Background
Objectives and hypotheses
Methods
Study design
Description of the AGR intervention and the setting
Eligibility criteria for AGR
Criteria | ICD-10 codes |
---|---|
Immobility | M96.8, M62.3, M62.5 |
cognitive impairment | G30, F00 – F07 |
incontinence | R32, N39, R15 |
decubitus ulcer | L89, L97, I83, L98 |
Malnutrition | R64, E41, E43, E44 |
Disturbances in fluid and electrolyte balance | E86, E87, R60 |
Depression and Anxiety | F30 – F33, F40, F41 |
chronic pain | R52 |
paraesthesia | R20, G50 – G59, G60 – G64 |
frailty | R54 |
severe visual or hearing impairment | H25, H28, H52-H54, H90, H91 |
Eligibility criteria | ICD-10 codes |
---|---|
Stroke and other cerebrovascular disorders | I60-I69 |
Status post fracture | S72.- |
Arterial obstructive disease with amputation or other surgery | I70.- |
Cox and osteoarthritis with Implantation of an endoprosthesis | M16.-, M17.- |
Heart failure | I50.- |
Exacerbated chronic obstructive pulmonary disease | J44.0, J44.1 |
Pneumonia and other respiratory tract infections | J10-J22 |
Other fractures and injuries | S00-T98 |
Other arthropathies | M00-M25 |
Spondylopathies and Discopathies, possibly with laminectomy | M45-M51 |
Coronary heart disease and other heart diseases with cardiac surgery | I05-I09; I20-I25 |
Delirium and other organic brain psychosis | F00-F05 |
Osteoporosis | M80-M81 |
Secondary Parkinsonsyndrom | G20.9 |
Symptoms, effecting the nervous system and musculoskeletal system | R29.5, R29.6, R29.8 |
Exclusion criteria from the analyses
Exclusion criteria | |
---|---|
- Age <70 or >95 years in the intervention billing period Prior to the intervention billing period: - nursing care >2 - <360 insured days in the four previous billing periods - living in a nursing home - hospital costs without out of pocket spending at the last billing period >33.000 € - hospital costs without out of pocket spending during the four last billing periods ≥44.000 € - ambulatory costs during the last billing period ≥2.200 € - ambulatory costs during the four last billing periods ∑ ≥5.500€ - remedy costs without out of pocket spending during the four previous billing periods ≥2.200 € - costs of aid without out of pocket spending during the four previous billing periods ≥4.000 € - drug costs without out of pocket spending during the four previous billing periods AGR ≥11.000 € - total health care costs without out of pocket spending during the four previous billing periods ≥44.000 € - diagnosed AIDS/HIV in the four previous billing periods - chemotherapy in the four previous billing periods - organ transplantation during the four previous billing periods - dialysis during the four previous billing periods |
Sample size
Outcome measures and data collection
Requirements | ||
---|---|---|
Nursing care level | total daily help (including help in household) | personal help (included in total daily help) |
1 | minimum 1,5 h | >45 min |
2 | minimum 3 h | ≥2 h, 3 times a day |
3 | minimum 5 h | ≥4 h permanent help |
Ambulatory care sensitive conditions | ICD-10 code |
---|---|
Ischaemic heart diseases | I25.0, I25.1, I25.5, I25.6, I25.8, I25.9 |
Heart failure | I50 |
Other diseases of the circulatory system | I05, I06, I08.0, I49.8, I49.9, I67.2, I67.4, I70, I73, I78, I80.0, I80.80, I83, I86, I87, I95, R00.0, R00.2 |
Bronchitis & COPD | J20, J21, J40-J44, J47 |
Mental and behavioural disorders due to use of alcohol or opioids | F10, F11 |
Back pain [dorsopathies] | M42, M47, M53, M54 |
Hypertension | I10 - I15 |
Gastroenteritis and other diseases of intestines | K52.2, K52.8, K52.9, K57, K58, K59.0 |
Intestinal infectious diseases | A01, A02, A04, A05, A07-A09 |
Influenza and pneumonia | J10, J11, J13, J14, J15.3, J15.4, J15.7, J15.8, J15.9, J16.8, J18.0, J18.1, J18.8, J18.9 |
Ear nose throat infections | H66, H67, J01-J04, J06, J31, J32, J35 |
Depressive disorders | F32, F33 |
Diabetes mellitus | E10.2-E10.6, E10.8, E10.9, E11, E13.6, E13.7, E13.9, E14, E16.2 |
Gonarthrosis [arthrosis of knee] | M17.0, M17.1, M17.4, M17.5, M17.9 |
Soft tissue disorders | G56.0, M67.4, M71.3, M75-M77, M79 |
Other avoidable mental and behavioural disorders | F40, F41, F43, F45, F50.0, F50.2, F60 |
Diseases of the eye | H25, H40 |
Diseases of urinary system | N30, N34, N39.0 |
Sleep disorders | G47 |
Diseases of the skin and subcutaneous tissue | A46, L01, L02, L04, L08.0, L08.8, L08.9, L60.0, L72.1, L98.0 |
