Ergänzende Modelle zur Verzögerung von Heimeintritten : Schlussbericht vom 26.02.2021

Der Kostendruck der Altersversorgung auf die Gemeinden ist gross und wird voraussichtlich auf Grund der erwarteten Veränderungen in der Demografie künftig noch steigen. Aus Sicht der Gemeinden – als grosse Mitfinanzierer der Alters- und Pflegeheimaufenthalte von Senioren und Seniorinnen, geht es daher unter anderem darum, frühzeitige Pflegeheimeintritte zu verhindern oder zu verzögern. Auch die fünf Gemeinden des rechten Limmattals (Geroldswil, Oberengstringen, Oetwil an der Limmat, Unterengstringen und Weiningen) haben sich dieses Ziel gesetzt. Daher haben sie das Winterthurer Institut für Gesundheitsökonomie beauftragt, nationale und internationale Versorgungsmodelle für die Verzögerung oder Vermeidung von Heimeintritten zu suchen, zu evaluieren und auf ihre Passung für das rechte Limmattal zu beurteilen. Dabei wurden sowohl die Effektivität der Modelle als auch die Kosteneffektivität respektive der Return on Investment berücksichtigt. In enger Zusammenarbeit mit den Gemeindevertretenden wurden die folgenden sechs Versorgungsmodelle ausgewählt und mit Hilfe von wissenschaftlicher Literatur evaluiert: 1.Sturzprävention zu Hause: Ein Modell der Rheumaliga Schweiz, das aus einem Hausbesuch einer Physio- oder Ergotherapeutin oder eines Physio- oder Ergotherapeuten und individuellen Beratungen besteht. 2.Präventive geriatrische Hausbesuche: Die beiden Modelle aus Bern und Winterthur beinhalteten präventive Hausbesuche inkl. geriatrischen Assessments, welche von ausgebildeten Pflegefachpersonen durchgeführt wurden, sowie eine Nachverfolgung zu Hause oder mittels Telefonanrufen. 3.Siedlungsassistenz: Gemeinwesenarbeiterinnen der Gemeinde Horgen sollen selbständiges Wohnen im Alter nachhaltig ermöglichen. Sie klären proaktiv den Bedarf der Senioren und Seniorinnen an stützenden Massnahmen (Pflege, Hilfe und Betreuung) und organisieren Unterstützung aus dem sozialen Umfeld oder (sekundär) von Organisationen. Zudem fördern sie die soziale Einbindung und Vernetzung der Seniorinnen und Senioren durch Gruppentreffen oder gemeinschaftliche Aktivitäten. 4. Lokal vernetzt älter werden: Gesundheitsförderung Schweiz unterstützt zehn Zürcher Gemeinden bei der Entwicklung und Erweiterung von Massnahmen (z.B. Mittagstische, Kurse, Nachbarschaftshilfe, Treffpunkte), welche das soziale Netzwerk und das selbständige Leben von Seniorinnen und Senioren verbessern sollen. 5.Ausgebautes Hilfs- und Betreuungsangebot der Spitex: Eine separate Organisationseinheit der Spitex Limmat in der Stadt Zürich, bietet - ergänzend zu den herkömmlichen Spitex- Leistungen - vermehrt Hilfs- und Betreuungsleistungen (z.B. Haushaltshilfe, Einkaufen, Kochen, Begleitung, Freizeitangebote) an, welche die Kunden in ihren Alltagstätigkeiten unterstützen. 6.Gutscheine für selbstbestimmtes Wohnen: Die Beratungsstelle Alter der Stadt Luzern hat die Möglichkeit Seniorinnen und Senioren mit fehlenden finanziellen Ressourcen mit kleinen finanziellen Beiträgen (so genannten Gutscheinen) zu unterstützen, wenn dadurch Heimeintritte vermieden oder verzögert oder Angehörige entlastet werden können. Diese Beiträge werden z.B. zur Finanzierung einer regelmässigen Haushaltshilfe, Umbauten, regelmässigen Besuchen einer Tagesstätte o.ä. verwendet. Die Wissensgrundlage zur Effektivität und Kosteneffektivität für die Vermeidung oder Verzögerung von Heimeintritten ist bei den Modellen «Sturzprävention zu Hause» und «präventive geriatrische Hausbesuche» am sichersten. Bei den anderen vier untersuchten Modellen gibt es erste Hinweise darauf, dass sie ebenfalls dazu beitragen könnten, Heimeintritte zu vermeiden, allerdings ist die Evidenz zur Kosteneffektivität noch sehr gering. In Bezug auf die Kosten fehlen zurzeit v.a. noch Analysen, mit deren Hilfe man die Kosteneffektivität / den Return on Investment aus Sicht der Gemeinden beurteilen könnte. Unter Berücksichtigung der bestehenden Evidenz und der Situation im rechten Limmattal schlagen wir den fünf Gemeinden des rechten Limmattals die folgende Umsetzung vor: 1) Umsetzung der Modelle «Präventive geriatrische Hausbesuche» und «Gutscheine für selbstbestimmtes Wohnen» (Pilotprojekt von 3-4 Jahren). 2) Abklärung des Bedarfs für die Modelle «Sturzprävention», «Siedlungsassistenz» und «Ausgebautes Hilfs- und Betreuungsangebot der Spitex» sowie deren Umsetzung je nach Bedarfslage. 3) Als Letztes empfehlen wir, dass das Modell «Lokal vernetzt älter werden» nicht direkt umgesetzt werden soll, da im rechten Limmattal bereits viele solche Angebote bestehen, aber dass die bestehenden Leistungserbringer symbolisch gestärkt werden sollen. Des Weiteren schlagen wir vor, dass das Pilotprojekt evaluiert und für die Erhebung von Daten für die Bedarfsermittlung (siehe Punkt 2 oben) und möglicher Kosten genutzt werden soll. Sokann sichergestellt werden, dass nur Modelle umgesetzt werden, die auch den gewünschtenEffekt respektive Bedarf aufweisen und sich finanziell lohnen

