Alexander Geissler
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Geissler
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Alexander
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alexander.geissler@unisg.ch
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+41 71 224 30 17
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  • Publication
    A composite measure for patient‑reported outcomes in orthopedic care: design principles and validity checks
    (Springer Nature, 2023-03-08)
    Schöner, Lukas
    ;
    David Kuklinski orcid-logo
    ;
    Geissler, Alexander orcid-logo
    ;
    Busse, Reinhard
    ;
    Pross, Christoph
    Background: The complex, multidimensional nature of healthcare quality makes provider and treatment decisions based on quality difficult. Patient-reported outcome (PRO) measures can enhance patient centricity and involvement. The proliferation of PRO measures, however, requires a simplification to improve comprehensibility. Composite measures can simplify complex data without sacrificing the underlying information. Objective and methods: We propose a five-step development approach to combine different PRO into one composite measure (PRO-CM): (i) theoretical framework and metric selection, (ii) initial data analysis, (iii) rescaling, (iv) weighting and aggregation, and (v) sensitivity and uncertainty analysis. We evaluate different rescaling, weighting, and aggregation methods by utilizing data of 3145 hip and 2605 knee replacement patients, to identify the most advantageous development approach for a PRO-CM that reflects quality variations from a patient perspective. Results: The comparison of different methods within steps (iii) and (iv) reveals the following methods as most advantageous: (iii) rescaling via z-score standardization and (iv) applying differential weights and additive aggregation. The resulting PROCM is most sensitive to variations in physical health. Changing weighting schemes impacts the PRO-CM most directly, while it proves more robust towards different rescaling and aggregation approaches. Conclusion: Combining multiple PRO provides a holistic picture of patients’ health improvement. The PRO-CM can enhance patient understanding and simplify reporting and monitoring of PRO. However, the development methodology of a PROCM needs to be justified and transparent to ensure that it is comprehensible and replicable. This is essential to address the well-known problems associated with composites, such as misinterpretation and lack of trust.
    Type: journal article
    Journal: Quality of Life Research
    URL: https://doi.org/10.1007/s11136-023-03395-0
    DOI: 10.1007/s11136-023-03395-0
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/107664
    Scopus© Citations 2
  • Publication
    Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality
    (Springer Nature, 2022-01-08)
    Strumann, Christoph
    ;
    Geissler, Alexander orcid-logo
    ;
    Busse, Reinhard
    ;
    Pross, Christoph
    Public reporting on the quality of care is intended to guide patients to the provider with the highest quality and to stimulate a fair competition on quality. We apply a difference-in-differences design to test whether hospital quality has improved more in markets that are more competitive after the first public release of performance data in Germany in 2008. Panel data from 947 hospitals from 2006 to 2010 are used. Due to the high complexity of the treatment of stroke patients, we approximate general hospital quality by the 30-day risk-adjusted mortality rate for stroke treatment. Market structure is measured (comparatively) by the Herfindahl–Hirschman index (HHI) and by the number of hospitals in the relevant market. Predicted market shares based on exogenous variables only are used to compute the HHI to allow a causal interpretation of the reform effect. A homogenous positive effect of competition on quality of care is found. This effect is mainly driven by the response of non-profit hospitals that have a narrow range of services and private for-profit hospitals with a medium range of services. The results highlight the relevance of outcome transparency to enhance hospital quality competition.
    Type: journal article
    Journal: The European Journal of Health Economics
    URL: https://link.springer.com/article/10.1007/s10198-021-01423-9
    DOI: https://doi.org/10.1007/s10198-021-01423-9
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/109085
  • Publication
    Qualitätstransparenz im Gesundheitswesen: eine gesundheitsökonomische Modellbetrachtung
    (Georg Thieme Verlag KG, 2021-08-03)
    Pross, Christoph
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    Schöner, Lukas
    ;
    Geissler, Alexander orcid-logo
    ;
    Busse, Reinhard
    A key concern for a well-functioning health care system is whether competition between providers and its regulation ensures the optimal level of quality of care. Currently, quality of care is often provided inconsistently or insufficiently. There are no uniform or comprehensive approaches for defining and measuring quality, neither from a clinical nor from a patient perspective. Moreover, in economic theory, health care is classified as a credence good and, thus, is characterized by strong information asymmetries between patients, health care providers, and payers. Using classic health economic approaches, this article examines the factors influencing quality of care on both the demand and the supply side and explores current health policy measures to support the optimal level of quality of care in competition between service providers.
