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Importance: Switzerland's mandatory health insurance provides universal coverage, but residents can opt for supplementary private insurance for nonessential, nonvital amenities. It is debated whether people with supplementary private insurance receive overtreatment due to financial incentives., Objective: To assess whether incidence rates of cardiovascular procedures in people with supplementary private insurance are higher than in those with basic insurance only., Design, Setting, and Participants: A population-based weighted cohort comparative effectiveness study, using administrative claims data from Switzerland assessing incidence rates (IRs), was conducted in adults undergoing a nonemergency cardiovascular inpatient procedure from January 1, 2012, to December 31, 2020. Analysis included primary or secondary discharge procedure codes for 1 of the following: percutaneous transluminal coronary angioplasty (PTCA), left atrial appendage (LAA) occlusion, patent foramen ovale (PFO) closure, transcatheter aortic valve replacement (TAVR), mitral valve clip implantation, cardiac pacemaker implantation, and atrial fibrillation/atrial flutter ablation., Exposures: Supplementary private health insurance., Main Outcomes and Measures: Incidence rates of cardiovascular procedures between insurance groups calculated by negative binomial regression adjusted by inverse probability weights., Results: Of 590 919 admissions (median age, 68 years; IQR, 57-77 years), 55.5% male, 15.7% non-Swiss nationality), 70.1% had basic insurance only. Independent of insurance status, IR for all cardiovascular procedures steadily increased over the study years. In general, people with supplementary private insurance received cardiovascular procedures more frequently (IR ratio [IRR], 1.11; 99% CI, 1.10-1.11) than people with basic insurance only. There was also an increase for every procedure: PTCA (IRR, 1.12; 99% CI, 1.12-1.13), LAA closure (IRR, 1.15; 99% CI, 1.13-1.16), mitral valve clip implantation (IRR, 1.08; 99% CI, 1.07-1.09), TAVR (IRR, 1.04; 99% CI, 1.03-1.06), PFO closure (IRR, 1.01; 99% CI, 1.00-1.02), pacemaker implantation (IRR, 1.08; 99% CI, 1.07-1.09), and atrial fibrillation/atrial flutter ablation (IRR, 1.12; 99% CI, 1.11-1.12). Sensitivity analyses, including side procedures, stratification by length of stay, and propensity score matching, suggested robustness of the results., Conclusions and Relevance: This study found an association between supplementary private insurance and a higher likelihood of receiving nonemergency cardiovascular procedures. Whether this higher rate of procedures in people with supplementary private insurance is based on clinical reasoning or due to financial incentives warrants further exploration.

Background: Cough is one of the most common health issues for which medical attention is sought. A chronic cough (CC) is understood as a cough that lasts longer than 8 weeks. CC encompasses two subsets referred to as refractory chronic cough (RCC) and unexplained chronic cough (UCC). This study aims to assess the current understanding and perceptions of a RCC and UCC, from a physician's perspective in Switzerland and how this understanding and practical work leads to the relevant diagnosis and treatment., Methods: In October 2020, 549 GPs and 338 pulmonologists in Switzerland, received an invite to participate in the online-based quantitative survey. Data collection was carried out through a 25-minute online survey. The questionnaire was based on structured questions, and conducted on a randomized sample of doctors (general practitioners -GPs and pulmonologists) in the German- and French-speaking part of Switzerland., Results: Overall, 33 pulmonologists and 52 GPs participated in the online survey. Only 39% of GPs, but 73% of pulmonologists, defined chronic cough as a cough lasting 8 weeks or longer. The majority of physicians (72%), especially pulmonologists (88%), perceived a clinical gap regarding the treatment of persistent cough. 74% of the sampled physicians agreed that persistent cough is a high burden of disease for patients. Based on the answers, the annual number of new patients with RCC and UCC in Switzerland is estimated at 9322 patients., Conclusions: Results of this study have highlighted differences in the terminology used to describe CC (RCC and UCC), in the diagnostic tests used and, in the treatments used between GPs and pulmonologists. These findings suggest the need to align the current language regarding the disease to facilitate a standardized approach for diagnosis and treatment and towards improving patient care and reduce burden of disease for CC (RCC and UCC) patients.

