Ein neuer Ansatz für Versorgungsevaluationen: Erprobung des PopGroupers für Vergleichsgruppenbildung und Morbiditätsmessung am Beispiel der DMP KHK und Brustkrebs

Abstract

Background

The PopGrouper is a population-based classification system that was created using data from a large German statutory health insurance fund. It annually assigns each individual to one mutually exclusive, clinically meaningful, and cost-homogeneous group at different levels of aggregation. This study tests the PopGrouper for matching and as a morbidity outcome measure in healthcare evaluations.

Methods

Disease management programs (DMPs) for coronary heart disease (CHD) and breast cancer were analyzed in a quasi-experimental design (matching: 2021, enrolment: 2022, follow-up: 2023). Insured persons were assigned 1:1 to the intervention (IG: DMP) or to the control group (CG: usual care) using a standard propensity score matching (benchmark), a pure and an extended PopGroup matching including disease-specific variables. Morbidity was assessed by comparing PopGroup distributions between IG and CG before and after intervention.

Results

In the CHD sample (CG pool n = 29,680; IG n = 7,557) and breast cancer sample (n = 111,509; n = 3,321), sample sizes were reduced by up to 3% after matching. Both benchmark and extended PopGroup matching achieved good covariate balance. Follow-up showed a higher proportion of patients with active breast cancer treatment in the IG than in the CG. CHD patients in the CG more often received no CHD treatment, had no health care use/disease, or were classified as high-cost cases.

Discussion

Extended PopGroup matching achieved results that are comparable to the benchmark with substantially less effort. As an outcome measure, the PopGrouper’s multidimensional morbidity mapping offers opportunities for exploratory analyses, including process quality, and can be combined with established endpoints such as mortality. The PopGrouper could contribute to a higher level of standardization in healthcare evaluations.