Subproject A: Claims data analysis

This retrospective cohort study uses Germany-wide data on hospitalisations for sepsis between 2016 and 2020, provided by the Scientific Institute of the AOK (WIdO) for insured persons with AOK insurance. Data on the selected study population is available for one year before and two years after the study.

In our subproject, we analyse in detail: (1) the pathway to inpatient care for patients with community-acquired sepsis; and (2) the care of sepsis survivors after discharge from hospital. In each case, defined care indicators and care costs are recorded over specified time periods.

Subproject C: Provider perspective – qualitative survey

A qualitative survey will be conducted using guided expert interviews and interdisciplinary and interprofessional focus groups to record care pathways and experiences from the provider perspective. Healthcare professionals involved in the preclinical, inpatient, and post-hospital treatment of sepsis patients, such as emergency medical technicians, nurses, therapists, and physicians, will be interviewed. The questions to be clarified in this subproject are: (1) What challenges, best practice examples and deficits exist in acute and long-term care after sepsis, particularly during transitions between sectors? (2) What factors influence the detection and adequate care of sepsis? What contributes to early detection and what to delayed detection? (3) To what extent can concrete optimisation proposals for care with and after sepsis be derived from the results?

• PD Dr. rer. pol./habil. med. A. Freytag
• Dr. rer. nat. B. Ditscheid
• M.Sc. Lea Draeger
• Dr. rer. pol. Fabian Dutschkus
• M.Sc. Josephine Storch
• Prof. Dr. med. J. Bleidorn

• Joost F, Rose N, Kimmig A, Ruhnke T, Dröge P, Freytag A, Günster C, Pletz MW, Roesler M, Reuken PA, Schlattmann P, Schmidt K, Stallmach A, Storch J, Reinhart K, Wedekind L, Fleischmann-Struzek C. Long‑term outcomes after intensive care unit‑treated COVID‑19, influenza and respiratory sepsis in 2020 – a comparative, population‑based cohort study Infection (2025). https://doi.org/10.1007/s15010-025-02644-3 
• Wedekind L, Rose N, Freytag A, Kimmig A, Schlattmann P, Pletz MW, Ruhnke T, Dröge P, Fleischmann-Struzek C. Rehospitalizations for ambulatory care sensitive conditions in sepsis survivors– a nationwide cohort study using health claims data 2016 – 2019. Infection (2025). https://doi.org/10.1007/s15010-025-02606-9 
• Ruhnke T, Storch J, Freytag Aet al. Transitional care after hospitalization for sepsis in Germany– results from the population-based AVENIR cohort study. Infection (2025). https://doi.org/10.1007/s15010-025-02589-7 
• Draeger L, Fleischmann-Struzek C, Gehrke-Beck S, Heintze C, Thomas-Rueddel DO, Schmidt K. Barriers and facilitators to optimal sepsis care – a systematized review of healthcare professionals’ perspectives. BMC Health Serv Res25, 591 (2025). https://doi.org/10.1186/s12913-025-12777-8
• Draeger L, Fleischmann-Struzek C, Bleidorn J, Kannengiesser L, Schmidt K, Apfelbacher C, Matthaeus-Kraemer C. Healthcare professionals’ perspectives on sepsis care pathways—qualitative pilot expert interviews. J Clin Med14, 619 (2025). https://doi.org/10.3390/jcm14020619
• Fleischmann-Struzek C, Rose N, Ditscheid B, Draeger L, Dröge P, Freytag A, Goldhahn L, Kannengießer L, Kimmig A, Matthäus‑Krämer C, Ruhnke T, Reinhart K, Schlattmann P, Schmidt K,Storch J, Ulbrich R, Ullmann S, Wedekind L, Swart E. Understanding health care pathways of patients with sepsis: protocol of a mixed-methods analysis of health care utilization, experiences, and needs of patients with and after sepsis. BMC Health Serv Res 24, 40 (2024). https://doi.org/10.1186/s12913-023-10509-4

