Alexander Geissler
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Prof. Dr.
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Geissler
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Alexander
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alexander.geissler@unisg.ch
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+41 71 224 30 17
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  • Publication
    Type: journal article
    DOI: https://doi.org/10.1038/s41533-024-00361-2
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/119013
  • Publication
    Type: journal article
    Journal: Health Policy
    DOI: 10.1016/j.healthpol.2024.105012
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/119858
  • Publication
    Type: journal article
    Journal: Health Policy
    Volume: 142
    DOI: 10.1016/j.healthpol.2024.105012
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/120180
  • Publication
    Gender health gap pre- and post-joint arthroplasty: Identifying affected patient-reported health domains
    ( 2024-02-27)
    Viktoria Steinbeck
    ;
    Anja Bischof orcid-logo
    ;
    Lukas Schöner
    ;
    Benedikt Langenberger
    ;
    David Kuklinski orcid-logo
    ;
    Christoph Pross
    ;
    Reinhard Busse
    ;
    Alexander Geissler orcid-logo
    Background As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. Methods The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). Results Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. Conclusions Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. Trial registration German Register for Clinical Trials, DRKS00019916, 26 November 2019.
    Type: journal article
    Journal: International Journal for Equity in Health
    Volume: 23
    Issue: 44
    DOI: 10.1186/s12939-024-02131-5
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/119341
  • Publication
    What is the association between gender and self-perceived health status when controlling for disease-specific conditions? A retrospective data analysis of pre- and post-operative EQ-5D-5L differences in total hip and knee arthroplasty
    ( 2023-11-27)
    Anja Bischof orcid-logo
    ;
    Viktoria Steinbeck
    ;
    David Kuklinski orcid-logo
    ;
    Carlos J. Marques
    ;
    Karina Bohlen
    ;
    Karl C. Westphal
    ;
    Frank Lampe
    ;
    Alexander Geissler orcid-logo
    Background The self-perceived health status of patients undergoing total hip and knee arthroplasty (THA and TKA) might differ post-operatively due to gender, age, or comorbidities. Patient-reported outcome measures (PROMs) such as the EQ-5D-5L measure the self-perceived health status. This study investigates whether the index score of the EQ-5D-5L is a valid tool for interpreting gender differences in outcomes for patients undergoing THA and TKA. Methods Routine and PROM-data of elective primary THA or TKA patients in two German hospitals between 2016 and 2018 were analyzed. Univariate analysis with Pearson’s chi-square was conducted to identify control variables for gender. To quantify the association between gender and the EQ-5D-5L dimensions, a cumulative odds ordinal logistic regression with proportional odds was conducted. Results Two thousand three hundred sixty-eight​​ THA patients (m = 978; f = 1390) and 1629 TKA patients (m = 715; f = 914) were considered. The regression analysis of the individual EQ-5D-5L dimensions showed that female gender was significantly associated with better self-care (THA and TKA) and better post-operative mobility (THA). In contrast, male gender was significantly associated with less pain/discomfort (TKA) and less anxiety/depression (THA) pre-surgery and 3-months post-surgery. Conclusion Our results confirmed that the self-perceived health status improved after surgery. However, due to the different associations of gender to the individual dimensions of the EQ-5D-5L, the weighted index score clouds the comparability between patients with different gender undergoing THA or TKA. Therefore, we argue to use the individual five dimensions for health status analysis, to reveal relevant additional information.
