The abstract should provide a summary of the HiT in no more than 250 words The Box provides an example from the Philippines HiT, 2011 Philippines HiT abstract Consistent with its commitment to the Alma Ata in 1978, the Philippine Government adopted the Primary Health Care (PHC) approach in 1979 to achieve health for all Filipinos by year 2000 The promulgation of the Local Development Code (RA 7160) in 1991 was in line with the community participation ideals of PHC (1992-1999) as it devolved responsibility for health care was devolved to Local Government Units The Health Sector Reform Agenda was introduced in 2005 to address problems in health care delivery at local level brought about by the devolution proves Issues of poor accessibility, inequities and inefficiencies of the health system have been the target of health reforms over the last 30 years Hospital, public health, financing, local health system and regulatory reforms comprised the HSRA approach In 2005, the DOH streamlined the reform program to ensure access and availability of essential and basic health packages by reducing the four reform areas, namely: 1) designating providers of basic and essential health service package in strategic locations; 2) assuring the quality of both basic and specialized health services; and 3) intensifying the current efforts to reduce the public health threats brought about by endemic, vaccine-preventable and priority diseases Although studies have yet to be done on the impact of reforming health service delivery, implementation of strategies to improve the hospital services and public health programs have shown some positive gains However, huge disparities in health outcomes across income groups and geographic areas and challenges in ascertaining physical and financial access to health services as evidenced by high out-of-pocket expenditures, concentration of physical and human resources for health in urban areas and migration of health professionals still exist The focus of future developments in health should be towards providing universal health care for Filipinos, starting with improving access of the poor and vulnerable to health services Source: APO, Philippines HiT Vol 1 No 2 2011

https://www.euro.who.int/__data/assets/pdf_file/0018/231516/HiT-Estonia.pdf

Health systems in transition.

Pancreatic cancer is likely to become the second most frequent cause of cancer-associated mortality within the next decade. Surgical resection with adjuvant systemic chemotherapy currently provides the only chance of long-term survival. However, only 10-20% of patients with pancreatic cancer are diagnosed with localized, surgically resectable disease. The majority of patients present with metastatic disease and are not candidates for surgery, while surgery remains underused even in those with resectable disease owing to historical concerns regarding safety and efficacy. However, advances made over the past decade in the safety and efficacy of surgery have resulted in perioperative mortality of around 3% and 5-year survival approaching 30% after resection and adjuvant chemotherapy. Furthermore, owing to advances in both surgical techniques and systemic chemotherapy, the indications for resection have been extended to include locally advanced tumours. Many aspects of pancreatic cancer surgery, such as the management of postoperative morbidities, sequencing of resection and systemic therapy, and use of neoadjuvant therapy followed by resection for tumours previously considered unresectable, are rapidly evolving. In this Review, we summarize the current status of and new developments in pancreatic cancer surgery, while highlighting the most important research questions for attempts to further optimize outcomes.

Optimizing the outcomes of pancreatic cancer surgery

This analysis of the German health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system in Germany is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources on health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, the German health care system still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges for the German health care system, as it leads to inequalities.

Germany: Health system review

NIRS in clinical neurology - a 'promising' tool?

Objective:We aimed to determine the effect of hospital volume on in-hospital mortality, and failure to rescue following major pancreatic resections using hospital discharge data of every inpatient case in Germany.Summary Background Data:Several studies have found strong volume–outcome relationships

Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany.

Objective: We aimed to determine the unbiased mortality rates for pancreatic surgery procedures at the national level through a comprehensive analysis of every inpatient case in Germany. 

Summary of background data: Several studies have proclaimed a general improvement of perioperative outcomes following pancreatic surgery. These results are challenged by recent analyses of large US databases that found strong volume-outcome relationships, with high mortality in low-volume facilities. 

Methods: All inpatient cases with a pancreatic surgery procedure code in Germany from 2009 to 2013 were identified from nationwide administrative hospital data. We determined the absolute number of patients and the in-hospital death rate for crucial subcategories such as medical indications and types of surgical procedure. 

Results: A total of 58,003 inpatient episodes of pancreatic surgery were identified between 2009 and 2013. Annual case numbers increased significantly, which was primarily attributed to patients aged 70 years and older. The overall in-hospital mortality rate (10.1%) did not significantly change during the study period. Major pancreatic resections were associated with mortality ranging from 7.3% (distal pancreatectomy) to 22.9% (total pancreatectomy). Postoperative interventions indicative of severe complications were documented frequently (eg, more than 6 blood transfusions in 20% of all patients and relaparotomy in 16%). Their occurrence was associated with a dramatic increase in mortality. 