    Type: journal article
    Journal: Gesundheitsökonomie & Qualitätsmanagement
    Volume: 26
    Issue: 04
    URL: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1543-4831
    DOI: DOI: 10.1055/a-1543-4831
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/110133
  • Publication
    The use of digitally collected patient-reported outcome measures for newly operated patients with total knee and hip replacements to improve post-treatment recovery: study protocol for a randomized controlled trial
    (Trials, 2020)
    David Kuklinski orcid-logo
    ;
    Oschmann, Laura
    ;
    Pross, Christoph
    ;
    Busse, Reinhard
    ;
    Alexander Geissler orcid-logo
    BACKGROUND The number of total knee replacements (TKRs) and total hip replacements (THRs) has been increasing noticeably in high-income countries, such as Germany. In particular, the number of revisions is expected to rise because of higher life expectancy and procedures performed on younger patients, impacting the budgets of health-care systems. Quality transparency is the basis of holistic patient pathway optimization. Nevertheless, a nation-wide cross-sectoral assessment of quality from a patient perspective does not yet exist. Several studies have shown that the use of patient-reported outcome measures (PROMs) is effective for measuring quality and monitoring post-treatment recovery. For the first time in Germany, we test whether early detection of critical recovery paths using PROMs after TKR/THR improves the quality of care in a cost-effective way and can be recommended for implementation into standard care. METHODS/DESIGN The study is a two-arm multi-center patient-level randomized controlled trial. Patients from nine hospitals are included in the study. Patient-centered questionnaires are employed to regularly measure digitized PROMs of TKR/THR patients from the time of hospital admission until 12 months post-discharge. An expert consortium has defined PROM alert thresholds at 1, 3, and 6 months to signal critical recovery paths after TKR/THR. An algorithm alerts study assistants if patients are not recovering in line with expected recovery paths. The study assistants contact patients and their physicians to investigate and, if needed, adjust the post-treatment protocol. When sickness funds’ claims data are added, the cost-effectiveness of the intervention can be analyzed. DISCUSSION The study is expected to deliver an important contribution to test PROMs as an intervention tool and examine the determinants of high-quality endoprosthetic care. Depending on a positive and cost-effective impact, the goal is to transfer the study design into standard care. During the trial design phase, several insights have been discovered, and there were opportunities for efficient digital monitoring limited by existing legacy care models. Digitalization in hospital processes and the implementation of digital tools still represent challenges for hospital personnel and patients. Furthermore, data privacy regulations and the separation between the in- and outpatient sector are roadblocks to effectively monitor and assess quality along the full patient pathway.
    Type: journal article
    Journal: Trials
    Volume: 21 (1)
    Issue: 322
    URL: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04252-y
    DOI: 10.1186/s13063-020-04252-y
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/112918
    Scopus© Citations 14
  • Publication
    Stroke units, certification, and outcomes in German hospitals: a longitudinal study of patient-based 30-day mortality for 2006-2014
    ( 2018-11)
    Pross, Christoph
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    Berger, Elke
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    Siegel, Martin
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    Geissler, Alexander orcid-logo
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    Busse, Reinhard
    Background Treatment of stroke patients in stroke units has increased and studies have shown improved outcomes. However, a large share of patients in Germany is still treated in hospitals without stroke unit. The effects of stroke unit service line, and total hospital quality certification on outcomes remain unclear. Methods We employ annual hospital panel data for 1100–1300 German hospitals from 2006 to 2014, which includes structural data and 30-day standardized mortality. We estimate hospital- and time-fixed effects regressions with three main independent variables: (1) stroke unit care, (2) stroke unit certification, and (3) total hospital quality certification. Results Our results confirm the trend of decreasing stroke mortality ratios, although to a much lesser degree than previous studies. Descriptive analysis illustrates better stroke outcomes for non-certified and certified stroke units and hospitals with total hospital quality certification. In a fixed effects model, having a stroke unit has a significant quality-enhancing effect, lowering stroke mortality by 5.6%, while there is no significant improvement effect for stroke unit certification or total hospital quality certification. Conclusions Patients and health systems may benefit substantially from stroke unit treatment expansion as installing a stroke unit appears more meaningful than getting it certified or obtaining a total hospital quality certification. Health systems should thus prioritize investment in stroke unit infrastructure and centralize stroke care in stroke units. They should also prioritize patient-based 30-day mortality data as it allows a more realistic representation of mortality than admission-based data.
    Type: journal article
    Journal: BMC Health Services Research
    Volume: 18
    Issue: 880
    URL: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3664-y
    DOI: 10.1186/s12913-018-3664-y.
