Primary care practice-based care management for chronically ill patients (PraCMan): study protocol for a cluster randomized controlled trial [ISRCTN56104508]

Background: Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising results. Care management programmes based on health care assistants (HCAs) targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need. Methods: PraCMan is a cluster randomized controlled trial with primary care practices as unit of randomisation. The study evaluates a complex primary care practice-based care management of patients at high risk for future hospitalizations. Eligible patients either suffer from type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure or any combination. Patients with a high likelihood of hospitalization within the following 12 months (based on insurance data) will be included in the trial. During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and resources as well as regular structured monitoring of symptoms. Assessment and monitoring will be performed by trained HCAs from the participating practices. Additionally, patients will receive written information, symptom diaries, action plans and a medication plan to improve self-management capabilities. This intervention is addition to usual care. Patients from the control group receive usual care. Primary outcome is the number of all-cause hospitalizations at 12 months follow-up, assessed by insurance claims data. Secondary outcomes are health-related quality of life (SF12, EQ5D), quality of chronic illness care (PACIC), health care utilisation and costs, medication adherence (MARS), depression status and severity (PHQ-9), self-management capabilities and clinical parameters. Data collection will be performed at baseline, 12 and 24 months (12 months post-intervention). Discussion: Practice-based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care demands. Trial registration: Current Controlled Trials ISRCTN5610450

Evaluation of an MPN test for the rapid enumeration of Pseudomonas aeruginosa in hospital waters.

In this study, the performance of a new most probable number (MPN) test (Pseudalert®/Quanti-Tray®) for the enumeration of Pseudomonas aeruginosa from hospital waters was compared with both international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water – Part 8 (MoDW Part 8), which both use Pseudomonas CN agar. The comparison based on the calculation of mean relative differences between the two methods was conducted according to ISO 17994:2014. Using both routine hospital water samples (80 from six laboratories) and artificially contaminated samples (192 from five laboratories), paired counts from each sample and the enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert®/Quanti-Tray®. For the artificially contaminated samples, the data revealed higher counts of P. aeruginosa being recorded by Pseudalert®/Quanti-Tray®. The Pseudalert®/Quanti-Tray® method does not require confirmation testing for atypical strains of P. aeruginosa, saving up to 6 days of additional analysis, and has the added advantage of providing confirmed counts within 24–28 hours incubation compared to 40–48 hours or longer for the ISO 16266 and MoDW Part 8 methods

Knowledge Antecedents of Absorptive Capacity: A Meta-Analysis

A firm’s absorptive capacity -its ability to recognize, assimilate, and exploit knowledge- has been viewed as one of the most investigated constructs in organizational research over the last two decades. Knowledge as a focal antecedent of absorptive capacity has been studied extensively. However, the results represent fundamentally different aspects of knowledge which has led to a fragmentation of the literature. Thus, it remains unclear which dimensions of knowledge are relevant for the development of absorptive capacity. By applying meta-analytical methods in 156 samples representing 284,144 firms, we examine the links between different knowledge antecedents and absorptive capacity, considering knowledge forms (knowledge assets and routines and processes), knowledge characteristics (quantity and quality) as well as knowledge contexts (firm internal and inter-firm). While our findings display significant positive impact of different knowledge antecedents on absorptive capacity, these relationships vary in strength. Our findings confirm the relevance of knowledge routines and processes and firm internal quality of knowledge for the development of absorptive capacity. Interestingly, the quantity of knowledge a firm possesses appears to be less important. Our results furthermore suggest knowledge antecedents to be more relevant in the firm internal context. This challenges the general assumption in the absorptive capacity literature, which emphasizes the importance of inter-firm cooperation for the development of absorptive capacity. In our post-hoc test, we extend our conceptual model and assess absorptive capacity’s mediating role between knowledge antecedents and innovation. We provide a fine-grained, integrated framework on absorptive capacity’s knowledge antecedents, highlighting their differential importance for absorptive capacity

Hospital Admission and Discharge: Lessons Learned from a Large Programme in Southwest Germany

Introduction: In the context of a GP-based care programme, we implemented an admission, discharge and follow-up programme. Description: The VESPEERA programme consists of three sets of components: pre-admission interventions, in-hospital interventions and post-discharge interventions. It was aimed at all patients with a hospital stay participating in the GP-based care programme and was implemented in 7 hospitals and 72 general practices in southwest Germany using a range of strategies. Its’ effectiveness was evaluated using readmissions within 90 days after discharge as primary outcome. Questionnaires with staff were used to explore the implementation process. Discussion: A statistically significant effect was not found, but the effect size was similar to other interventions. Intervention fidelity was low and contextual factors affecting the implementation, amongst others, were available resources, external requirements such as legal regulations and networking between care providers. Lessons learned were derived that can aid to inform future political or scientific initiatives. Conclusion: Structured information transfer at hospital admission and discharge makes sense but the added value in the context of a GP-based programme seems modest. Primary care teams should be involved in pre- and post-hospital care. Abstrakt Einleitung: Im Rahmen der hausarztzentrierten Versorgung wurde ein Programm zur Verbesserung von Krankenhausaufnahmen und -entlassungen sowie der Nachsorge implementiert. Beschreibung: Das VESPEERA-Programm bestand aus verschiedenen Komponenten, die vor der Aufnahme, während des Krankenhausaufenthalts sowie nach der Entlassung durchgeführt wurden. Das Programm richtete sich an alle Patienten mit einem Krankenhausaufenthalt, die an der hausarztzentrierten Versorgung teilnahmen und wurde in 7 Krankenhäusern und 72 Hausarztpraxen in Südwestdeutschland unter Anwendung einer Reihe von Strategien implementiert. Seine Wirksamkeit wurde anhand des primären Endpunkts “Rehospitalisierungen innerhalb von 90 Tagen nach der Entlassung” bewertet. Anhand einer Fragebogenbefragung beim Personal wurde der Implementierungsprozess untersucht. Diskussion: Ein statistisch signifikanter Effekt konnte nicht gefunden werden, die Effektgröße war jedoch ähnlich wie bei anderen Interventionen. Die Interventionstreue war gering. Kontextfaktoren, die die Implementierung beeinflussten, waren unter anderem verfügbare Ressourcen, externe Anforderungen wie gesetzliche Vorschriften und die Vernetzung von Leistungserbringern. Es wurden Schlussfolgerungen gezogen, die für künftige politische oder wissenschaftliche Initiativen hilfreich sein können. Schlussfolgerung: Eine strukturierte Informationsweitergabe bei der Aufnahme und Entlassung aus dem Krankenhaus ist sinnvoll, doch scheint der zusätzliche Nutzen im Rahmen der hausarztzentrierten Versorgung begrenzt. Teams der Primärversorgung sollten in die prä- und poststationäre Versorgung einbezogen werden. Schlagwörter: Übergänge in der Versorgung; Einweisungsmanagement; Nachsorge nach Entlassung; Krankenhauswiederaufnahmen; Versorgungskontinuität; starke Primärversorgung; integrierte Versorgun