The influence of process and result quality on the cost-effectiveness of treating patients with flexor tendon injuries - Flexor Tendon Study

Status:

completed 09/2010

Aims:

The research project was designed as a prospective multi-centre study. The study design provided for the inclusion of patients undergoing treatment under statutory accident insurance - after an accident at work - as well as patients covered by statutory health insurance. That provided an opportunity to look into different systems of healthcare provision. The main aim of the study was to review the structural, process and result quality of employer's liability treatment of "flexor tendon injuries".

Activities/Methods:

After standardising the therapy regime, target criteria were defined to record the quality of treatment. They included mobility (Buck-Gramcko/TAM score), strength, duration of certified incapacity for work, and patient satisfaction (SF 12, EQ 5 D, DASH). They were correlated by means of independent variables, also known as predictors, and the results were subjected to bi- and multivariate analysis and checked for sustainability.

Results:

Numerous significant variables for a good functional outcome of flexor tendon injuries were detected. Eventually, a prognostic score was calculated from the data by means of ROC analyses that will in future permit early management of the rehabilitation procedure and quality monitoring of treatment facilities. A further practical implementation recommendation results from analyses of the duration of certified incapacity for work. The same applies to the duration of inpatient treatment and intensity of treatment required, which is categorised in accordance with the injury pattern and the prognostic score. Analysis of cost-effectiveness (statutory health insurance/employer's liability insurance) again showed the difficulty of establishing costs incurred for treating statutory health insurance patients. Validation of the weekly cost diary used in the study was only partly possible. That is why evaluations could only be undertaken to a limited extent. These, then, are starting points for follow-on projects. The study confirmed the advantage of employer's liability treatment in respect of functional results and, by analysing scientific medical data, enabled action guidelines to be specified for the first time with regard to intensity of treatment, return to fitness for work and management of therapeutic procedures, depending on the prognosis.

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