eTable 2. Indicators that could be operationalized and evaluated (n = 101).
| ID | Indicator name (short) | Indicator statement (long) | Supply need | Donabedian | ||||
| Acute | Chronic | Prevention | Structure | Process | Outcome | |||
| 1 – Heart failure | ||||||||
| 1.1 | Treatment with an ACE inhibitor or AT1 blocker (> 90 DDD) | Proportion of heart failure patients prescribed at least 90 daily doses (DDD) of an ACE inhibitor or AT1 blocker in the previous 12 months | X | X | ||||
| 1.2 | Treatment with class-I and -III antiarrhythmic drugs | Proportion of heart failure patients prescribed class-I and -III antiarrhythmic drugs (excluding amiodarone), calcium channel blockers (except amlodipine, felodipine), and non-steroidal anti-inflammatory drugs in the previous 12 months | X | X | ||||
| 1.3 | Treatment with anti-inflammatory drugs | Proportion of heart failure patients prescribed non-selective NSAID (e.g., diclofenac, ibuprofen, naproxen) or selective Cox-2 inhibitors (coxibs) in the previous 12 months | X | X | ||||
| 1.4 | Treatment with beta-blockers I | Proportion of heart failure patients prescribed at least 90 DDD of a beta-blocker in the previous 12 months | X | X | ||||
| 1.6 | Assessment of electrolyte disturbance | Proportion of heart failure patients diagnosed with an electrolyte disorder (hyponatremia, hypokalemia, and hyperkalemia) in the previous 12 months | X | X | ||||
| 1.8 | Hospital admission rate due to heart failure | Proportion of heart failure patients requiring inpatient admission for heart failure in the previous 12 months | X | X | ||||
| 1.9 | Patient counse ling | Proportion of heart failure patients who received instruction on managing their chronic disease in the previous 12 months | X | X | ||||
| 1.10 | Digoxin level monitoring | Proportion of heart failure patients prescribed digoxin who had their serum digoxin level checked in the previous 6 months | X | X | ||||
| 1.11 | Medication monitoring/ medication plan | Proportion of heart failure patients with drug monitoring | X | X | ||||
| 1.13 | Renal function and electrolyte monitoring | Proportion of heart failure patients with serum electrolyte and renal function monitoring at least every 6 months | X | X | ||||
| 1.15 | Stroke in heart failure | Proportion of heart failure patients that required inpatient admission for ischemic stroke in the previous 12 months | X | X | ||||
| 1.16 | Tricyclic antidepressants | Proportion of heart failure patients with depression and an indication for treatment with antidepressants who were prescribed tricyclic antidepressants | X | X | ||||
| 2 – Osteoporosis | ||||||||
| 2.1 | Bisphosphonate | Proportion of osteoporosis patients treated witha bisphosphonate within the previous 12 months | X | X | ||||
| 2.2 | Medication (calcium/vitamin D) for a fracture | Proportion of osteoporosis patients with a pathologic fracture who received a combination of calcium and/or vitamin D supplementation in the previous 12 months | X | X | ||||
| 2.3 | Physiotherapy after fracture | Proportion of patients with osteoporosis and pathological fractures who received physiotherapy within the last 12 months. | X | X | ||||
| 3 – Metabolic syndrome/diabetes mellitus | ||||||||
| 3.1 | Treatment with antihypertensive drugs I | Proportion of patients with metabolic syndrome who were prescribed antihypertensive drugs in the previous 12 months | X | X | ||||
| 3.2 | Diabetic eye screening | Proportion of patients with diabetes mellitus who have had an annual eye exam | X | X | ||||
| 3.4 | Amputations in diabetes | Proportion of patients with diabetes mellitus who underwent a lower extremity amputation in the previous 12 month | X | X | ||||
| 3.5 | Exercise ECG in obesity | Proportion of obese patients that underwent an exercise ECG from their primary care physician to assess training performance in the ‧previous 12 months | X | X | ||||
| 3.6 | Diabetic retinopathy | Proportion of diabetic patients with newly diagnosed diabetic retinopathy in the previous 12 months | X | X | ||||
| 3.7 | Participation in the type-1 and type-2 diabetes mellitus DMP | Proportion of patients with type-1 and type-2 diabetes mellitus participating in the diabetes mellitus type 1 and type 2 DMP | X | X | ||||
| 4 – Chronic obstructive pulmonary disease (COPD) | ||||||||
| 4.1 | Respiratory therapy | Proportion of COPD patients that received respiratory therapy in the previous 12 months | X | X | ||||
| 4.4 | Participation in the COPD DMP | Proportion of COPD patients participating in the COPD DMP | X | X | ||||
