{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T04:42:29Z","timestamp":1772944949057,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.73875.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000}}],"reference-count":33,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Innovation Committee at the Joint Federal Committee in Germany","award":["01VSF18026"],"award-info":[{"award-number":["01VSF18026"]}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>\n                    <ns3:bold>Background:\u00a0<\/ns3:bold>\n                    Hospitalizations of nursing home residents are associated with various health risks. Previous research indicates that, to some extent, hospitalizations of this vulnerable population may be inappropriate and even avoidable. This study aimed to develop a consensus list of hospital discharge diagnoses considered to be nursing home-sensitive, i.e., avoidable.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Methods:\u00a0<\/ns3:bold>\n                    The study combined analyses of routine data from six statutory health insurance companies in Germany and a two-stage Delphi panel, enhanced by expert workshop discussions, to identify and corroborate relevant diagnoses. Experts from four different disciplines estimated the proportion of hospitalizations that could potentially have been prevented under optimal conditions.\n                    <ns3:bold>\u00a0<\/ns3:bold>\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Results:\u00a0<\/ns3:bold>\n                    We analyzed frequencies and costs of data for hospital admissions from 242,236 nursing home residents provided by statutory health insurance companies. We identified 117 hospital discharge diagnoses, which had a frequency of at least 0.1%. We recruited experts (primary care physicians, hospital specialists, nursing home professionals and researchers) to estimate the proportion of potentially avoidable hospitalizations for the 117 diagnoses deemed avoidable in two Delphi rounds (n=107 in Delphi Round 1 and n=96 in Delphi Round 2, effective response rate=91%). A total of 35 diagnoses with high and consistent estimates of the proportion of potentially avoidable hospitalizations were identified as nursing home-sensitive. In an expert workshop (n=16), a further 25 diagnoses were discussed that had not reached the criteria, of which another 23 were consented to be nursing home-sensitive conditions. Extrapolating the frequency and mean costs of these 58 diagnoses to the national German context yielded total potentially avoidable care costs of \u20ac768,304,547, associated with 219,955 nursing home-sensitive hospital admissions.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Conclusion:\u00a0<\/ns3:bold>\n                    A total of 58 nursing home-relevant diagnoses (ICD-10-GM three-digit level) were classified as nursing home-sensitive using an adapted Delphi procedure. Interventions should be developed to avoid hospital admission from nursing homes for these diagnoses.\n                  <\/ns3:p>","DOI":"10.12688\/f1000research.73875.2","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T06:45:09Z","timestamp":1649227509000},"page":"1223","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1119-9786","authenticated-orcid":false,"given":"Sabine","family":"Bohnet-Joschko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9913-7610","authenticated-orcid":false,"given":"Maria Paula","family":"Valk-Draad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Schulte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1099-2950","authenticated-orcid":false,"given":"Oliver","family":"Groene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"193-199","DOI":"10.1111\/j.1532-5415.2010.03239.x","article-title":"Functional recovery of elderly patients hospitalized in geriatric and general medicine units. 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Res."},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.17605\/OSF.IO\/EAJ58","article-title":"Nursing home-sensitive conditions.","author":"S Bohnet-Joschko","year":"2021"}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T13:19:44Z","timestamp":1700399984000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,6]]},"references-count":33,"URL":"https:\/\/doi.org\/10.12688\/f1000research.73875.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.123399.r129944","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.123399.r129944","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,6]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.123399.r129944, Daniela Holle, Hochschule f\u00fcr Gesundheit, University of Applied Sciences, Bochum, Germany, 11 Apr 2022, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2#referee-response-129944","order":0,"name":"referee-response-129944","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.77561.r126098, Tim Badgery-Parker, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia, 21 Mar 2022, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/10-1223\/v1#referee-response-126098","order":1,"name":"referee-response-126098","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Sabine Bohnet-Joschko<\/b>; <i>Posted: 01 Apr 2022<\/i>; Dear editors, Dear Tim Badgery-Parker, We kindly thank you for your reply and for offering us the revision of our manuscript for consideration in the <i>F1000Research <\/i>Platform. We carefully considered the comments offered by you to improve the quality of the initial draft of the manuscript. Please find below a point-by-point response, in which we describe how we have addressed the suggestions. All changes or adjustments are shown in <i>italic font <\/i>and in revision mode in the revised paper accordingly. Again thank you for taking the time to critically review the paper. We truly appreciate the constructive input and hope that our revisions meet your approval. Yours sincerely, from the research team, Prof. Dr. Sabine Bohnet-Joschko <b>Comment 1:<\/b> &quot;The results include a comparison of the preventability estimates between subgroups of the Delphi panel, this does not appear to be described in the methods.&quot; <b>Authors\u2019 response to comment 1:<\/b> Thank you very much indeed for your review and the comments. We have now added two sentences to address this aspect: In the \u201cMethod\u201d section, subsection \u201cDelphi study and expert workshop\u201d, fourth paragraph, last sentence: <i>\u201c\u2026<\/i>and planned to recruit 100 experts: 30 outpatient\/clinical physicians each, 30 nursing professionals and 10 scientists. <i>This also allowed for comparison of preventability assessments by expert group.<\/i>\u201d And in the ninth paragraph: \u201cIn case the preventability potential of at least 75% was not comprised in the range of 75% of all expert assessments, the ICD-10 codes were excluded. For all other ICD-10 codes, statistical data (median, modal values, dispersion parameters, bar charts) <i>, results of expert group comparison on preventability assessments (Kruskal-Wallis (K-W)-Test), <\/i>and categorized comments from the Delphi questionnaire were provided for the expert workshop <i>.\u201d<\/i> <b>Comment 2:<\/b> &quot;The results also describe criteria for excluding or combining diagnoses after the first round for presentation in the second round. (The criteria were not met for any diagnosis.) These criteria should really be in the methods.&quot; <b>Authors\u2019 response to comment 2:<\/b> Thank you for bringing this to our attention, which we, unfortunately, overlooked before. We have now moved the criteria to the methods section and only referred to them in the results section, as follows: In the \u201cMethod\u201d section, subsection \u201cDelphi study and expert workshop\u201d, eighth paragraph, second sentence: \u201c <i>ICD-10 codes were planned to be excluded for assessment in the second round, when at least 75% of the experts estimated the preventability as zero in the first round. Secondly, ICD-10 codes were planned to be combined if the diseases were very similar (in terms of symptoms, diagnosis, prognosis, treatment) and the proportions of potential preventability were nearly identical. Two conditions for \u201cnearly identical potential preventability\u201d had to be fulfilled: the medians of the estimated preventability should not differ by more than 5% and the limits of the interquartile range had to be less than 10% apart. <\/i>Based on this information, <i> the ICD-10 codes for the second round were identified and <\/i>the participants were asked to quantify the proportion of potentially avoidable hospitalization again in the second round. <i>\u201d<\/i> And in the \u201cResults\u201d section, subsection \u201cDelphi study and expert workshop\u201d, second paragraph, rather at the end, we changed the text &quot;Furthermore, ICD-10 Codes... . Neither conditions were met sufficiently.&quot; was changed as follows: <i>&quot;The condition that at least 75% of the experts estimated the preventability as zero in the first round was met for none of the ICD-10 codes. Furthermore, none of the ICD-10 codes could be combined as the conditions for \u201cnearly identical potential preventability\u201d were not fulfilled.&quot; <\/i>","URL":"https:\/\/f1000research.com\/articles\/10-1223\/v2#referee-comment-8044","order":2,"name":"referee-comment-8044","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Innovation Committee of the Federal Joint Committee (G-BA) under grant agreement number 01VSF18026. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}