Aim of the Study: To compare admission characteristics, predictors and outcomes of patients with confirmed coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the first and second waves of the pandemic., Methods: This retrospective observational analysis included adult patients with  severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection confirmed by a real-time reverse transcriptase polymerase chain reaction (RT-PCR) or rapid antigen test and hospitalised at the Cantonal Hospital Aarau from 26 February to 30 April 2020 (first wave) and from 1 October to 31 December 2020 (second wave). The primary endpoint was all-cause in-hospital mortality. The secondary endpoints were transfer to the intensive care unit (ICU) and length of hospital stay (LOS)., Results: Overall, 486 patients (mean age 65.9 years ± 14.7 SD, 65% male) were included. Ninety-two patients (19%) died during the hospital stay and 92 patients (19%) were transferred to the ICU. Admission characteristics, including comorbidities and frailty, were similar for patients of the first (n = 100) and second wave (n = 386). However, during the second wave the median time from symptom onset to presentation to the emergency department (ED) was shorter (7 days, interquartile range [IQR] 4–9 vs 8 days, IQR 4–11; p = 0.02). In the second wave, most patients received high-dose glucocorticoid treatment (0% vs 76%, p <0.01). In-hospital mortality was similar among COVID-19 patients in the first (19/100, 19%) and second wave (73/386, 19%); this finding persisted after full adjustment in multiple regression models (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.49–2.80; p = 0.71). Risk for ICU admission was also similar (24% vs 18%; aOR 0.98, 95% CI 0.46–2.06; p = 0.95). More patients were transferred to rehabilitation facilities in the second wave (18% vs 31%; aOR 2.06, 95% CI 1.04–4.07; p = 0.04) and LOS was 2.5 days shorter (9.0 vs 6.5 days; adjusted difference −2.53 days, 95%-CI −4.51 to −0.54; p = 0.01). Main predictors for in-hospital death were patient age (aOR 1.07, 95% CI 1.02–1.11; p <0.01), male sex (aOR 2.41, 95% CI 1.05–5.55; p = 0.04) and the age-adjusted Charlson comorbidity index (aOR 1.27, 95% CI 1.09–1.48 p <0.01)., Conclusion: Despite differing treatment regimens, mortality and ICU admission remained largely unchanged for COVID-19 patients admitted during the second wave of the pandemic in our tertiary care hospital. However, discharge processes were optimised with patients leaving the hospital earlier and going to rehabilitation facilities more often. &nbsp.

Purpose: Estimating the probability of readmission following hospitalization using prediction scores can be complex. Quality of life (QoL) may provide an easy and effective alternative., Methods: Secondary analysis of the prospective "TRIAGE" cohort. All medical in-patients admitted to a Swiss tertiary care institution (2016-2019) ≥18 years with a length of stay of ≥2 days (23,309 patients) were included. EQ-5D VAS, EQ-5D index, and Barthel index were assessed at a single telephone interview 30-day after admission. Patients lost to follow-up were excluded. Readmission was defined as a non-elective hospital stay at our institution >24 h within 1 year after discharge and assessed using area under the curve (AUC) analysis with adjustment for confounders., Results: 12,842 patients (43% females, median age 68, IQR 55-78) were included. Unadjusted discrimination was modest at 0.59 (95% CI 0.56-0.62) for EQ-5D VAS. Partially adjusted discrimination (for gender) was identical. Additional adjustment for insurance, Charlson comorbidity index, length of stay, and native language increased the AUC to 0.66 (95% CI 0.63-0.69). Results were robust irrespective of time to event (12, 6 or 3 months). A cut-off in the unadjusted model of EQ-5D VAS of 55 could separate cases with a specificity of 80% and a sensitivity of 30%., Conclusion: QoL at day 30 after admission can predict one-year readmission risk with similar precision as more intricate tools. It might help for identification of high-risk patients and the design of tailored prevention strategies.

Aims: To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals., Design: A modified Delphi-Consensus Technique., Methods: We examined 19 indicators based on the current evidence and that were pre-selected by nursing scientists. Between August-October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two-round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3-point Likert-type scale., Results: The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking., Conclusion: A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing-sensitive indicators., Impact: The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets., (© 2020 John Wiley & Sons Ltd.)