    Type: journal article
    Volume: 24
    URL: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-07026-0
    DOI: https://doi.org/10.1186/s12891-023-07026-0
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/118765
  • Publication
    Making the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth
    ( 2023)
    Anja Yvonne Bischof orcid-logo
    ;
    Alexander Geissler orcid-logo
    Background: In the absence of medical necessity, opting for caesarean sections exposes mothers and neonates to increased risks of enduring long-term health problems and mortality. This ultimately results in greater economic burden when compared to the outcomes of spontaneous vaginal births. In Switzerland around 33% of all births are by caesarean section. However, the rate of caesarean sections without medical indication is still unknown. Therefore, we devise an identification strategy to differentiate caesarean sections without medical indication using routine data. In addition, we aim to categorize the influencing factors for women who undergo spontaneous vaginal births as opposed to those with caesarean sections without medical indication. Method: We use Swiss Federal Statistics data including 98.3% of all women giving birth from 2014 to 2018. To determine non-medically indicated caesarean sections in our dataset, we base our identification strategy on diagnosis-related groups, diagnosis codes, and procedure classifications. Subsequently, we compare characteristics of women who give birth by non-medically CS and external factors such as the density of practicing midwives to women with spontaneous vaginal birth. Logistic regression analysis measures the effect of factors, such as age, insurance class, income, or density of practicing midwives on non-medically indicated caesarean sections. Results: Around 8% of all Swiss caesarean sections have no medical indication. The regression analysis shows that higher age, supplemental insurance, higher income, and living in urban areas are associated with non-medically indicated caesarean sections, whereas a higher density of midwives decreases the likelihood of caesarean sections without medical indication. Conclusions: By identifying non-medically indicated caesarean sections using routine data, it becomes feasible to gain insights into the characteristics of impacted mothers as well as the external factors involved. Illustrating these results, our recommendation is to revise the incentive policies directed towards healthcare professionals. Among others, future research may investigate the potential of midwife-assisted pregnancy programs on strengthening spontaneous vaginal births in absence of medical complications.
    Type: journal article
    Journal: BMC Pregnancy and Childbirth
    Volume: 23
    Issue: 1
    URL: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06070-x
    DOI: 10.1186/s12884-023-06070-x
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/118437
    Scopus© Citations 2
  • Publication
    Robotic‑assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?
    ( 2023-05-10)
    David Kuklinski orcid-logo
    ;
    Justus Vogel orcid-logo
    ;
    Cornelia Henschke
    ;
    Christoph Pross
    ;
    Alexander Geissler orcid-logo
    Background: Between 2008 and 2018, the share of robotic-assisted surgeries (RAS) for radical prostatectomies (RPEs) has increased from 3 to 46% in Germany. Firstly, we investigate if this diffusion of RAS has contributed to RPE treatment centralization. Secondly, we analyze if a hospital’s use of an RAS system influenced patients’ hospital choice. Methods: To analyze RPE treatment centralization, we use (bi-) annual hospital data from 2006 to 2018 for all German hospitals in a panel-data fixed effect model. For investigating RAS systems’ influence on patients’ hospital choice, we use patient level data of 4614 RPE patients treated in 2015. Employing a random utility choice model, we estimate the influence of RAS as well as specialization and quality on patients’ marginal utilities and their according willingness to travel. Results: Despite a slight decrease in RPEs between 2006 and 2018, hospitals that invested in an RAS system could increase their case volumes significantly (+ 82% compared to hospitals that did not invest) contributing to treatment centralization. Moreover, patients are willing to travel longer for hospitals offering RAS (+ 22% than average travel time) and for specialization (+ 13% for certified prostate cancer treatment centers, + 9% for higher procedure volume). The influence of outcome quality and service quality on patients’ hospital choice is insignificant or negligible. Conclusions: In conclusion, centralization is partly driven by (very) high-volume hospitals’ investment in RAS systems and patient preferences. While outcome quality might improve due to centralization and according specialization, evidence for a direct positive influence of RAS on RPE outcomes still is ambiguous. Patients have been voting with their feet, but research yet has to catch up.