The impact of the AO foundation on fracture care : an evaluation of 60 years AO foundation

Objectives Sixty years ago, the Association of Osteosynthesis (AO) was founded with the aim to improve fracture treatment and has since grown into one of the largest medical associations worldwide. Aim of this study was to evaluate AO's impact on science, education, patient care and the MedTech business. Design/methods Impact evaluations were conducted as appropriate for the individual domains: Impact on science was measured by analyzing citation frequencies of publications promoted by AO. Impact on education was evaluated by analyzing the evolution of number and location of AO courses. Impact on patient care was evaluated with a health economic model analyzing cost changes and years of life gained through the introduction of osteosynthesis in 17 high-income countries (HICs). Impact on MedTech business was evaluated by analyzing sales data of AO-associated products. Results Thirty-five AO papers and 2 major AO textbooks are cited at remarkable frequencies in high ranking journals with up to 2000 citations/year. The number of AO courses steadily increased with a total of 645'000 participants, 20‘000 teaching days and 2‘500 volunteer faculty members so far. The introduction of osteosynthesis saved at least 925 billion Swiss Francs [CHF] in the 17 HICs analyzed and had an impact on avoiding premature deaths comparable to the use of antihypertensive drugs. AO-associated products generated sales of 55 billion CHF. Conclusion AO's impact on science, education, patient care, and the MedTech business was significant because AO addressed hitherto unmet needs by combining activities that mutually enriched and reinforced each other

Lebensqualität, psychische Gesundheit, Einsamkeit und Adhärenz an Schutzmassnahmen während der Covid-19-Pandemie : Schlussbericht zum Covid-19 Social Monitor

Seit März 2020 stellte die Covid-19-Pandemie die Schweizer Bevölkerung laufend vor grosse gesellschaftliche Herausforderungen. Mit dem Projekt Covid-19 Social Monitor stand seit Ende März 2020 ein kontinuierliches Monitoring zu sozialen und gesundheitlichen Veränderungen der Bevölkerung zur Verfügung. Aktuelle Ergebnisse des Monitorings wurden jeweils wenige Tage nach Erhebung auf der Webseite https://covid19.ctu.unibe.ch präsentiert und diverse Indikatoren konnten bzw. können über die Zeit und nach Subgruppen betrachtet werden. Der vorliegende Schlussbericht steht ergänzend und zusammenfassend zu den Resultaten auf der Webseite und gibt einen Überblick über Veränderungen im Lauf der Pandemie zwischen März 2020 und November 2022. Der Fokus liegt dabei auf dem allgemeinen Wohlbefinden, der psychischen Befindlichkeit (inkl. Kinder und Jugendliche) und dem Einsamkeitsempfinden. Zudem wird die Adhärenz der Bevölkerung an Schutzmassnahmen zur Eindämmung der Pandemie betrachtet

Cost-utility analysis of thumb carpometacarpal resection arthroplasty : a health economic study using real-world data