Background: There is growing evidence that patients with functional decline are at increased risk of readmission, mortality and institutionalization. Instruments to measure the status of self-care could provide important information for efficient care planning. The widely used Self Care Index serves as an indicator for the severity of nursing dependency. To date, no evidence is available on the association of the instrument with rehospitalization, mortality and institutionalization., Objectives: To examine the association of functional status measures (Self Care Index on admission, at discharge and functional decline) with 30-day mortality, readmission and institutionalization in hospitalized non-surgical patients., Design: Prospective cohort study., Participants: We included 4540 emergency medical patients at a single hospital in Switzerland., Methods: Primary outcome was 30-day mortality rate; secondary outcomes were 30-day readmission and institutionalization. We analyzed the association of the functional status with the binary endpoints using logistic regression models and C-statistics for discrimination., Results: All of the examined measures were significant predictors of overall 30-day mortality; Self Care Index on admission: adj. OR: 0.90 (95% CI: 0.87-0.92); Self Care Index at discharge: adj. OR: 0.86 (95% CI: 0.83-0.88); functional decline: adj. OR: 1.22 (95% CI: 1.14-1.31) and all Self Care Index single items. A combined model (functional status on admission and functional decline during hospitalization) showed a good accuracy with regard to the AUC: adj. AUC: 0.80 (95% CI: 0.74-0.86)., Conclusions: Several functional measures were associated with 30-day mortality. Self Care Index total score, five single items and a combined model showed the best performance., Competing Interests: Declaration of competing interest The authors of this manuscript declare no competing financial interests related to this work., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims of the Study: To describe admission characteristics, risk factors and outcomes of patients with coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the early phase of the pandemic., Methods: This retrospective cohort study included adult patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction (PCR) testing and hospitalised at the cantonal hospital Aarau (Switzerland) between 26 February 2020 and 30 April 2020. Our primary endpoint was severe COVID-19 progression defined as a composite of transfer to the intensive care unit (ICU) and in-hospital mortality., Results: A total of 99 patients (median age 67 years [interquartile range 56–76], 37% females) were included and 35% developed severe COVID-19 progression (24% needed ICU treatment, 19% died). Patients had a high burden of comorbidities with a median Charlson comorbidity index of 3 points and a high prevalence of hypertension (57%), chronic kidney disease (28%) and obesity (27%). Baseline characteristics with the highest prognostic value for the primary endpoint by means of area under the receiver operating characteristic curve were male gender (0.63) and initial laboratory values including shock markers (lactate on ambient air 0.67; lactate with O2 supply 0.70), markers of inflammation (C-reactive protein 0.72, procalcitonin 0.80) and markers of compromised oxygenation (pO2 0.75 on ambient air), whereas age and comorbidities provided little prognostic information., Conclusion: This analysis provides insights into the first consecutively hospitalised patients with confirmed COVID-19 at a Swiss tertiary care hospital during the initial period of the pandemic. Markers of disease progression such as inflammatory markers, markers for shock and impaired respiratory function provided the most prognostic information regarding severe COVID-19 progression in our sample.

Background: Several clinical risk scores for unplanned 30-day readmission have been published, but there is a lack of external validation and head-to-head comparison., Objective: Retrospective replication of six clinical risk scores (LACE, HOSPITAL, SEMI, RRS, PARA, Tsui et al.)f DESIGN: Models were fitted with the original intercept and beta coefficients as reported. Otherwise, a logistic model was refitted (SEMI and Tsui et al). We performed subgroup analyses on main admission specialty. This report adheres to the TRIPOD statement for reporting of prediction models., Participants: We used our prospective cohort of 15,639 medical patients from a Swiss tertiary care institution from 2016 through 2018., Main Measures: Thirty-day readmission rate and area under the curve (AUC < 0.50 worse than chance, > 0.70 acceptable, > 0.80 excellent) CONCLUSIONS: Among several readmission risk scores, HOSPITAL, PARA, and the score from Tsui et al. showed the best predictive abilities and have high potential to improve patient care. Interventional research is now needed to understand the effects of these scores when used in clinical routine., Key Results: Among the six risk scores externally validated, calibration of the models was overall poor with overprediction of events, except for the HOSPITAL and the PARA scores. Discriminative abilities (AUC) were as follows: LACE 0.53 (95% CI 0.50-0.56), HOSPITAL 0.73 (95% CI 0.72-0.74), SEMI 0.47 (95% CI 0.46-0.49), RRS 0.64 (95% CI 0.62-0.66), PARA 0.72 (95% CI 0.72-0.74), and the score from Tsui et al. 0.73 (95% CI 0.72-0.75). Performance in subgroups did not differ from the overall performance, except for oncology patients in the PARA score (0.57, 95% CI 0.54-0.60), and nephrology patients in the SEMI index (0.25, 95% CI 0.18-0.31), respectively.