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/99909
  • Publication
    Type: journal article
    Journal: PLOS ONE
    Volume: 13
    Issue: 9:e0203017
    URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203017
    DOI: https://doi.org/10.1371/journal.pone.0203017
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/100100
  • Publication
    Health care public reporting utilization – user clusters, web trails, and usage barriers on Germany’s public reporting portal Weisse-Liste.de
    ( 2017-04-21)
    Pross, Christoph
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    Averdunk, Lars-Henrik
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    Stjepanovic, Josip
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    Busse, Reinhard
    ;
    Geissler, Alexander orcid-logo
    Background: Quality of care public reporting provides structural, process and outcome information to facilitate hospital choice and strengthen quality competition. Yet, evidence indicates that patients rarely use this information in their decision-making, due to limited awareness of the data and complex and conflicting information. While there is enthusiasm among policy makers for public reporting, clinicians and researchers doubt its overall impact. Almost no study has analyzed how users behave on public reporting portals, which information they seek out and when they abort their search. Methods: This study employs web-usage mining techniques on server log data of 17 million user actions from Germany’s premier provider transparency portal Weisse-Liste.de (WL.de) between 2012 and 2015. Postal code and ICD search requests facilitate identification of geographical and treatment area usage patterns. User clustering helps to identify user types based on parameters like session length, referrer and page topic visited. First-level markov chains illustrate common click paths and premature exits. Results: In 2015, the WL.de Hospital Search portal had 2,750 daily users, with 25% mobile traffic, a bounce rate of 38% and 48% of users examining hospital quality information. From 2013 to 2015, user traffic grew at 38% annually. On average users spent 7 min on the portal, with 7.4 clicks and 54 s between clicks. Users request information for many oncologic and orthopedic conditions, for which no process or outcome quality indicators are available. Ten distinct user types, with particular usage patterns and interests, are identified. In particular, the different types of professional and non-professional users need to be addressed differently to avoid high premature exit rates at several key steps in the information search and view process. Of all users, 37% enter hospital information correctly upon entry, while 47% require support in their hospital search. Conclusions: Several onsite and offsite improvement options are identified. Public reporting needs to be directed at the interests of its users, with more outcome quality information for oncology and orthopedics. Customized reporting can cater to the different needs and skill levels of professional and non-professional users. Search engine optimization and hospital quality advocacy can increase website traffic.
    Type: journal article
    Journal: BMC Medical Informatics and Decision Making
    Issue: 17
    URL: https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-017-0440-6
    DOI: https://doi.org/10.1186/s12911-017-0440-6
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/102452
  • Publication
    Type: journal article
    Journal: Health Policy
    Volume: 121
    Issue: 8
    URL: https://www.sciencedirect.com/science/article/abs/pii/S0168851017301732?via%3Dihub
    DOI: https://doi.org/10.1016/j.healthpol.2017.06.009
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/102138
  • Publication
    Measuring, Reporting, and Rewarding Quality of Care in 5 Nations: 5 Policy Levers to Enhance Hospital Quality Accountability.
    ( 2017-03-07)
    Pross, Christoph
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    Geissler, Alexander orcid-logo
    ;
    Busse, Reinhard
    Context: Studies have documented wide quality variation among hospitals within and across countries. Increasing quality‐of‐care accountability for hospitals, especially for patients and the general public, is an important policy objective, but no study has yet systematically and comprehensively compared leading countries’ initiatives in this regard. Methods: Based on expert interviews and an extensive literature review, we investigate hospital quality accountability in England, Germany, the Netherlands, Sweden, and the United States. The underlying framework includes 3 elements: measuring quality, reporting quality, and rewarding quality. Each element is subdivided into 2 dimensions, with measuring composed of indicator type and data source, reporting composed of degree of reporting centralization and data accessibility, and rewarding composed of extent of application and type of quality‐related payments. Findings: The results show a wide spectrum of approaches and progress levels. Measuring strategies are more similar across countries, while quality reporting and financial rewards are more dissimilar. Reporting of process indicators is more prevalent than reporting of outcomes. Most countries have introduced some quality‐related payment schemes, with the United States having the most comprehensive approach. Based on the cross‐country assessment, 5 policy levers to enhance quality transparency are identified and illustrated through country‐specific examples: (1) the government should take a central role in establishing standards and incentives for quality transparency and health IT system integration; (2) system centralization and decentralization need to be balanced to ensure both national comparability and local innovation; (3) health systems need to focus more on outcome transparency and less on process measures; (4) health systems need to engage providers as proponents of quality transparency; and (5) reporting should focus on hospital and condition levels to ensure comparability and enable meaningful patient choice. Conclusions: The findings facilitate cross‐country learning and best‐practice adoption by assessing hospital quality accountability strategies in 5 countries in a structured and comparative manner. The identified policy levers are relevant for enhancing breadth, depth, and value of quality accountability.
    Type: journal article
    Journal: The Milbank Quarterly
    Volume: 95
    Issue: 1
    URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/1468-0009.12248
    DOI: https://doi.org/10.1111/1468-0009.12248
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/102556
  • Publication
    Implikationen von Mindestmengen und Zertifizierungsvorgaben: Auswirkungen verschiedener Vorgaben auf den deutschen Krankenhaussektor
    (Medizinisch Wissenschaftliche Verlagsgesellschaft, 2018)
    Justus Vogel orcid-logo
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    Polin, Katherine
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    Pross, Christoph
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    Geissler, Alexander orcid-logo
    ;
    Dormann, Franz
    ;
    Klauber, Jürgen
    ;
    Kuhlen, Ralf
    Type: book section
    URL: https://www.mwv-berlin.de/produkte/!/title/qualitaetsmonitor-2019/id/606
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/101648