Team Institute of General Practice and Family Medicine: Prof. Jutta Bleidorn, Dr. Paul Jung, Markus Puschmann, Liliana Rost

Team Neurological Outpatient Clinic: OA Dr. Albrecht Günther, PD Dr. Florian Rakers, Dr. Milan Stojiljkovic, Sabine Winter

Feasibility study

• Piloting a randomized study at the level of medical practices

Evaluation

• Exploratory analysis of efficacy based on the pilot study
  • Can the intervention lead to a reduction in the utilization of diagnostic tests?
  • How can this be measured reliably?
• Piloting the health economic evaluation

Development of implementation strategies

• Presentation of the healthcare situation of patients with thyroid diseases using statutory health insurance (SHI) routine data
  • Presentation of care pathways using sequence analysis
  • Analysis of patient groups with similar care needs and patterns using sequence analysis
• Modeling and analysis of the transferability of the diagnostic box into standard care

• Prof. Dr. Verena Vogt
• Meik Hildebrandt, M.Sc.
• Kristina Söhl, MPH

• Institute of General Practice, University Hospital Erlangen: Dr. phil. Susann Hueber, Dr. med. Lisette Warkentin, and Prof. Dr. Thomas Kuehlein (Consortium Lead)
• Faculty of Medicine Carl Gustav Carus, Department of General Practice, Technische Universitaet Dresden: Dr. Dipl.-Soz. Karen Voigt
•  MPH, Dr. Jeannine Schuebel
• GWQ ServicePlus AG, Duesseldorf
• Association of Statutory Health Insurance Physicians of Thuringia (KVT), Weimar

[1] Schübel J, Voigt K, Uebel T. Erhöhter TSH-Wert in der Hausarztpraxis: S2k-Leitlinie: Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V; 2023. https://www.degam.de/leitlinie-s2k-053-046.

[2] Hueber S, Biermann V, Tomandl J, Warkentin L, Schedlbauer A, Tauchmann H, Klemperer D, Lehmann M, Donnachie E, Kühlein T. Consequences of early thyroid ultrasound on subsequent tests, morbidity and costs: an explorative analysis of routine health data from German ambulatory care. BMJ Open. 2023;13(3):e059016. DOI:10.1136/bmjopen-2021-059016

[3] Hildebrandt M, Pioch C, Dammertz L, Ihle P, Nothacker M, Schneider U, Swart E, Busse R, Vogt V. Quantifying Low-Value Care in Germany: An Observational Study Using Statutory Health Insurance Data From 2018 to 2021. Value in Health. 2024. https://doi.org/10.1016/j.jval.2024.10.3852 .

The introduction of the new form of care (NVF) is being evaluated within the framework of an accompanying scientific study by the Quantitative Health Services Research working group of the Institute of General Practice. The evaluation covers the following key areas:

• Screening rates: Does the introduction of the NVF lead to a higher rate of fundus screening examinations among statutorily insured individuals with diabetes mellitus in underserved regions of Thuringia?
• Impact on ophthalmological capacities: Does the NVF relieve ophthalmic practices and create capacity for other necessary treatments?
• Implementation in practice: How effectively can the NVF be integrated into existing healthcare structures?
• Participant satisfaction: How do patients and healthcare professionals rate the new form of care?
• Cost-effectiveness: Is the NVF economically viable compared to conventional ophthalmic care?

• Prof. Dr. Verena Vogt
• Richard Schmidt
• Dr. rer. nat. Robby Markwart
• Dr. rer. medic. Sarah Salomo

Association of Statutory Health Insurance Physicians of Thuringia (KV Thuringia)

• Universitätsklinikum Jena, Institut für Allgemeinmedizin
• BARMER
• DAK-Gesundheit
• Techniker Krankenkasse

• AOK PLUS
• KKH
• BKK Landesverband Mitte

The planned study is a retrospective, longitudinal, observational study (2016–2021). It is based on outpatient physician billing data (VDX data) from the Thuringia Association of Statutory Health Insurance Physicians, in accordance with Section 295 of the German Social Code V.