Sepsis is associated with impaired clinical outcomes. It requires timely diagnosis and urgent therapeutic management. Because staffing during after-hours is limited, we explored whether after-hour admissions are associated with worse clinical outcomes in patients with sepsis.In this retrospective cohort study, we analyzed nationwide acute care admissions for a main diagnosis of sepsis in Switzerland between 2006 and 2016 using prospective administrative data. The primary outcome was in-hospital mortality using multivariable logistic regression models. Secondary outcomes were intensive care unit (ICU) admission, intubation, and 30-day readmission.We included 86,597 hospitalizations for sepsis, 60.1% admitted during routine-hours, 16.8% on weekends and 23.1% during night shift. Compared to routine-hours, we found a higher odds ratio (OR) for in-hospital mortality in patients admitted on weekends (Adjusted OR 1.05, 95% confidence interval [95% CI] 1.01, 1.10, P = .041). Also, the OR for ICU admission (OR 1.14, 95% CI 1.10, 1.19, P < .001) and intubation (OR 1.18, 95% CI 1.12, 1.25 P < .001) was higher for weekends compared to routine-hours. Regarding 30-day readmission, evidence for an association could not be observed. Night shift admission, compared to routine-hours, was associated with a higher OR for ICU admission and intubation (ICU admission: OR 1.28 (1.23, 1.32), P < .001; intubation: OR 1.31, 95% CI 1.25, 1.37, P < .001) but with a lower OR for in-hospital mortality (OR 0.93, 19% CI 0.89, 0.97, P = .001).Among hospitalizations with a main diagnosis of sepsis, weekend admissions were associated with higher OR for in-hospital mortality, ICU admission, and intubation. Whether these findings can be explained by staffing-level differences needs to be addressed.

Objectives: Recently, the Hospital Frailty Risk Score based on a derivation and validation study in the UK has been proposed as a low-cost, systematic screening tool to identify older, frail patients who are at a greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful. We aimed to validate this Score in an independent cohort in Switzerland., Design: Secondary analysis of a prospective, observational study (TRIAGE study)., Setting: One 600-bed tertiary care hospital in Aarau, Switzerland., Participants: Consecutive medical inpatients aged ≥75 years that presented to the emergency department or were electively admitted between October 2015 and April 2018., Primary and Secondary Outcome Measures: The primary endpoint was all-cause 30-day mortality. Secondary endpoints were length of hospital stay, hospital readmission, functional impairment and quality of life measures. We used multivariate regression analyses., Results: Of 4957 included patients, 3150 (63.5%) were classified as low risk, 1663 (33.5%) intermediate risk, and 144 (2.9%) high risk for frailty. Compared with the low-risk group, patients in the moderate risk and high-risk groups had increased risk for 30-day mortality (OR (OR) 2.53, 95% CI 2.09 to 3.06, p<0.001 and OR 4.40, 95% CI 2.94 to 6.57, p<0.001) with overall moderate discrimination (area under the ROC curve 0.66). The results remained robust after adjustment for important confounders. Similarly, we found longer length of hospital stay, more severe functional impairment and a lower quality of life in higher risk group patients., Conclusion: Our data confirm the prognostic value of the Hospital Frailty Risk Score to identify older, frail people at risk for mortality and adverse outcomes in an independent patient population., Trial Registration Number: NCT01768494; Post-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: No conflicts of interest were reported.

Following the fatal invasive meningococcal disease in a Swiss student who had been visiting Berlin, several public health institutions on local, regional and national level cooperated to ensure that the appropriate measures such as contact tracing and post exposure prophylaxis were taken to prevent further cases. The incidence highlighted the importance of early disease notification and showed that if an infectious disease requiring public health action occurs in an international context, it is vital that relevant information is communicated to all levels of the public health systems of the countries involved.

