We welcome the critical discussion of our study and are fully aware of the limitations of the underlying data. These were discussed appropriately (1). There are certainly selection factors that cannot be captured in the setting of such an assessment on the basis of primarily economic data. The advantage of the approach we chose is, however, the inclusion of all hospital admissions.
The descriptive statistic did in fact yield some surprising individual results, which are, however, reasonable. It is not appropriate to speak of contradictory results in this context. The key messages, furthermore, are based on a multivariance analysis—an approved and tested method to consider interactions between variables. In the selection of variables, we considered, among others, disease state, hospital size, and certification status as crucial selection factors.
The results are robust in consideration of the reported limitations and are consistent with comparable studies of the care of other disorders (2). As discussed, a conclusive assessment of the quality of care is not possible on the basis of these data. Registry data can be valuable in providing answers to many questions, but it is unlikely that the registry of the German Society of Angiology—which includes very few certified vascular centers—as advertised by our correspondents enables a robust reflection of the nationwide reality of care, independent of the specialization in vascular medicine.
Selection bias is aggravating in a setting where only few clinics are included, who participate voluntarily and are exclusively specialized in angiology and cardiology. This is even more the case when it relates to a pathology that is being treated by professionals from different disciplines and potentially with slightly different approaches. Our research question cannot be answered by using such registry data. We could see advantages in collecting linked longitudinal inpatient and outpatient care data, such as are available to health insurance companies, for example.
Footnotes
Conflict of interest statement
Prof. Kröncke received lecture fees from Abbott Vascular.
References
- 1.Decker JA, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. The in-hospital care of patients with peripheral arterial occlusive disease—the effects of hospital size and certification status. Dtsch Arztebl Int. 2022;119:611–618. doi: 10.3238/arztebl.m2022.0235. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Musallam E, Johantgen M, Connerney I. Hospital disease-specific care certification programs and quality of care: a narrative review. Jt Comm J Qual Patient Saf. 2016;42:364–368. doi: 10.1016/s1553-7250(16)42051-9. [DOI] [PubMed] [Google Scholar]