Sub-project 1: PD Dr Kilian Rapp is the project leader in this sub-project.

Sub-project 1 from Work Package 1 evaluates the exercise programme "Trittsicher durchs Leben" ("Stepping Safely through Life") offered by a health insurance company to reduce osteoporotic fractures in older people living in rural areas. The insured persons in controlled randomised intervention regions are advised on the implementation of guideline-based recommendations on bone health and physical activity. The cost-effectiveness of this exercise programme according to health economic criteria is analysed in subproject 4.1; the addressing of their high-risk patients via a corresponding assessment, which is important for health insurance companies, is dealt with in subproject 4.2.


Subproject 2: Prof. Dr. Clemens Becker is the project leader in this subproject.

Subproject 2 from Work Package 2 compares two forms of care for elderly patients with hip fractures: care in geriatric trauma centres with standard care. The main endpoints being compared are mortality, re-hospitalisation, need for care and costs.


Sub-project 4: Prof. Dr. Hans-Helmut König is the project leader in this sub-project.

• The aim of sub-project 4.1 is to analyse the cost-effectiveness of the implemented programme. In addition to the economic determination of the implementation costs, the fracture-related costs for hospitalisation, rehabilitation treatment and care of patients in the intervention and control groups are calculated. The calculations are based on accounting data from the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). The incremental cost-effectiveness ratio (ICER) is calculated over the entire 30-month period, whereby the net benefit approach (NBA) is also used to control for confounding variables in the calculation of the ICER.
  
  
• In order to enable health insurance companies with similar programmes to specifically identify their high-risk patients for osteoporotic fractures in the future, a risk assessment tool working with routine data from the SVLFG is being developed in subproject 4.2. Using a Cox proportional hazard model, patient characteristics associated with osteoporotic fractures are first determined. The results then enable the calculation of risk scores for the individual characteristics and the determination of an overall risk score.
  
  

Subproject 5: Prof Rothenbacher is the project leader in this subproject, which consists of 2 subprojects.

• Sub-project 5.1 from Work Package 2 is concerned with analysing regional differences in various target variables, i.e. mortality, use of healthcare services and long-term care, costs after femur fractures. This information is important to identify gaps in health care and avoid inequalities.
  
  This sub-project is carried out in close cooperation with the Institute for Health Economics and Health Services Research, University Hospital Hamburg-Eppendorf.
  Routine data from the Scientific Institute of Local Health Insurance Funds (WIdO) is used, which includes all patients with femur fractures aged 65 years and older in 2009 and 2010. Hierarchical generalised linear models (HGLM) are used to calculate the relationship between these target variables and both the covariates on the provider side (e.g. hospital density, number of rehabilitation facilities or Medicine specialists) and the covariates on the patient level. This requires regional information from various sources, which is summarised at NUTS2 level (39 regions in Germany) and linked to the routine data. In order not to overestimate the regional effects, risk adjustment at patient level is also ensured.
  
  
• Sub-project 5.2 from Work Package 3 analyses a special form of regional variation analysis by comparing two different systems of geriatric rehabilitation that are currently offered in different federal states in Germany:
  1) "Early rehabilitative complex treatment" (§108/109), which in the past was offered almost exclusively in Hesse, and
  2) "Inpatient geriatric rehabilitation" (§111), which in the past was offered almost exclusively in Bavaria and Baden-Württemberg. By comparing these two systems in the aforementioned federal states, differences in the utilisation of service performances, mortality and costs in patients after femur fracture can be revealed.
  
  Routine data from the Scientific Institute of the Local Health Insurance Funds (WIdO) is also used for this sub-project, which contains all patients aged 80 and over from the federal states of Baden-Württemberg, Bavaria and Hesse with OF in the years 2009 and 2010. The aim is to identify groups of people (e.g. according to gender, need for care, comorbidities) who benefit more or less from one of the systems. Hierarchical generalised linear models are used to examine differences between the two systems, taking into account relevant co-variables at patient level (e.g. age, polypharmacy) and structural information at hospital/regional level.

In the other sub-projects, the Institute is involved in data preparation of routine data and evaluation data, data collection from study participants and epidemiological analyses.