart failure patients with inpatient hospitalization for heart failure and follow-up with an outpatient physician in the same or subsequent quarter Heart failure patients who had an inpatient hospitalization with principal diagnosis ICD I50* and were coded I50* by an outpatient physician in the same quarter or in the following quarter.
Heart failure patients who had an inpatient hospitalization in the first, second, or third quarter of the observation period with principal discharge diagnosis I50*. Rate of influenza and pneumonia patients who consulted a primary care physician after an inpatient hospitalization for pneumonia in the same or subsequent quarter Patients who were coded ICD J12* / J13* / J14* / J15* as principal inpatient diagnosis and for whom any EBM billing item was billed by a primary care physician (general practitioner (family physician), physician/practitioner (family physician), internist (family physician)) in the same or subsequent quarter Influenza and pneumonia patients who were coded ICD J12* / J13* / J14* / J15* as main inpatient diagnosis. Only patients with index event in the 1st to 3rd quarter considered. Not fully depictable in routine data Heart failure Share of patients with heart failure prescribed ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB)

Redundant indicator -already depicted in an included indicator
Rate of patients with heart failure and a beta blocker prescription Redundant indicator -already depicted in an included indicator Among of patients with heart failure due to left ventricular systolic dysfunction who are treated with an ACE-I or ARB, the Share of patients who are additionally currently treated with a beta-blocker licensed for heart failure Redundant indicator -already depicted in an included indicator Share of primary health care patients with CHF who are taking ACE inhibitors or ARBs Not fully depictable in routine data Share of patients with heart failure due to left ventricular dysfunction on ACE inhibitor therapy Redundant indicator -already depicted in an included indicator Share of patients hospitalised for heart failure who were being treated with both Renin angiotensin aldosterone system inhibitors and beta blockers after 12-18 months Not fully depictable in routine data Share of patients hospitalized for heart failure who had a follow-up contact within 4 weeks of discharge Redundant indicator -already depicted in an included indicator Share of patients with heart failure prescribed an ACE inhibitor or ARB within 1 year Redundant indicator -already depicted in an included indicator Share of patients with heart failure prescribed a beta-blocker within 1 year Redundant indicator -already depicted in an included indicator Share of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, who are treated with an ACE-I or ARB Indicator is subject to a specific subgroup