Innovations in healthcare of peripheral regions – Greifswald as incubator for the Baltic Sea region?

Health care systems are called to reconcile at least three conflicting goals: They have to provide sufficient health care services of appropriate quality for the population, keep the cost at an affordable level, and make services accessible for every member of the society. Achieving all three of these goals at the same time is sometime like squaring the circle: Good ser- vices accessibly for everybody even in peripheral regions require resources and generate costs which – too often – seem inappropriate for many politicians and members of the society. At the same time, high quality ser- vices are only affordable with centralised systems where the number of patients permits sufficient routine. However, this centralisation means that services are not available close of the places where people live, in particu- lar in rural areas. The only answer are innovations of health care provision which increase the efficiency of the system and make it possible to achieve all objectives at the same time. The district of Vorpommern-Greifswald has developed, adopted, and implemented innovations in the field of telemedicine, emergency services, drones, and cross-border health care, which have already proven relevant for the region. These innovations are ready to diffuse into other countries of the Baltic Sea region. At the same time, innovations from other countries could be fruitful innovations seedlings for the district in North-Eastern Germany. However, this would require overcoming a number of financial, cultural, and personal barriers in order to improve the health care situation even in peripheral regions. This paper discusses the “magic triangle” of cost, quality, and accessi- bility as the fundamental goal system of a health care system. Furthermore, it presents some insights into the innovations implemented in the district of Vorpommern-Greifswald. Finally, it discusses a model of innovation adop- tion and potentials entering into an adoption and adaption process within the Baltic Sea region

Leistungsprogrammplanung karitativer Nonprofit-Organisationen als Instrument des Ethik-Controlling: eine exemplarische Analyse des Portfolios diakonischer Sozialleistungsunternehmen in Vorpommern

"This paper presents a portfolio analysis of diaconic institutions in the region of Western Pomerania. It is built on an adopted BCG-matrix and reveals strengths and weaknesses of existing service packages. It is obvious that a service is usually started when a diaconic institution realizes a social necessity for aid, but no financial support is given by insurances or the government. In order to be able to render this service the institution must have funds raised by donations or by cash flows from products that are generating profit. However, this will call for-profit competitors on the market and challenge the system of internal subsidy." (author's abstract

Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis – a perspective from structurally- and process-oriented hygiene

In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene

Cost-effectiveness of Screen-Triage-Treat approach with Primary HPV Testing for Cervical Cancer Screening in Low- and Middle-Income Countries: Protocol for a Systematic Review

Background: Cervical cancer is a leading cause of mortality among women in low- and middle-income countries (LMICs). Early detection through screening is key to cervical cancer prevention. HPV DNA testing (community-based self-sampling and facility-based provider sampling) has recently been recommended by WHO as the primary screening in LMIC in a “screen, triage and treat” approach. A lack of economic evidence considering the intervention cost and the value of health gain leads to insufficient public funds allocated for healthcare. Objectives of this systematic review: 1) To summarize and compare the incremental resource use, implementation cost, and incremental cost-effectiveness of adopting different algorithms using HPV DNA primary tests followed by triage tests in LMICs. 2) To summarize and compare the resource use, implementation cost and cost-effectiveness of two sample collection methods (community-based self-sampling and facility-based provider-sampling) of the HPV-based primary screening as part of the screen-triage-treat approach for cervical cancer screening in LMICs. 3) To summarize and compare the resource use, implementation cost, and cost-effectiveness of different “Screen-triage-treat" methods in general population versus high-risk HIV-positive women. 4) To describe the methodological considerations applied in the economic evaluation studies (outcome, measures, analytical viewpoint, time horizon, discount rate, decision models) and assess the quality of economic evidence using standard CHEERS and Drummond checklists Method: A systematic review will be performed following Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) using literature from multiple databases including PubMed, Embase, Web of Science, CEA registry, NHS Economic Evaluation Database, Health Economic Evaluation Database (HEED), CINAHL, EconLit, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Cochrane Library as well as grey literature from other sources. Details of search strategies, eligibility criteria and process for study screening, study selection, quality assessment, data extraction and analysis are described in the attachment

Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre

<p>Abstract</p> <p>Background</p> <p>Against the background of a decreasing number of general practitioners (GPs) in rural regions in Germany, the AGnES-concept (AGnES = GP-supporting, community-based, e-health-assisted, systemic intervention) supports the delegation of regular GP-home visits to qualified practice assistants. The concept was implemented and evaluated in different model projects in Germany.</p> <p>To explore the economic effects of this concept, the development of the number of home visits in an ambulatory healthcare centre was analysed and compared with the number of home visits in the surrounding county.</p> <p>Methods</p> <p>Information about GP-home visits was derived from reimbursement data of the ambulatory healthcare centre and a statutory health insurance. Information about home visits conducted by AGnES-practice assistants was collected from the project documentation over a time period of 12 consecutive quarter years, four quarter years before the beginning of the project and 8 quarter years while the project was implemented, considering background temporal trends on the population level in the study region.</p> <p>Results</p> <p>Within the ambulatory healthcare centre, the home visits by the GPs significantly decreased, especially the number of medically urgent home visits. However, the overall rate of home visits (conducted by the GPs and the AGnES-practice assistants together) did not change significantly after implementation of the AGnES-concept. In the surrounding county, the home visit rates of the GPs were continuous; the temporal patterns were approximately equal for both usual and urgent home visits.</p> <p>Conclusion</p> <p>The results of the analyses show that the support by AGnES-practice assistants led to a decrease of GP-home visits rather than an induction of additional home visits by the AGnES-practice assistants. The most extended effect is related to the medically urgent home visits rather than to the usual home visits.</p

Krankheitsbedingte Fehlzeiten des Pflegepersonals eines Maximalversorgers – Analyse und Handlungsanweisungen

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Hintergrund&lt;/jats:title&gt; &lt;jats:p&gt;Krankheitsbedingte Fehlzeiten stellen im gesundheitsbetrieblichen Leistungserstellungsprozess Produktivitätsminderungen dar. Angesichts knapper Pflegefachkräfte, des demografischen Wandels und der Veränderung des Krankheitspanoramas sind die Kenntnis und das Management von Ausfällen in der betrieblichen Zielkonzeption zu verankern, um die Leistungsbereitschaft sicherzustellen. Für die systematische Einordnung möglicher Ausfallursachen und Ableitung von Maßnahmen zur Vermeidung von Produktivitätsverlusten wird ein auf die Krankenpflege ausgerichtetes Modell entwickelt und vorgestellt. Dieses soll die Analyse von Fehlzeitendaten der Pflegekräfte eines maximalversorgenden Krankenhauses strukturieren.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ziel&lt;/jats:title&gt; &lt;jats:p&gt;Ziele dieser Studie sind die Entwicklung eines Analysemodells für Fehlzeiten von Pflegepersonal in Krankenhäusern und dessen Anwendung auf Fehlzeitendaten eines maximalversorgenden Krankenhauses. Mithilfe des Modells sollen die Ursachen für Fehlzeiten systematisch erfasst, strukturiert und schließlich analysiert werden. Aus den Analyseergebnissen sollen schließlich Ansatzpunkte, wie sich Fehlzeiten betrieblich steuern lassen könnten, abgeleitet werden.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Methodik&lt;/jats:title&gt; &lt;jats:p&gt;Zur Analyse von Fehlzeiten im Pflegeberuf wird ein systematischer Ordnungsrahmen entwickelt. Die Anwendung der Analysemethode erfolgt am Beispiel eines deutschen maximalversorgenden Krankenhauses, das Daten zur wissenschaftlichen Auswertung zur Verfügung stellte. Im Betrachtungszeitraum von 2 Jahren wurde ein Datensatz von 73.996 registrierten Ausfällen von rund 1500 Pflegekräften explorativ analysiert.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ergebnisse&lt;/jats:title&gt; &lt;jats:p&gt;Das Modell zur Analyse von Fehlzeiten beweist seine Anwendbarkeit für die Strukturierung und die systematische Erfassung von Ausfallursachen. Der erarbeitete Denkrahmen liefert damit sowohl einen wissenschaftlichen als auch praktischen Beitrag und kann in weiteren Fehlzeitenanalysen Anwendung finden. Als wichtiger Ansatzpunkt zur Reduktion der Fehlzeiten am Erfahrungsobjekt erweist sich die Homogenisierung der Personalstruktur, die an den Organisationeinheiten ansetzen sollte. Diese kann z. B. über den Altersdurchschnitt gesteuert werden, da den Ergebnissen zufolge ältere Pflegekräfte im Durchschnitt deutlich höhere krankheitsbedingte Fehlzeiten verursachen als junge. Männliche Pflegekräfte fehlten indes krankheitsbedingt öfter als weibliche. Darüber hinaus sollte anhand von Mitarbeitergesprächen regelmäßig der Kontakt zur Belegschaft gesucht werden, um motivationsbedingte Fehlzeiten zu verhindern und frühzeitig Kenntnis über etwaige Probleme zu erlangen.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Fazit&lt;/jats:title&gt; &lt;jats:p&gt;Die erarbeitete Analysemethode ermöglicht die systematische Erfassung und Untersuchung von Fehlzeiten. Eine Reduktion der Fehlzeiten ist möglich. Sie erfordert die konsequente Umsetzung von Maßnahmen, die sich in der betrieblichen Zielkonzeption wiederfinden müssen.&lt;/jats:p&gt; &lt;/jats:sec&gt

