The aim of the study is to identify and evaluate incentive mechanisms for the implementation of quality-relevant care processes. The objective is to correlate adherence to individual process-based quality indicators or their combination with outcome data. In addition, cost shares and case revenues are evaluated. Indices are also derived from routine data that may represent additional influencing factors (Charlson Comorbidity Index or secondary diagnoses that increase case severity based on ICD-10 coding and procedures based on the Surgery and procedure codes system).
Patients with complete, electronically documented intensive care treatment data, including vital sign monitor data and laboratory data from the patient documentation system.
Complete, electronically documented treatment data for these patients from the hospital information system.
Data from cost and revenue accounting from the hospital information system, §21 routine data records.
Age ≥ 18 years
None
Intensive care unit patients (2012-2022) from the Department of Anesthesiology and Intensive Care Medicine (CCM/CVK) of Charité - University Medicine Berlin with a length of stay \> 24 hours.
Cohort
Retrospective
Not listed
Proceeds
Per Case Revenue in Euro \[€\] (Revenue = base rate x DRG-rate) according to the Diagnosis Related Groups (DRG) reimbursement flat rate catalogue and the base rate for the state of Berlin for the respective billing year.
Case costs
Per case costs in Euro \[€\] according to case-related analysis based on financial controlling data.
Charlson Comorbidity Index
Charlson Comorbidity Indices are generated from the number and type of secondary diagnoses according to ICD-10 Diagnosis Related Groups coding.(Scale from 0-37; higher Score values indicating more severe comorbidities and less probability of 10-year survival)
30-day readmission rate
30-day readmission rate from routine data up to one year
In-house mortality
In-house mortality from routine data up to one year
Infection rate
Infection rate form routine data, based on ICD-10 coding
Degrees of fulfillment of process-based quality indicators
Degrees of fulfillment of process-based quality indicators based on Quality indicators the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) are measured in percentages.
Quality indicator compliance
German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)-Quality indicator compliance is measured in dependence on primary and secondary diagnoses. The indicators are evaluated according to the following list: QI1: "Ward round" QI2: "PAD-Management" QI3: "Mechanical ventilation" QI4: "Weaning from ventilation" QI5: "infection prevention" QI6: "management of infections" QI7: "nutrition management" QI8: "communication with relatives" QI9: "mobilization"
Outcome indicators
Degree of fulfillment of individual other process indicators based on German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) Quality indicators. In-House Quality measures like length of hospital stay or infection rates following surgery and their dependence on the fulfillment of DIVI-quality indicators. The indicators are evaluated according to the following list: QI1: "Ward round" QI2: "PAD-Management" QI3: "Mechanical ventilation" QI4: "Weaning from ventilation" QI5: "infection prevention" QI6: "management of infections" QI7: "nutrition management" QI8: "communication with relatives" QI9: "mobilization"
Bundle of process indicators
Degree of fulfillment of individual other process indicators based on a combination of German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) Quality indicators (known as a "bundle"). The indicators are evaluated according to the following list: QI1: "Ward round" QI2: "PAD-Management" QI3: "Mechanical ventilation" QI4: "Weaning from ventilation" QI5: "infection prevention" QI6: "management of infections" QI7: "nutrition management" QI8: "communication with relatives" QI9: "mobilization"
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