The data is transferred to the Institute of General Practice and Family Medicine in a pseudonymised form. This means that any information that could be used to identify physicians or patients is not transmitted. The Thuringian Ministry of Labour, Social Affairs, Health, Women and Family has approved the transfer of this data for research purposes (approval for the transfer of social data for use in research in accordance with Section 75 of the Social Code X).

• Dr. rer. nat. Robby Markwart (Project Manager)
• PD Dr. rer. pol./habil. med. Antje Freytag (Co-Project Manager)
• M.Sc. Josephine Storch (Research Associate)

Kassenärztliche Vereinigung Thüringen

Trade journals:

• Markwart R, Storch J, Bleidorn J, Freytag A. Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany: an analysis of claims data. BMJ Open 2024;14:e093780. doi:10.1136/bmjopen-2024-093780

Conference:

• Storch J, Freytag A, Markwart R. Schnelltests in der hausärztlichen Versorgung: Eine Analyse von Abrechnungsdaten der Kassenärztlichen Vereinigung Thüringen (Vortrag). 57. Kongress der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin. 28.09.-30.09.2023; Berlin.  

Prof. Dr. med. Jutta Bleidorn (Director Institute of General Medicine, University Hospital Jena)

Anni Matthes, M.Sc. (project management)

Dr. rer. nat. Bettina Stieber

Dr. rer. nat. Ann-Sophie Mägdefrau

Dr. rer. nat. Robby Markwart

Anni Matthes, M.Sc.

E-Mail:  

• Mägdefrau A-S, Kathner-Schaffert C, Matthes A, Bleidorn J, Markwart R. The Impact of Point-of-Care Testing for Group A Streptococcal Pharyngitis on Antibiotic Prescribing and Patient Health Outcomes in Outpatient Care: A Systematic Review and Meta-analysis of Randomized Controlled Trials, Open Forum Infectious Diseases, Volume 12, Issue 7, July 2025, ofaf407, https://doi.org/10.1093/ofid/ofaf407
• Markwart R, Storch J, Bleidorn J, Freytag A. Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany: an analysis of claims data. BMJ Open 2024;14:e093780. doi:10.1136/bmjopen-2024-093780
• Markwart R, Lehmann LS, Krause M, Jung P, Rost L, Doepfmer S, Kuempel L, Kuschick D, Toutaoui KJ, Heintze C, Bleidorn J, Wolf F. Utilization and consequences of CRP point-of-care-testing in primary care practices: a real-world multicentre observational study with 1,740 patient cases in Germany. BJGP Open. 2024. doi: 10.3399/BJGPO.2024.0120.Link
• Rödenbeck M, Ayobami O, Eckmanns T, Pletz TW, Bleidorn J, Markwart R. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Euro Surveill.2023;28(20):pii=2200672. Link
• Matthes A, Wolf F, Wilde E, Bleidorn J, Markwart R. Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services. BMJ Open.2023;13:e069453. doi: 10.1136/bmjopen-2022-069453. Link
• Matthes A, Wolf F, Schmiemann G, Gágyor I, Bleidorn J, Markwart R. Point‑of‑care laboratory testing in primary care: utilization, limitations and perspectives of general practitioners in Germany. BMC Primary Care. doi:10.1186/s12875-023-02054-0. Link
• Wolf F, Matthes A, Markwart R, Bleidorn J. Perspectives of physicians and medical assistants on the implementation of NAAT-based point-of-care testing for SARS-CoV-2 in primary care in Germany.  Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ).2022. doi: 10.1016/j.zefq.2022.09.006 Link
• Matthes A, Bleidorn J, Markwart R. Research on point-of-care tests in outpatient care in Germany: A scoping review and definition of relevant endpoints in evaluation studies. Z Evid Fortbild Qual Gesundhwes. 2022;30:1865-9217. doi: 10.1016/j.zefq.2022.06.002 Link
• Matthes A, Wolf F, Bleidorn J, Markwart R. “It Was Very Comforting to Find Out Right Away.” – Patient Perspectives on Point-of-Care Molecular SARS-CoV-2 Testing in Primary Care. Patient Prefer Adherence.2022;16:2031-2039. doi: 10.2147/PPA.S372366 Link