Sustaining medical research – the role of trust and control

Abstract Background Medical research is increasingly interdisciplinary. However, not all projects are successful and cooperation is not always sustained beyond the end of funding. This study empirically assesses the effect of control and trust on the sustainability of interdisciplinary medical research in terms of its performance and satisfaction. Methods The sample consists of 100 German publicly funded medical research collaborations with scientists from medicine, natural and social sciences (N = 364). We develop a system model to analyze the influence of trust and control on performance and satisfaction of the cooperation. Findings Both control and trust are important prerequisites for sustainability, control mainly for the performance of the collaboration, and trust primarily for its satisfaction. While the level of interdisciplinarity is a positive moderator for performance, expectation of continuity is a negative intervening variable for the effect of trust and control on satisfaction. Moreover, trust principally adds to the positive impact of control on sustainability. Conclusions Interdisciplinary medical research requires a participative but systematic management of the respective consortium

Eine deutschlandweite Befragung zur Organisation von regionalen Netzwerktreffen

Eine erfolgreiche Zusammenarbeit in regionalen MRE-Netzwerken (MRE – multiresistente Erreger) beruht unter anderem auf dem aktiven Austausch der Netzwerkakteure in regelmäßig stattfindenden Treffen. Mit einer deutschlandweiten Befragung der Gesundheitsämter konnte erstmalig der aktuelle Stand zur Durchführung von regionalen MRE-Netzwerktreffen aufgezeigt werden. Es konnte belegt werden, dass am häufigsten der Öffentliche Gesundheitsdienst (ÖGD) die Treffen organisiert. Diese finden zumeist einmal im Halbjahr mit durchschnittlich 10 – 20 Teilnehmern statt. Insbesondere Akteure aus dem Bereich des ÖGD sowie der Krankenhaushygiene konnten als regelmäßige Teilnehmer der Netzwerkkonferenzen ermittelt werden. Die Erarbeitung von Leitlinien wurde als häufigstes Thema genannt. Die im Rahmen der Studie identifizierten Problemfelder lagen in den knappen personellen Ressourcen des ÖGD, der oftmals unzureichenden Finanzierung der Netzwerkarbeit sowie in einer schlechten Motivation zur Teilnahme insbesondere in der Gruppe der niedergelassenen Ärzte.Peer Reviewe