Purpose: Knowledge about the costs and benefits of hand surgical interventions is important for surgeons, payers, and policy makers. Little is known about the cost-effectiveness of surgery for thumb carpometacarpal osteoarthritis. The objective of this study was to examine patients’ quality of life and economic costs, with focus on the cost-utility ratio 1 year after surgery for thumb carpometacarpal osteoarthritis compared with that for continued nonsurgical management. Methods: Patients with thumb carpometacarpal osteoarthritis indicated for resection arthroplasty were included in a prospective study. The quality of life (using European Quality of Life-5 Dimensions-5 Level), direct medical costs, and productivity losses were assessed up to 1 year after surgery. Baseline data at recruitment and costs sustained over 1 year before surgery served as a proxy for nonsurgical management. The total costs to gain 1 extra quality-adjusted life year and the incremental cost-effectiveness ratio were calculated from a health care system and a societal perspective. Results: The mean European Quality of Life-5 Dimensions-5 Level value for 151 included patients improved significantly from 0.69 to 0.88 (after surgery). The productivity loss during the preoperative period was 47% for 49 working patients, which decreased to 26% 1 year after surgery. The total costs increased from US $20,451 in the preoperative year to US$24,374 in the postoperative year. This resulted in an incremental cost-effectiveness ratio of US $25,370 per quality-adjusted life year for surgery compared with that for simulated nonsurgical management. Conclusions: The calculated incremental cost-effectiveness ratio was clearly below the suggested Swiss threshold of US$92,000, indicating that thumb carpometacarpal surgery is a cost-effective intervention

Cost-utility analysis of arthroscopic rotator cuff repair : a prospective health economic study using real-world data

Purpose: To assess the change in quality of life (QOL) and costs for patients with rotator cuff tears after arthroscopic rotator cuff repair (aRCR) compared with continued nonoperativemanagement, using real-world evidence. Methods: Patients indicated for aRCR were included in a prospective study and followed up to 2 years after surgery (postop) for allmeasurements. QOL (EQ-5D-5L) and shoulder function (Constant Score, Oxford Shoulder Score, subjective shoulder value) were assessed. Sixteen major insurance companies provided all-diagnoses direct medical costs in Swiss francs (CHF; 1 CHF ¼ 1.03 USD). Baseline data at recruitment and costs sustained over 1 year before surgery (preop) served as a proxy for nonoperative management. Total direct medical costs to gain 1 extra quality-adjusted life year (QALY) were calculated as the incremental costeffectiveness ratio (ICER; mean of 2 years postop compared with 1 year preop) from a societal perspective. Subgroup analyses were separately performed for traumatic (trauma-OP) and degenerative (degen-OP) rotator cuff tear patients. Sensitivity analyses for aRCR patients includedmore intensive nonoperative treatment with corresponding QOL gain. The relationship between QOL and shoulder function was explored using regression analysis. Results: For 153 aRCR patients (mean age 57 years; 63% male), themean EQ-5D index improved from 0.71 (preop) to 0.94 (1 year postop) and 0.96 (2 years postop). Mean total costs increased from 5,499 CHF (preop) to 17,116 CHF (1 year postop), then decreased to 4,226CHF (2 years postop). The ICER for all aRCR patients was 24,924 CHF/QALY (95%confidence interval [CI] 16,742 to 33,106) and 17,357 CHF/QALY (95% CI 10,951 to 23,763) and 36,474 CHF/QALY (95% CI 16,301 to 56,648) for the trauma-OP and degen-OP groups, respectively. QOL and shoulder function were significantly associated (P < .001). Conclusions: For RC patients treated at a specialized Swiss orthopaedic clinic, aRCR is a cost-effective intervention associated with clinically relevant improvement in QOL up to 2 years after repair compared with prior nonoperative management. Level of Evidence: Economic Analyses e Developing an Economic Model, Level I

Cost-utility analysis of total shoulder arthroplasty : a prospective health economic study using real-world data

