At the Copenhagen conference “Preventing Overdiagnosis meeting 2023”, nine authors presented the first results of the IndiQ project (1) based at the Technical University of Berlin. The title of her presentation: “Measuring prevalence and trends in low-value care using German performance data” (2). The IndiQ project, an acronym for “Development of a tool for measuring indication quality in routine data and identifying needs and strategies for action”, aims to develop an instrument for measuring indication quality or for the systematic recording of inappropriate indications in the German healthcare system To develop the use of GKV routine data - and thus gain insights into improving the quality of care and care efficiency.

>> If the project is successful, the indicators developed will be used to illustrate dimensions, trends and regional differences, identify needs for action and opportunities for improving care with regard to the quality of indications, and formulate targeted implementation strategies. The indicators are examined using a mix of methods consisting of systematic research, technical coordination and discussions between experts from the areas of documentation and clinical practice, as well as analyzes of billing data from patient treatment. The analysis
includes all those insured by statutory health insurance who were treated in the outpatient or inpatient sector during the period under review. In the opinion of the project partners*, if successful, the
Results for health services research
can be used, for example to determine the factor
to explore factors that influence indication quality and to develop possible improvement strategies. In practice, care areas or regions in particular could be identified where there is a particular need for action.
In their presentation “Measuring prevalence and trends in low-value care using German claims data” (English title: “Measuring prevalence and trends in low-value care using German claims data – first results of the IndiQ project”) the nine authors** at the Copenhagen conference, organized by the Danish House
medical association, presented their first results. According to this, after completing the identification process, the project partners selected 36 indicators that should be measured in German performance data. According to the group of authors, both the absolute frequency and the prevalence of low-value care differ significantly between the indicators. Overall, the absolute number of low-value care cases in the sensitive area is over seven million, and in the specific area it is still over three million. According to the statement made in the lecture, many of the indicators as well as the cumulative number of cases show a declining trend in low-value care (e.g. electrotherapy for pressure sores, opioid analgesics for non-specific back pain). In addition, some indicators showed patterns of change with the outbreak of the Covid-19 pandemic in 2020. For example, antibiotic prescriptions for uncomplicated respiratory infections have declined significantly since the beginning of the Covid-19 pandemic. The preliminary conclusion: “The great importance of low-value care is confirmed by the measured indicators. However, the selected set of indicators neither represents the entirety of low-value care services nor does it aim to identify individual, possibly inappropriate cases.”
Nevertheless, the results achieved so far could serve as a basis for further investigations. To this end, regional variations and sectoral differences in the selected indicators would be examined to identify possible determinants of low-value care. Finally, the results would be used to develop intervention recommendations, categorized according to the most promising paths in terms of the expected effort and benefits. <<

background
An appropriate indication, i.e. H. The right decision about when, whether and how treatment should take place is necessary in order to avoid over-, under- and incorrect care. The indication quality records whether a medical service is appropriate. To date, however, there is no comprehensive set of indicators that can be used to measure indication quality.

*IndiQ project partner
The project sponsor is the Technical University of Berlin with the Department of Management in Healthcare, headed by Prof. Dr. Reinhard Busse. The other consortium partners are the Techniker Krankenkasse (TK) and the Central Institute for Statutory Health Care in the Federal Republic of Germany (Zi). The project is also supported by the working group of scientists
Medical professional societies e. V. (AWMF),
represented by the Institute for Medical Knowledge Management (IMWi) and the working group on collection and use of routine data (AGENS) of the German Society for Social Medicine and Prevention
(DGSMP) and the German Society for Epidemiology (DGEpi)

**Authors
Meik Hildebrandt MSc1, Hanna Ermann MSc 1,
Lotte Dammertz2, Dr. Monika Nothacker MPH3, PD Dr. Udo Schneider4, APL Prof. Dr. Enno Swart5, Dr. Peter Ihle6, Prof. Dr. Reinhard Busse MPH FFPH1, Prof. Dr. Verena Vogt1.7

1: Department of Management in Healthcare, TU Berlin
2: Central Institute for Statutory Health Insurance in the Federal Republic of Germany (Zi), Berlin
3: AWMF Institute for Medical Knowledge Management (AWMF-IMWi)
4: Techniker Krankenkasse, Hamburg
5: Institute for Social Medicine and Health Systems Research (ISMG) at the Otto von Guericke University, Magdeburg
6: PMV research group at the University of Cologne
7: since June 2023: Holder of the professorship for quantitative health services research at the Jena University Hospital