    Type: journal article
    Journal: Health Economics Review
    Volume: 13
    URL: https://link.springer.com/epdf/10.1186/s13561-023-00444-9?sharing_token=FlpJURXBFdEbN9bcsERvtW_BpE1tBhCbnbw3BuzI2RMLGgz_XbSuCztAi1PXYurJj4F1BVw13-FW1_-xYkvOxgYxbq-v8heQG_gAearxnN164HEbW2OfCUh72vyu_xdAIkMaFdQJscebTCuOuA7K7YDDEIU9uAnYED0oR9J5V70=
    DOI: https://doi.org/10.1186/s13561-023-00444-
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/117489
  • Publication
    A composite measure for patient‑reported outcomes in orthopedic care: design principles and validity checks
    (Springer Nature, 2023-03-08)
    Schöner, Lukas
    ;
    David Kuklinski orcid-logo
    ;
    Geissler, Alexander orcid-logo
    ;
    Busse, Reinhard
    ;
    Pross, Christoph
    Background: The complex, multidimensional nature of healthcare quality makes provider and treatment decisions based on quality difficult. Patient-reported outcome (PRO) measures can enhance patient centricity and involvement. The proliferation of PRO measures, however, requires a simplification to improve comprehensibility. Composite measures can simplify complex data without sacrificing the underlying information. Objective and methods: We propose a five-step development approach to combine different PRO into one composite measure (PRO-CM): (i) theoretical framework and metric selection, (ii) initial data analysis, (iii) rescaling, (iv) weighting and aggregation, and (v) sensitivity and uncertainty analysis. We evaluate different rescaling, weighting, and aggregation methods by utilizing data of 3145 hip and 2605 knee replacement patients, to identify the most advantageous development approach for a PRO-CM that reflects quality variations from a patient perspective. Results: The comparison of different methods within steps (iii) and (iv) reveals the following methods as most advantageous: (iii) rescaling via z-score standardization and (iv) applying differential weights and additive aggregation. The resulting PROCM is most sensitive to variations in physical health. Changing weighting schemes impacts the PRO-CM most directly, while it proves more robust towards different rescaling and aggregation approaches. Conclusion: Combining multiple PRO provides a holistic picture of patients’ health improvement. The PRO-CM can enhance patient understanding and simplify reporting and monitoring of PRO. However, the development methodology of a PROCM needs to be justified and transparent to ensure that it is comprehensible and replicable. This is essential to address the well-known problems associated with composites, such as misinterpretation and lack of trust.
    Type: journal article
    Journal: Quality of Life Research
    URL: https://doi.org/10.1007/s11136-023-03395-0
    DOI: 10.1007/s11136-023-03395-0
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/107664
    Scopus© Citations 1
  • Publication
    Electronic Patient-Reported Outcome Monitoring to Improve Quality of Life After Joint Replacement
    ( 2023-09)
    Viktoria Steinbeck
    ;
    Benedikt Langenberger
    ;
    Lukas Schöner
    ;
    Laura Wittich
    ;
    Wolfgang Klauser
    ;
    Martin Mayer
    ;
    David Kuklinski orcid-logo
    ;
    Justus Vogel orcid-logo
    ;
    Alexander Geissler orcid-logo
    ;
    Christoph Pross
    ;
    Reinhard Busse
    Importance Although remote patient-reported outcome measure (PROM) monitoring has shown promising results in cancer care, there is a lack of research on PROM monitoring in orthopedics. Objective To determine whether PROM monitoring can improve health outcomes for patients with joint replacement compared with the standard of care. Design, Setting, and Participants A 2-group, patient-level randomized clinical trial (PROMoting Quality) across 9 German hospitals recruited patients aged 18 years or older with primary hip or knee replacement from October 1, 2019, to December 31, 2020, with follow-up until March 31, 2022. Interventions Intervention and control groups received the standard of care and PROMs at hospital admission, discharge, and 12 months after surgery. In addition, the intervention group received PROMs at 1, 3, and 6 months after surgery. Based on prespecified PROM score thresholds, at these times, an automated alert signaled critical recovery paths to hospital study nurses. On notification, study nurses contacted patients and referred them to their physicians if necessary. Main Outcomes and Measures The prespecified outcomes were the mean change in PROM scores (European Quality of Life 5-Dimension 5-Level version [EQ-5D-5L; range, −0.661 