DC ElementWertSprache
dc.contributor.advisorScherer, Martin-
dc.contributor.authorSchulze, Josefine-
dc.date.accessioned2023-07-11T08:49:26Z-
dc.date.available2023-07-11T08:49:26Z-
dc.date.issued2023-
dc.identifier.urihttps://ediss.sub.uni-hamburg.de/handle/ediss/10312-
dc.description.abstractMultimorbidity, the presence of multiple chronic conditions in one person, is a major challenge for healthcare systems worldwide. Fragmentation and lack of reliable evidence are among the main obstacles for healthcare providers, making the care of patients with multimorbidity vulnerable to quality deficits. As overburdened patients are more likely to be less compliant and have a poorer experience of care, treatment burden is an important aspect of quality of care for this patient group. Inadequate application of clinical guidelines and quality metrics designed for single conditions can adversely affect the quality of care. Standardised quality measures that take account of multimorbidity are needed to assess the current state of health care. So far, however, there are none available for Germany. This thesis comprises three studies designed to gain insight into the quality of care for patients with multimorbidity and their experience of care. The research employed a mixed-methods approach and addressed the following objectives: (1) developing quality indicators and a measurement framework for the management of multimorbidity, (2) exploring patients’ perspectives on the quality of care through focus groups; and (3) creating a German version of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and determining its validity. The development of the quality indicator set was informed by a systematic literature review of guidelines and quality metrics, which resulted in the identification of 81 recommendations and six relevant metrics. The results of the focus group supported most of the quality aspects found in the literature, and four new ones emerged. These were used to create new quality indicators, which were then assessed by an independent multidisciplinary expert panel. In a two-stage nominal group consensus process, the panel selected a set of 25 indicators. A conceptual framework was developed to visualise and organise quality measurement for multimorbidity covering three layers of multilevel influences on quality of care. Another main outcome is the German adaptation of the MTBQ, a brief tool to assess treatment burden in patients with multimorbidity. A robust and well-established methodology was utilised for translation and minor changes were made to the obtained version in order to ensure cross-cultural validity. The analysis showed robust face validity, acceptable reliability, a single-factor structure and good construct validity. These findings present the first standardised instruments to assess the quality of care for multimorbidity in the German health care system. The importance of including the patient perspective in quality assessment is underlined by the involvement of patients at multiple stages of the research process. Further empirical validation is needed before the indicators can be used to evaluate standard care. The MTBQ holds potential as an outcome measure in future clinical trials, and its effectiveness as a tool in clinical practice should be examined in the future. Both instruments offer a promising solution to the limitations of disease-specific measures of quality of care that fail to address the complexity of multimorbidity.en
dc.language.isoende_DE
dc.publisherStaats- und Universitätsbibliothek Hamburg Carl von Ossietzkyde
dc.relation.hasparthttps://doi.org/10.1186/s12955-022-01993-zde_DE
dc.relation.hasparthttps://doi.org/10.1136/bmjopen-2020-047025de_DE
dc.relation.hasparthttps://doi.org/10.1093/geront/gnac013de_DE
dc.rightshttp://purl.org/coar/access_right/c_abf2de_DE
dc.subjectQualitätsindikatorende
dc.subjectScreeningde
dc.subjectKomorbiditätde
dc.subjectBelastungsfaktorende
dc.subjectMultimedikationde
dc.subject.ddc610: Medizinde_DE
dc.titleQuality of Care for Patients with Multimorbidityen
dc.title.alternativeQualität der Versorgung von Patientinnen und Patienten mit Multimorbiditätde
dc.typedoctoralThesisen
dcterms.dateAccepted2023-06-08-
dc.rights.cchttps://creativecommons.org/licenses/by/4.0/de_DE
dc.rights.rshttp://rightsstatements.org/vocab/InC/1.0/-
dc.subject.bcl44.62: Allgemeinmedizinde_DE
dc.subject.gndMultimorbiditätde_DE
dc.subject.gndQualitätde_DE
dc.subject.gndMedizinische Versorgungde_DE
dc.subject.gndAlterde_DE
dc.subject.gndChronische Krankheitde_DE
dc.type.casraiDissertation-
dc.type.dinidoctoralThesis-
dc.type.driverdoctoralThesis-
dc.type.statusinfo:eu-repo/semantics/publishedVersionde_DE
dc.type.thesisdoctoralThesisde_DE
tuhh.type.opusDissertation-
thesis.grantor.departmentMedizinde_DE
thesis.grantor.placeHamburg-
thesis.grantor.universityOrInstitutionUniversität Hamburgde_DE
dcterms.DCMITypeText-
dc.identifier.urnurn:nbn:de:gbv:18-ediss-109898-
item.creatorGNDSchulze, Josefine-
item.languageiso639-1other-
item.fulltextWith Fulltext-
item.creatorOrcidSchulze, Josefine-
item.advisorGNDScherer, Martin-
item.grantfulltextopen-
Enthalten in den Sammlungen:Elektronische Dissertationen und Habilitationen
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