Thyroid disorder | E03 - E05, E89.0 |
Metabolic disorders | E86, E87.6 |
Melanoma and other malignant neoplasms of skin | C43, C44 |
Gastritis and duodenitis | K21, K29.7, K29.9, K30, K31 |
Migraine and headache syndromes | G43, G44.0, G44.1, G44.3, G44.4, G44.8, R51 |
Malnutrition & nutritional deficiencies | E40 - 64, R63.6, D50, D51-D52, D53.1, D56 |
Alcoholic liver disease | K70 |
Dental diseases | K02, K04-K06, K08, K12, K13 |
Inflammatory diseases of female pelvic organs and disorders of female genital tract | N70-N72, N75, N76, N84.1, N86, N87 |
Dementia | F01, F03 |
Diseases of male genital organs | N41, N45, N48.4 |
Asthma | J45 |
Other polyneuropathies | G62 |
Avoidable infectious and parasitic diseases | A15.3, A15.4, A15.9, A16.2, A16.3, A16.5, A16.8, A16.9, A34 - A37, A50-A58, A63, A64, A80, B05 - B07, B15, B16.1, B16.9, B17, B18.0, B18.1, B20 - B24, B26, B34.9, B51 - B54, B77, B86 |
Convulsions, not elsewhere classified | R56 |
Decubitus ulcer and pressure area | L89 |
Obesity | E66 |
Rare diseases with <5000 cases each | F80, R63.0, R63.3, R63.8, Z73 |
Cellulitis | L03, L04, L08.0, L08.8, L08.9, L88, L98.0, I891, L010, L011, L020 - L024, L028, L029 |
Angina | I20, I24.0, I24.8, I24.9, I25, R072, R073, R074, Z034, Z035 |
Convulsions and epilepsy | G25.3, G40, G41, O15, R56, R568 |
Dehydration and infections | A02, A04, A09, A05.9, A07.2, A08.0, A08.1, A08.3, A08.4, A08.5, E86, K52.0, K52.1, K52.2, K52.8, K52.9 |
Gangrene | R02 |
Iron-deficiency anaemia | D46.0, D46.1, D46.3, D46.4, D50.1, D50.8, D50.9, D51.0–D51.3, D51.8, D52.0, D52.1, D52.8, D52.9, D53.1, D57.1, D58.0, D58.1, D59.0 – D59.2, D59.9, D60.1, D60.8, D60.9, D61.0, D61.1, D64.0 - D64.4, D64.8 |
Pelvic inflammatory disease | N70, N73, N74 |
Perforated/bleeding ulcer | K20, K21.0, K21.9, K22.1, K22.6, K25.0 – K25.2, K25.4 – K25.6, K25.9, K26.0 – K26.2, K26.4 – K26.6, K27,K28.0 – 28.2, K28.4 – K28.6, K92.0, K92.1, K92.2, L97 |
Pyelonephritis | N10, N11, N12, N13.6, N15.9, N30.0, N30.8, N30.9, N39.0, |
Atrial fibrillation and flutter | I47.1, I47.9, I49.5, I49.8, I49.9, R00.0, R00.2, R00.8 |
Constipation | K59.0 |
Deliberate self-harm | S16 |
Dyspepsia and other stomach function disorders | K21, K30 |
Hypokalaemia | E87.6 |
Neuroses | E10, E13.6 – E13.9, E14.9 |
Tuberculosis | A15, A16, A17, A18, A19 |
Schizophrenia | F20, F21, F23.2, F25 |
Stroke | I61, I62, I63, I64, I66, I67.2, I69.8, R47.0 |
Matching and statistical analyses
Matching Criterion | Pre Matching | Propensity Score |
---|---|---|
Age | x ± 2 years | x |
Sex | x | x |
Area of residence | x | |
Days being insured | x | |
Level of nursing care | x | x |
Hospital admission yes/no | x | x |
Charlson Comorbidity index (CCI) | x | |
Days spent in the hospital | x | |
Hospital costs without out-of-pocket spending | x | x |
Ambulatory costs | x | |
Costs of remedy | x | |
Costs of medical aid | x | |
Drug costs without out-of-pocket spending | x | x |
Total costs with out-of-pocket spending | x | |
Main diagnoses before AGR | ||
Musculo-skeletal
| x a
| |
Status post fracture or joint replacement | ||
Cox- or gonarthrosis with endoprothesis | x | |
Other fractures and injuries | x | |
Other arthropaties | x | |
Osteoporosis | x | |
Spondylopathies and Discopathies, possibly with laminectomy | x | |
Infection
| ||
Pneumonia and other lung inflammations | x a
| x |
Cardio-vascular system
| ||
Heart failure | ||
Chronic obstructive pulmonary disease (COPD) | x | |
Arterial obstructive disease with amputation or other surgery | x a
| x |
Coronary heart diseases with surgery | x | |
Stroke and other cerebrovascular diseases | x | |
Neuro-psychiatric
| ||
Delirium and other organic brain psychosis | x | |
Secondary Parkinsonsyndrom | x a
| x |
Symptoms, effecting the nervous system and musculoskeletal system | x | |
Charlson Comorbidity Index | ||
Any Malignancy | x | x |
Cerebrovascular disease | x | |
Chronic pulmonary disease | x | |
Congestive heart failure | x | |
Metastatic solid tumor | x | |
Dementia | x | x |
Hemiplegia or paraplegia | x | |
Mild liver disease | x | |
Myocardial infarction | x | |
Renal disease | x | |
Peripheral vascular disease | x | |
Geriatric Multimorbidity | ||
Cognitive deficit | x | |
Chronic pain | x | |
Depression, Anxiety | x | |
Incontinence | x | |
Severe visual/hearing impairment | x | |
Paraesthesia | x | |
Immobility | x | x |
Chemotherapy | x | x |