to 1.0, with higher values indicating higher levels of health-related quality of life (HRQOL)], European Quality of Life Visual Analogue Scale [EQ-VAS; range, 0-100, with higher values indicating higher levels of HRQOL], Hip Disability and Osteoarthritis Outcome Score–Physical Function Shortform [HOOS-PS; range, 0-100, with lower values indicating lower physical impairment] or Knee Injury and Osteoarthritis Outcome Score–Physical Function Shortform [KOOS-PS; range, 0-100, with lower values indicating lower physical impairment], Patient-Reported Outcomes Measurement Information System [PROMIS]–fatigue [range, 33.7-75.8, with lower values indicating lower levels of fatigue], and PROMIS-depression [range, 41-79.4, with lower values indicating lower levels of depression]) from baseline to 12 months after surgery. Analysis was on an intention-to-treat basis. Results The study included 3697 patients with hip replacement (mean [SD] age, 65.8 [10.6] years; 2065 women [55.9%]) and 3110 patients with knee replacement (mean [SD] age, 66.0 [9.2] years; 1669 women [53.7%]). Exploratory analyses showed significantly better health outcomes in the intervention group on all PROMs except the EQ-5D-5L among patients with hip replacement, with a 2.10-point increase on the EQ-VAS in the intervention group compared with the control group (HOOS-PS, −1.86 points; PROMIS-fatigue, −0.69 points; PROMIS-depression, −0.57 points). Patients in the intervention group with knee replacement had a 1.24-point increase on the EQ-VAS, as well as significantly better scores on the KOOS-PS (−0.99 points) and PROMIS-fatigue (−0.84 points) compared with the control group. Mixed-effect models showed a significant difference in improvement on the EQ-VAS (hip replacement: effect estimate [EE], 1.66 [95% CI, 0.58-2.74]; knee replacement: EE, 1.71 [95% CI, 0.53-2.90]) and PROMIS-fatigue (hip replacement: EE, −0.65 [95% CI, −1.12 to −0.18]; knee replacement: EE, −0.71 [95% CI, −1.23 to −0.20]). The PROMIS-depression score was significantly reduced in the hip replacement group (EE, −0.60 [95% CI, −1.01 to −0.18]). Conclusions and Relevance In this randomized clinical trial, the PROM-based monitoring intervention led to a small improvement in HRQOL and fatigue among patients with hip or knee replacement, as well as in depression among patients with hip replacement. Trial registration Deutsches Register Klinischer Studien ID: DRKS00019916
    Type: journal article
    Journal: JAMA Network Open
    Volume: 6
    Issue: 9
    DOI: 10.1001/jamanetworkopen.2023.31301
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/118380
  • Publication
    Service-, needs-, and quality-based hospital capacity planning – The evolution of a revolution in Switzerland
    (Elsevier B.V., 2022-09-25)
    Bleibtreu, Elena
    ;
    von Ahlen, Christine
    ;
    Geissler, Alexander orcid-logo
    Most developed countries spend a large amount of their health budget on hospital capacities and inpatient services. However, those capacities and services are often not comprehensively planned what leads to vague service delivery steering and non-need driven hospital facilities. Switzerland is different as the planning procedure was completely reformed in 2012 and is further refined in 2021/2022. The Canton of Zurich, the frontrunner in Switzerland, has made a comprehensive update of its hospital capacity planning model for acute, psychiatric, and rehabilitative care. The result of this model is the hospital list. This list includes all hospitals which fulfil predefined quality, efficiency, and need requirements. Hospitals on the list receive a mandate to provide inpatient treatments for specific and selected service groups (n=196), clustered in three areas (acute care, psychiatry, rehabilitation). The underlying health care policy process is transparent and is characterized by a high participation of all relevant actors. The building blocks of the planning model are a classification system of service groups, different quality and efficiency requirements attached to these groups, and an analysis of current and future need for health care. Hospitals which are willing to perform services must apply and demonstrate that the requirements are fulfilled. The Canton then decides needs-based which hospital can deliver which services.
    Type: journal article
    Journal: Health Policy
    Issue: 126
    URL: https://www.sciencedirect.com/science/article/pii/S0168851022002561
    DOI: https://doi.org/10.1016/j.healthpol.2022.09.011
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/108215