| 4.6 | Inpatient admission due to COPD | Proportion of COPD patients that required inpatient admission for exacerbations in the previous 12 months | X | X | ||||
| 5 – Depression | ||||||||
| 5.1 | Follow-up care | Proportion of patients with depression who received follow-up care (quarterly visits to a psychiatrist or psychotherapist) in the previous 12 months | X | X | ||||
| 5.2 | Inpatient admission for moderate depression | Proportion of patients diagnosed with moderate depression who required inpatient admission in the previous 12 months | X | X | ||||
| 5.3 | Psychotherapy II | Proportion of patients with depression who received psychotherapy in the previous 12 months | X | X | ||||
| 5.4* | Hospital readmission for depression | Proportion of patients treated as inpatients for depression who needed to be readmitted to hospital within 30 days, 90 days, or 1 year | X | X | ||||
| 6 – Rheumatoid arthritis | ||||||||
| 6.1 | Functional diagnostics | Proportion of rheumatoid arthritis patients aged 18 years and over undergoing regular and comprehensive disease monitoring | X | X | ||||
| 6.2 | Renal function monitoring | Proportion of rheumatoid arthritis patients in whom renal values were monitored | X | X | ||||
| 6.3 | Medication (disease-modifying antirheumatic drugs) | Proportion of patients aged 18 years and over with newly diagnosed rheumatoid arthritis in the previous 12 months who received at least one prescription of a disease-modifying antirheumatic drug in the ‧previous 12 months | X | X | ||||
| 7 – Chronic pain | ||||||||
| 7.1 | Screening for depression | Proportion of chronic pain patients that were screened for depression | X | X | ||||
| 7.2 | Constipation prophylaxis | Proportion of patients on chronic pharmacological pain management who received a prescription for laxatives in the previous 12 months | X | X | ||||
| 7.3 | Psychotherapy III | Proportion of chronic pain patients with depression who received psychotherapy in the previous 12 months | X | X | ||||
| 7.4 | Pain analysis | Proportion of chronic pain patients who received a pain analysis with differential diagnosis in the previous 12 months | X | X | ||||
| 7.5 | Peptic ulcer under pain medication | Proportion of chronic pain patients who developed peptic ulcer under pain medication in the previous 12 months | X | X | ||||
| 8 – Back pain | ||||||||
| 8.1 | Incapacity for work | Proportion of patients with low back pain in the previous 12 months and unable to work for more than 14 days | X | X | ||||
| 8.2 | Specialist physician contact I | Proportion of patients with back pain treated by a specialist physician in the previous 12 months | X | X | ||||
| 8.3 | Opioids | Proportion of patients with back pain who were prescribed opioids in the previous 12 months | X | X | ||||
| 9 – Antibiotic therapy | ||||||||
| 9.1 | Cystitis pathogen detection | Proportion of patients with hematuria due to urinary tract infection for whom a midstream urine culture was performed | X | X | ||||
| 9.2 | Fluoroquinolones and cephalosporins | Proportion of uncomplicated cystitis patients prescribed fluoroquinolones and/or cephalosporins as first-line antibiotics | X | X | ||||
| 9.3 | Prescription of reserve antibiotics | Proportion of urinary tract infection patients that were prescribed reserve antibiotics in the previous 12 months | X | X | ||||
| 10 – Pediatric preventive medicine | ||||||||
| 10.2 | HPV vaccinations | Proportion of girls aged 12–17 years who received their first and second vaccinations against cervical cancer (HPV) | X | X | ||||
| 10.3 | Hip screening | Proportion of children aged < 6 weeks who underwent screening for developmental dysplasia of the hip | X | X | ||||
| 10.4 | Visual impairment | Proportion of children aged < 36 months who underwent an eye examination for impaired vision | X | X | ||||
| 10.5 | ADHD | Proportion of children aged > 4 years who presented again 30 days after an initial prescription for ADHD medication | X | X | ||||
| 11 – Age-specific indicators | ||||||||
| 11.1 | Flu vaccination | Proportion of patients aged ≥ 60 years who received a flu vaccination in the previous 12 months | X | X | ||||
| 11.3 | Polymedication I | Proportion of patients aged ≥ 65 years that were concomittantly prescribed five and more active substances in the previous 12 months | X | X | ||||
| 11.4 | Adverse drug reactions (ADRs) | Proportion of patients aged ≥ 65 years who required inpatient admission due to ADRs in the previous 12 months | X | X | ||||
| 11.5 | Long-term prescription of benzodiazepines | Proportion of patients aged ≥ 65 years with long-term prescription (longer than 8 weeks) of benzodiazepines in the previous 12 months | X | X | ||||