Routine Data Analysis
To support the project, we analyze BARMER claims data with the following objectives:

• Identifying frequently performed outpatient surgical procedures to facilitate an evidence-based selection of relevant procedures for PROM (Patient-Reported Outcome Measures) assessment.
• Mapping postoperative complications of the selected procedures via routine administrative data using:
  
  • ICD-10 codes for complications (e.g., hemorrhages, postoperative infections)
  • ATC codes for analgesic prescriptions (e.g., opioids, anti-inflammatory drugs)
  • Hospital readmissions within 30 to 90 days
  • Secondary surgical interventions indicative of a complication
• Identifying patient-specific risk factors associated with an increased likelihood of complications.
• Analyzing regional variations in UFO rates to detect potential differences in healthcare quality and geographic patterns.

Patient Involvement
The perspectives and firsthand experiences of patients undergoing surgical procedures play a central role in the project. Therefore, the initiative is continuously supported by a Patient Advisory Board. During advisory board meetings, researchers and patients collaboratively deliberate on project content, methodological approaches, and findings. For instance, patients provide insight into experienced symptoms of impending complications or share their experiences regarding inpatient and outpatient postoperative care. These insights directly inform the development of the survey instrument.
Patient involvement within the UFO project is integrated into the initiative "Joint Research with Citizens" of the Institute of General Practice and the "Patient Involvement" Working Group of the Center for Health Services Research. Furthermore, in collaboration with general practitioners through the RESPoNsE Teaching and Research Practice Network of the Institute of General Practice, we are exploring how the developed survey instrument can be integrated into postoperative follow-up care.
Would you like to participate in the project as a patient or general practitioner, or do you have feedback for us? Please let us know. Contact:

• Prof. Dr. Verena Vogt
• Meik Hildebrand, M.Sc.
• Anni Matthes, M.Sc.
• Richard Schmidt
• Josephine Storch, M.Sc.
• Prof. Dr. med. J. Bleidorn

• Klinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Jena: apl. Prof. Dr. Winfried Meißner (Projektleitung, Konsortialführung)
• Bundesverband für Ambulantes Operieren e.V. (BAO)
• BARMER
• Deutsche Gesellschaft für Anäesthesiologie und Intensivmedizin (DGAI)
• Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)

• Aktionsbündnis für Patientensicherheit (APS)

This part of the process evaluation aims to capture the perspective of general practitioners (GPs) regarding the feasibility, benefits and acceptance of the intervention. This will involve both qualitative and quantitative surveys.

At the beginning of the intervention phase, participating GPs will be surveyed using semi-structured interviews. These interviews will provide early insights into the project processes, identifying barriers and facilitators for patient inclusion, and enabling adjustments to be made to (communication) processes as the project progresses. The results of the interviews will also be used to develop a questionnaire for the quantitative assessment of satisfaction, feasibility and acceptance. This will be distributed out to all doctors participating in the WATCH project at the end of the intervention period for the final evaluation. The results will be used to prepare for the continuation of the new form of care.

Project team:

Miriam Pfeiffer

Prof. Dr. Jutta Bleidorn

The health economic evaluation of the new form of care WATCH is an important complement to the evaluation of clinical effectiveness, conducted at Martin Luther University Halle-Wittenberg. It follows the main idea that early, structured interventions can improve the physical, cognitive and psychological symptoms of the study participants, increase the chances of a full recovery and reduce the likelihood of chronicity. The health economic evaluation is based primarily on claims data from three statutory health insurance funds participating in the project and aims to answer the following questions:

(1) Does the intervention reduce healthcare costs?

(2) Does the intervention reduce the number of days of incapacity for work?

The results of the health economic evaluation will provide one important basis for the G-BA's decision on whether to transfer this form of care into standard care.

Project team:

Dr Franziska Meissner

PD Dr Antje Freytag