Background: With increasing health care expenditures, knowledge about the benefit and costs of surgical interventions such as total shoulder arthroplasty (TSA) becomes important for orthopedic surgeons, social insurances and health policy decision makers. We examined the impact of TSA on quality of life (QOL), direct medical costs and productivity losses, and evaluated the cost-utility ratio of TSA compared to ongoing nonoperative management using real-world data. Methods: Patients with shoulder osteoarthritis and/or rotator cuff tear arthropathy indicated for anatomical or reverse TSA were included in this prospective study. Quality of life (EQ-5D-5L) and shoulder function (Constant Score, Shoulder Pain and Disability Index, short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, Subjective Shoulder Value) were assessed before (preop) and up to 2 years after surgery (postop). Health insurance companies provided all-diagnoses direct medical costs for 2018 in Swiss francs (CHF), where 1 CHF was equivalent to 1.02 USD. Indirect costs were assessed using the work productivity and activity impairment questionnaire. Baseline data at recruitment and the total costs of the preop year served as a proxy for nonoperative management. The incremental cost-effectiveness ratio (ICER) was calculated as the total costs to gain one extra quality-adjusted life year (QALY) based on both the health care system and societal perspective. The relationship between QOL and shoulder function was assessed by regression analysis. Results: The mean preOP EQ-5D-5L utility index of 0.68 for a total of 150 patients (mean age 71 years; 21% working; 58% female) increased to 0.89 and 0.87 at 1 and 2 years postop, respectively. Mean direct medical costs were 11,771 CHF (preop), 34,176 CHF (1 year postop) and 11,763 CHF (2 years postop). The ICER was 63,299 CHF/QALY (95% confidence interval [CI]: 44,391; 82,206). Mean productivity losses for 30 working patients decreased from 40,574 CHF per patient (preop) to 26,114 CHF at 1 year postop and 10,310 CHF at 2 years postop. When considering these productivity losses, the ICER was 35,549 CHF/QALY (95% CI: 12,076; 59,016). Quality of life was significantly associated with shoulder function (p < 0.001). Conclusion: Using real-world direct medical cost data, we calculated a cost-utility ratio of 63,299 CHF/QALY for TSA in Switzerland, which clearly falls below the often suggested 100,000 CHF/QALY threshold for acceptable cost-effectiveness. In view of productivity losses, TSA becomes highly cost-effective with an ICER of 35,546 CHF/QALY

Phosphocreatine interacts with phospholipids, affects membrane properties and exerts membrane-protective effects

A broad spectrum of beneficial effects has been ascribed to creatine (Cr), phosphocreatine (PCr) and their cyclic analogues cyclo-(cCr) and phospho-cyclocreatine (PcCr). Cr is widely used as nutritional supplement in sports and increasingly also as adjuvant treatment for pathologies such as myopathies and a plethora of neurodegenerative diseases. Additionally, Cr and its cyclic analogues have been proposed for anti-cancer treatment. The mechanisms involved in these pleiotropic effects are still controversial and far from being understood. The reversible conversion of Cr and ATP into PCr and ADP by creatine kinase, generating highly diffusible PCr energy reserves, is certainly an important element. However, some protective effects of Cr and analogues cannot be satisfactorily explained solely by effects on the cellular energy state. Here we used mainly liposome model systems to provide evidence for interaction of PCr and PcCr with different zwitterionic phospholipids by applying four independent, complementary biochemical and biophysical assays: (i) chemical binding assay, (ii) surface plasmon resonance spectroscopy (SPR), (iii) solid-state (31)P-NMR, and (iv) differential scanning calorimetry (DSC). SPR revealed low affinity PCr/phospholipid interaction that additionally induced changes in liposome shape as indicated by NMR and SPR. Additionally, DSC revealed evidence for membrane packing effects by PCr, as seen by altered lipid phase transition. Finally, PCr efficiently protected against membrane permeabilization in two different model systems: liposome-permeabilization by the membrane-active peptide melittin, and erythrocyte hemolysis by the oxidative drug doxorubicin, hypoosmotic stress or the mild detergent saponin. These findings suggest a new molecular basis for non-energy related functions of PCr and its cyclic analogue. PCr/phospholipid interaction and alteration of membrane structure may not only protect cellular membranes against various insults, but could have more general implications for many physiological membrane-related functions that are relevant for health and disease

Associations between domains of physical activity, sitting time, and different measures of overweight and obesity

AbstractObjectiveTo describe 1) cross-sectional associations between domain-specific physical activity, sitting time and different measures of overweight/obesity and 2) longitudinal associations between patterns of change in physical activity and overweight/obesity ten years later.MethodsCross-sectional and longitudinal analyses based on the first and second follow-up of the Swiss cohort study SAPALDIA (SAP) were conducted (SAP2 in 2002/03, SAP3 in 2010/11). Physical activity was assessed by self-report using the long International Physical Activity Questionnaire (IPAQ) and four short questions regarding moderate and vigorous activities. Overweight/obesity were defined based on body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and percent body fat based on bioelectric impedance analysis (BIA), all measured objectively. Multivariable logistic regression was used for analyses.ResultsCross-sectionally, leisure-time and vigorous physical activity were inversely associated with all obesity parameters. Most consistent associations were found with BIA percent body fat. There were no associations between work-related and domestic activities and overweight/obesity. Sitting time was positively associated with BIA percent body fat, but not with BMI, WHR and WHtR. Longitudinally, remaining inactive from SAP2 to SAP3 was associated with obesity and BIA percent body fat at SAP3 and with weight increase, becoming inactive with BIA percent body fat and weight increase.ConclusionsThe results support associations between physical activity and overweight/obesity cross-sectionally and longitudinally. Most consistent associations were found for BIA percent body fat. For prevention purposes, the results indicate that physical activity can have an important contribution to weight management