| 11.6 | Prescription of long-acting benzodiazepines | Proportion of patients aged ≥ 65 years prescribed a long-acting benzodiazepine | X | X | ||||
| 12 – Multiple sclerosis | ||||||||
| 12.1 | Physiotherapy | Proportion of patients diagnosed with multiple sclerosis who received physiotherapy | X | X | ||||
| 13 – Coronary heart disease | ||||||||
| 13.1 | Prescription of antihypertensive drugs II | Proportion of CHD patients treated with ACE inhibitors or ARB (AT2 antagonists) in the previous 12 months | X | X | ||||
| 13.2 | Prescription of acetylsalicylic acid (ASA) | Proportion of CHD patients prescribed ASA in the previous 12 months | X | X | ||||
| 13.3 | Prescription of beta-blockers II | Proportion of CHD patients prescribed a beta-blocker in the previous 12 months | X | X | ||||
| 13.4 | Participation in the CHD DMP | Proportion of CHD patients participating in the CHD DMP | X | X | ||||
| 13.5 | Contact with a specialist physician II | Proportion of CHD patients with a comorbidity such as hypertension and/or diabetes mellitus and/or depression who were referred to a specialist physician in the previous 12 months | X | X | ||||
| 13.6 | Prescription of nitrates/calcium antagonists due to absolute contraindications to beta blockers | Proportion of CHD patients prescribed nitrates and/or calcium antagonists in the previous 12 months due to absolute contraindications to beta blockers | X | X | ||||
| 13.9 | Rehabilitation | Proportion of CHD patients post acute coronary syndrome, post coronary revascularization, and/or with stable angina pectoris and limiting symptoms and/or with chronic heart failure who received rehabilitation | X | X | ||||
| 13.10 | Prescription of statins I | Proportion of CHD patients prescribed statins in the previous 12 months | X | X | ||||
| 14 – Myocardial infarction | ||||||||
| 14.1 | Prescription of ACE inhibitors or ARBs for left ventricular systolic dysfunction | Proportion of post-myocardial infarction patients with left ventricular systolic dysfunction that received a prescription for ACE inhibitors or ARBs (angiotensin receptorblockers) | X | X | ||||
| 14.2 | Prescription of beta-blockers III | Proportion of patients that suffered a myocardial infarction and received a prescription for beta-blockers | X | X | ||||
| 14.3 | Prescription of statins II | Proportion of patients that suffered myocardial infarction and received a prescription for statins | X | X | ||||
| 14.4 | Prescription of antiplatelet drugs | Proportion of patients that suffered myocardial infarction and received a prescription for an antiplatelet drug | X | X | ||||
| 15 – Stroke | ||||||||
| 15.2 | Duplex ultrasound | Proportion of patients with stroke/TIA who underwent duplex ultrasound of the carotid arteries | X | X | ||||
| 15.3 | Antiplatelet drugs | Proportion of stroke patients that received an antiplatelet drug | X | X | ||||
| 15.5 | Hospital readmission for stroke | Proportion of stroke patients that required hospital readmission for stroke in the year following discharge | X | X | ||||
| 15.6 | Antidepressants | Proportion of patients with stroke and depression who received a selective serotonin reuptake inhibitor (SSRI) | X | X | ||||
| 16 – Dementia | ||||||||
| 16.1 | Prescription of acetylcholinesterase inhibitors | Proportion of patients with Alzheimer’s disease who received an acetylcholinesterase inhibitor | X | X | ||||
| 16.2 | Imaging | Proportion of with newly diagnosed dementia patients that underwent brain imaging at diagnosis | X | X | ||||
| 16.4 | Laboratory tests | Proportion of newly diagnosed dementia patients that underwent the following laboratory blood tests in the previous 12 months: blood count, TSH, electrolytes, glucose, vitamin B 12 | X | X | ||||
| 16.6 | Polymedication II | Proportion of dementia patients that were concomitantly prescribed ≥ five active substances | X | X | ||||
| 16.7 | Test methods in suspected dementia | Proportion of dementia patients in whom a dementia-specific testing procedure was performed | X | X | ||||
| 16.8 | GP-led geriatric assessment in the primary care setting | Proportion of patients that received a basic geriatric assessment by their GP | X | X | ||||
| 17 – Drug safety | ||||||||
| 17.1 | Dementia and prescription of piracetam | Proportion of dementia patients that were prescribed piracetam in the previous 12 months | X | X | ||||
| 18 – Screening/prevention | ||||||||
| 18.1 | Skin cancer screening | Proportion of patients aged ≥ 35 years who underwent skin cancer screening in the previous 12 months | X | X | ||||