After the publication of the Swiss plan for pandemic preparation, specific tasks for the general practitioners (GPs) in Switzerland in the case of a pandemic situation have been analysed. A comprehensive preparation of the GPs for the pandemic is essential, first because of the increasing number of sick people and second because of the experience and competence of GPs in recognising and treating people affected by influenza. This article underlines the importance of the GPs in public health services and assists the GPs in their preparation for a pandemic.

The seasonal flu strikes every year with many different faces. Beside a common flu, influenza claims every year a high number of victims especially among the elderly. Despite an active surveillance of the flu activity and circulating viruses on a national and international level, the factors which determine the spread of the influenza virus remain unclear. Regarding the thread of a new pandemic, both, basic research and surveillance of influenza has been intensified to get a more detailed view on the activity and transmissibility of the influenza virus. This article describes the influenza surveillance schemes in Austria, Germany and especially Switzerland highlighting the differences between the three countries. In addition, the new mortality surveillance method used in Switzerland is presented.

Background: Influenza infections are considered responsible for a substantial burden of disease and mortality in the elderly, especially during winter time. However, death certificates indicating influenza as the cause of death might only partly reflect the mortality attributable to influenza., Methods: We estimated influenza-attributable mortality for the Swiss resident population of age 60 and older from 1969 to 1999 by Poisson regression modelling of all cause and influenza mortality, and examined long-term trends by age and gender. In sensitivity analyses we additionally used data on official pneumonia deaths, as well as clinical diagnosis of influenza-associated illnesses from the Swiss Sentinel Network., Results: For the 30 successive respiratory seasons (July of a given year to June of the next year) from 1969/70 to 1998/99 the estimated total number of influenza-attributable deaths in the Swiss population of 60+ was 24 800 (95% confidence interval: 21 000 to 28 600), about 2 times the official count of influenza deaths. Influenza-attributable mortality rate declined from 1969 to 1999, but the yearly number of influenza-attributable deaths nevertheless stabilised at around 600 to 700 in the ninety's due to aging of the population. The oldest-aged groups persistently showed the highest influenza mortality rate. Influenza-attributable mortality estimates were substantially higher when using the general practice influenza indicator (by 66%) or the combined cause-of-death category pneumonia and influenza (by 169%)., Conclusions: Only counting official influenza deaths underestimated influenza-attributable mortality in Switzerland by a factor of two to three. Despite a gradual decline in age-specific influenza attributable mortality rates in the years 1969 to 1999, we estimated an average annual number of 830 deaths in the elderly Swiss resident population. The elderly remain the primary target group for influenza vaccination to reduce influenza-attributable mortality.

From 1984 to 2004 a total of 1370 TBE cases have been reported to the Federal Office of Public Health through the notification system. A significant increase of cases was observed in the nineties. Since 1999 the yearly average of reported cases was 101, corresponding to a yearly incidence of 1.4/10(5) inhabitants for all of Switzerland or to an incidence of approximately 6/10(5) if only the population living in endemic regions is taken into account. Male cases were twice as frequent as female ones. The age distribution showed two peaks in the age ranges of 6 to 14 and 60 to 69 years. Cases in children under 6 years of age were very rare with a yearly average of two hospitalised children. The severity of the disease increased with age. In 86% of the patients CNS involvement was present while 14% showed only flu-like symptoms. Ninety percent of patient with CNS involvement were hospitalised, 1,3% died (on average one death per year since 1999). Cases in fully vaccinated persons were very rare. The majority of patients had most probably been infected at their place of residence or in the nearer surroundings. The incidence in the large cities was low (< or = 1/10(5)/year). In smaller towns located directly in an endemic region, the incidence rose to as much as 18/10(5)/year. During the 21 years of observation, the endemic regions in four cantons known in the early eighties had clearly expanded and new infected regions appeared in seven other cantons. A frequent recreational or occupational exposure in wooded areas was mentioned by 85% of the patients. Although 80% of these concerned leisure time activities (mainly walking), the incidence is most probably still higher in occupationally exposed persons. This indicates that not only persons with leisure time exposure but also occupationally exposed persons are still insufficiently vaccinated to achieve an optimal control of this disease in Switzerland.