Conclusion: At the national level in Germany, perioperative mortality is higher than anticipated from previous studies. The absence of a significant reduction in overall mortality challenges current health policies that aim to improve the outcomes of high-risk surgical procedures in Germany.

Nationwide In-hospital Mortality Following Pancreatic Surgery in Germany is Higher than Anticipated.

BACKGROUND The number of hip and knee replacement operations is rising in many industrialized countries. To evaluate the current situation in Germany, we analyzed the frequency of procedures in Germany compared to the USA, with the aid of similar case definitions and taking demographic differences into account. METHODS We used individual inpatient data from Germany (DRG statistics) and the USA (Nationwide Inpatient Sample) to study differences in the age- and sex-adjusted rates of hip and knee replacement surgery and the determinants of trends in case numbers over the years 2005 to 2011. RESULTS In 2011, hip replacement surgery was performed 1.4 times as frequently in Germany as in the USA (284 vs. 204 cases per 100 000 population per year; the American figures have been adjusted to the age and sex structure of the German population). On the other hand, knee replacement surgery was performed 1.5 times as frequently in the USA as in Germany (304 [standardized] vs. 206 cases per 100,000 population per year). Over the period of observation, the rates of both procedures increased in both countries. The number of elective primary hip replacement operations in Germany grew by 11%, from 140,000 to 155 300 (from 170 to 190 per 100,000 persons); after correction for demographic changes, a 3% increase remained. At the same time, the rate of elective primary hip replacement surgery in the USA rose by 28%, from 79 to 96 per 100 000 population, with a 13% increase remaining after correction for demographic changes. CONCLUSION There are major differences between Germany and the USA in the frequency of these operations. The observed upward trend in elective primary hip replacement operations was mostly due to demographic changes in Germany; non-demographic factors exerted a stronger influence in the USA than in Germany. With respect to primary knee replacement surgery, non-demographic factors exerted a comparably strong influence in both countries.

Hip and Knee Replacement in Germany and the USA: Analysis of Individual Inpatient Data From German and US Hospitals for the Years 2005 to 2011

Objectives To explore the existence and strength of a relationship between hospital volume and mortality, to estimate minimum volume thresholds and to assess the potential benefit of centralisation of services. Design Observational population-based study using complete German hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)). Setting All acute care hospitals in Germany. Participants All adult patients hospitalised for 1 out of 25 common or medically important types of inpatient treatment from 2009 to 2014. Main outcome measure Risk-adjusted inhospital mortality. Results Lower inhospital mortality in association with higher hospital volume was observed in 20 out of the 25 studied types of treatment when volume was categorised in quintiles and persisted in 17 types of treatment when volume was analysed as a continuous variable. Such a relationship was found in some of the studied emergency conditions and low-risk procedures. It was more consistently present regarding complex surgical procedures. For example, about 22 000 patients receiving open repair of abdominal aortic aneurysm were analysed. In very high-volume hospitals, risk-adjusted mortality was 4.7% (95% CI 4.1 to 5.4) compared with 7.8% (7.1 to 8.7) in very low volume hospitals. The minimum volume above which risk of death would fall below the average mortality was estimated as 18 cases per year. If all hospitals providing this service would perform at least 18 cases per year, one death among 104 (76 to 166) patients could potentially be prevented. Conclusions Based on complete national hospital discharge data, the results confirmed volume–outcome relationships for many complex surgical procedures, as well as for some emergency conditions and low-risk procedures. Following these findings, the study identified areas where centralisation would provide a benefit for patients undergoing the specific type of treatment in German hospitals and quantified the possible impact of centralisation efforts.

https://bmjopen.bmj.com/content/bmjopen/7/9/e016184.full.pdf

Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014.

In German hospitals, quality measurement, monitoring, and management have undergone considerable development. This includes an array of mandatory measures, including a nationwide benchmar...

/pdf/measuring-monitoring-and-managing-quality-in-germany-s-3nzh8srl3q.pdf

Thomas Mansky

Papers

Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany.

Nationwide In-hospital Mortality Following Pancreatic Surgery in Germany is Higher than Anticipated.

Hip and Knee Replacement in Germany and the USA: Analysis of Individual Inpatient Data From German and US Hospitals for the Years 2005 to 2011

Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014.

Measuring, Monitoring, And Managing Quality In Germany’s Hospitals