| 18.2 | MMRV vaccine (11–23 months) | Proportion of children (11–23 months) that received all four measles, mumps, rubella, and chickenpox vaccinations | X | X | ||||
| 18.3 | Measles, mumps, rubella, and chickenpox vaccine (11–23 months) | Proportion of children (11–23 months) that received at least one of the measles, mumps, rubella, or chickenpox vaccines | X | X | ||||
| 18.5 | Colon cancer screening | Proportion of patients aged ≥ 55 years that underwent colonoscopy for colon cancer screening | X | X | ||||
| 19 – Asthma | ||||||||
| 19.1 | Allergy history | Proportion of patients with newly diagnosed bronchial asthma whose allergy-focused clinical history was taken | X | X | ||||
| 19.2 | Long-term medication with inhaled glucocorticosteroids | Proportion of patients with chronic bronchial asthma (stage 2 and higher) receiving long-term medication with inhaled glucocorticosteroids (ICS) | X | X | ||||
| 20 – Regional: demography | ||||||||
| 20.1 | Live births | Live births per 1000 women aged 15–49 | Not classified | X | ||||
| 20.5 | Deaths | Deaths per 100,000 inhabitants | Not classified | X | ||||
| 20 – Regional: utilization (inpatient) | ||||||||
| 20.7 | Overall hospital cases | Insured persons hospitalized per 100,000 inhabitants | X | X | ||||
| 20.8 | Myocardial infarction hospital cases | Insured persons hospitalized due to myocardial infarction per 100,000 inhabitants | X | X | ||||
| 20.9 | Ischemic heart disease hospital cases | Insured persons hospitalized due to ischemic heart disease per 100,000 inhabitants | X | X | ||||
| 20.10 | COPD hospital cases | Insured persons hospitalized due to COPD per 100 000 inhabitants | X | X | ||||
| 20.11 | Diabetes mellitus hospital cases | Insured persons hospitalized due to diabetes mellitus per 100 000 inhabitants | X | X | ||||
| 20.12 | Stroke hospital cases | Insured persons hospitalized due to stroke per 100 000 population | X | X | ||||
| 20.13 | Knee and hip replacements | Insured persons undergoing a knee or hip replacement per 100 000 inhabitants | X | X | ||||
| 20.14 | Cesarean section deliveries | Proportion of cesarean section deliveries relative to all deliveries | Not classified | X | ||||
| 20.15 | Mental illness hospital cases | Insured persons hospitalized due to mental illness per 100 000 inhabitants | X | X | ||||
| 20.16 | Malignant neoplasms hospital cases | Insured persons hospitalized due to malignant neoplasms per 100 000 inhabitants | X | X | ||||
| 20 – Regional: cancer incidence | ||||||||
| 20.17 | New cancer cases | New cancer cases per 100 000 inhabitants | Not classified | X | ||||
| 20 – Regional: nursing care | ||||||||
| 20.19 | Care-dependent persons | Persons in need of long-term care per 100 000 inhabitants | Not classified | Not classified | ||||
| 20 – Regional: utilization (outpatient) | ||||||||
| 20.40 | Outpatient medical and psychotherapeutic treatment | Proportion of insured persons receiving medical and psychotherapeutic treatment | Not classified | X | ||||
| 20 – Regional: pharmacotherapy | ||||||||
| 20.43 | Generic drugs | Proportion of generic drug prescriptions relative to all prescriptions of generically available drugs | Not classified | X | ||||
| 20.44 | Analog preparations | Proportion of prescriptions of drugs classified as analog preparations with the potential for high savings | Not classified | X | ||||
| 20.45 | RSCA | Proportion of prescriptions of RSCA-compliant antidiabetic drugs relative to all antidiabetic drugs | Not classified | X | ||||
| Total | 3 | 70 | 19 | 1 | 74 | 25 | ||
* Indicator has three forms (5.4.30, 5.4.90. 5.4.365).
IACE inhibitors, angiotensin converting enzyme inhibitors; ADHD, attention deficit hyperactivity disorder; ARB, angiotensin II receptor blockers; ASA, acetylsalicylic acid; AT1 blockers, angiotensin II receptor antagonists; AT2 antagonists, angiotensin II antagonists; COPD, chronic obstructive pulmonary disease; DDD, defined daily dose; DMP, disease management program; ECG, electrocardiogram; GP, general practitioner; HPV, human papillomavirus; ICS, inhaled corticosteroids; CHD, coronary heart disease; NSAID, non-steroidal anti-inflammatory drug; RSCA, German Risk Structure Compensation Act; SSRI, selective serotonin reuptake inhibitors; TIA, transient ischemic attack; TSH, thyroid stimulating hormone; ADR, adverse drug reactions
The contents of the table were taken from the detailed compilation of all approved indicators in the supplement to the publication by Geraedts et al. 2020 (18), with kind permission from the Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen (ZEFQ).