Regional Evaluation of Patients with Ambulatory Care Sensitive Conditions (ACSC) in Austria

Fractures due to falls of less than three meters height are a major reason for long-term hospitalization, higher need for care and – as a consequence thereof- growing lack of independency, especially for the elderly. They are a good example for incidences with remarkable effect on the health care system. Reduction of the fracture cases and the complications due to primary prevention would be beneficial. Prevention strategies are often under discussion and an objective assessment concerning the benefit of different programs in a passage of time is imperative for the decision-maker. Major goal is the feasibility analysis and development of methods for evaluation of these primary prevention strategies.

The life stage of children and adolescents is a comparatively healthy one and is characterized through the therein included developmental tasks and steps of socialization. This project, therefore, deals with the study of two disease groups, each represented by two diagnoses-chapters (ICD-10 chapters) for the age-cohort 0-16 years. Thereby the two main starting points are, on one hand, the ICD-categories of neurological/motoric/psychiatric developmental disorders (ICD-10 F+G) and, on the other hand, accidents (ICD-10 S+T). This project is one example of DEXHELPP’s approach to analyze morbidity for diverse population groups in order to use these information for future analysis & models, which map diversity and focus groups. The regionality evaluations together with the focus on changes over time give a basis for further planning strategies in the health care system.

Based on routine data, DEXHELPP analyzed the amount of TNF inhibitors in Austria. TNF inhibitors are expensive medicines causing a substantial amount of costs in the healthcare system. Several patents on these medicines expire in the coming years. Hence, cheaper biosimilars allow significant savings- an important question for health system. The main focus was finding out how many patients are given TNF inhibitors for each disease out of rheumatoid arthritis, ulcerative colitis, Crohn’s disease, psoriasis und ankylosing spondylitis.

Information on doctor’s offices about their location and their corresponding opening hours is available. However, aggregated views of the amount of these offices dependent on specialization or contract type for analysis of density of care was missing. Therefore the goals of this project was to evaluate and visualize the numbers of ordination types and their hours of operation.

In the project comparison of methods in the field of epidemiology different data sources and methods are evaluated, in order to capture epidemiological, numerical values for different diseases. First diabetes, cataracts and strokes were selected as illnesses of major interest within media. The prevalence is calculated in diverse ways and the outcomes are compared with each other in order to analyze the differences in results of the methods in this project. Based on the result an online atlas is implemented and presented to the public. The atlas features first diseases and will be updated permanently. One goal of this project was to enable fast and easy publishing and comparison of measures of morbidity of different approved methods. Also external results and data can be integrated to allow for a comparison of strategies and to foster the health discussion.

Availability of medical services depends on the number of trained physicians of the various fields and other health personnel. The dynamic change caused by the number of newly qualified health care professionals, migration, retirements and new challenges regarding skill mix requires prognosis of available persons for the different services to avoid treatment-bottlenecks. In this project the interdependencies between services, patients and the effects of new treatments (e.g. change of therapy) are analyzed with regards to geographical and time aspects, and a model for the use in Austrian health work force planning is developed.

Der DEXHELPP Research Server (DRS) ist als sichere, flexible und performante Umgebung für kollaboratives Arbeiten entwickelt worden. Das gemeinsame Analysieren sensibler Daten aus unterschiedlichen Quellen ist eines der methodischen Ziele von DEXHELPP ...

Publicly available data that the Austrian Ärztekammern[m1] of the nine Austrian states publish on the web gets scraped, processed and finally saved in a database on the DEXHELPP research server for further analyses. The processing is done in such a way that questions about the supply effectiveness of doctors in Austria can be answered in a way that is as comfortable as possible. The scraping is repeated periodically in order to have the possibility to carry out a historiography and to investigate the chronological sequence of the answers to the previously mentioned questions.

[m1]Belassen wir den deutschen Begriff oder verwenden wir medical associations?

Primary care is an essential part of the extramural sector in health care in Austria, which differs regionally. In the Comet-Project DEXHELPP the actual treatment situation is captured in detail also considering demographic and geographic influence factors. This provides a basis for the development of methods for analysis, extrapolation of future demands and the calculation of scenarios.

The medical care in care homes is an important component of the care about older people in Austria. Until now we don’t know a lot about the services which are provided for the residents of the care homes, except the medicinal care.

The aims of this projects are:

• give an overview about the cooperative aspects in the medical care of care homes,
• create a base for an improvement in quality,
• illustrate the current situation on a quantitative base and
• enable the illustration of existing differences.

Besides cardiovascular diseases and cancer, strokes are one of the main causes of death in Austria and the main cause for permanent disability. With about 24,000 cases per year, strokes constitute a significant economical factor. Early and targeted rehabilitation is crucial for limiting secondary disorders and ideally starts simultaneously to in-patient treatment.

This project tackles the analysisof the status quo of care in stroke patients in Austria, development and deployment of methods in decision support, elaboration of approaches with pseudonymized routine data in general and development of a model for prognosis and assessment of stroke cases and structural care facilities with a time horizon of 15 to 20 years. The project currently relies on datafrom routine treatment of stroke patients for testing and comparison of methods from visual computing, statistics, complex networks research and dynamic modeling.

This project addresses the development of methods and possibilities of a monitoring system for primary care in Austria to support quality assessment and future development. Different indicators are defined that quantitatively describe the purpose and aim of primary care in Austria to uncover the changes in the health care system. For this purpose about 80 indicators were defined, tested on collected data for a sample of 461 primary care structures (general practitioners) and their patients out of routine data, and proposed to the health system partners. Interactive visualization supports the quality assessment, exploration, and presentation of the data.

The aim of this project is to identify and analyze individual and structural characteristics of a treatment-intensive population. Furthermore, this can be used as an active, individual health care approach. In this case the focus group is not based on age, but on data-based characteristics (contacts with the health system) generating a higher proportion of costs (with maybe no additional benefit for patients). New statistical methods are implemented and tested resulting in higher quality for future decisions on prevention or high risk group care.

This pilot project establishes a protocol on how to link microdata from different administrative sources without violating privacy regulations. The data linked contain information on health records and socio economic matters. Based on the data the pilot project analyses the interaction between the incidence/prevalence of spells of morbidity and the social economic position of those who are affected.

The aim is to depict the primary care of the elderly (60+) based on routine data. Frequency of contacts to physicians(categorized by region and medical specialists) are surveyed. The requirements of the elderly in health care differ from those of younger persons, regarding their restricted mobility and their multi-morbidity. These obvious differences can be taken into account in the areas of prevention and organization, as well as in supply structures. Apart from the analysis and presentation of detailed outcomes these investigations might be helpful in their function as augmentation to the standard methods of the Main Association of Austrian Health Security Institutions (HVB). The analyses and methods can furthermore be reused when data time span will be extended or additional patient groups are integrated.

The Austrian Social Security Institutions and outpatient clinics of hospitals are legally obligated to send data about outpatient procedures to the Austrian Ministry of health. The data of outpatient clinics is transmitted by the provincial health fund. The Austrian Social Security uses secondary data containing the respective information about the procedures provided by their contract partners. Every sickness fund has its own fee structure and contracts with providers. Moreover, in every fee structure and contract, every procedure has a different code and name. Therefore, they have to be “mapped” (literally meaning aggregated) to one catalogue of ambulatory procedures, that is issued by the Ministry of health. In the maintenance process, changes in mapping can occur. The aim of the project in DEXHELPP is to develop a method to systematically analyze these changes and display them in an appropriate way.

The indicator “Years of Potential Life Lost” (PYLL) is used to assess the level of impact of certain diseases on premature death. Though the indicator is used internationally, there is no unique definition for it. The used definitions, although similar, differ in details. In this project an overview of internationally used definitions, their differences compared to other indicators and their potential use in DEXHELPP are evaluated. Indicators are a highly discussed aspect, as the measurement of outcome clearly influences the interpretation of results of outcome significantly.

Availability of health care services and their impact on health service utilization are a much-discussed topic. In this project outpatient healthcare services and their effects on utilization patterns are explored. Also, the impact of socio-economic determinants and the role of public versus private suppliers are investigated.

Medical treatments in the outpatient sector depend on population structure, availability of medical doctors and the (compulsory) health insurance. The aim of this project is to provide aggregates and visualizations of the collected information for supporting analysis and planning of health researchers

Publicly available information on all Austrian non SHI-accredited doctors of choice is linked to data on refunds of privately paid bills to these health service providers. The aim is to provide a uniform, reproducible and repeatable analysis of and answers to questions on performance in the outpatient, private practice sector with a special focus on activities of the electoral doctors. In addition to these major goals, the project will also focus on data processing in compliance with data protection regulation (GDPR), the integration of algorithmic comparisons with human expertise and the exploration of previously unknown data sources.