The size of the population potentially in need of palliative care in Germany - an estimation based on death registration data

BACKGROUND: No data exist on the size of the population potentially in need of palliative care in Germany. The aim of this study is to estimate the size of the German population that may benefit from palliative care. METHOD: Based on existing population-based methods (Rosenwax and Murtagh), German death registration data were analyzed and contrasted with international results. The data include all death cases in 2013 in Germany. RESULTS: According to the method Rosenwax defined, between 40.7 % (minimal estimate) and 96.1 % (maximal estimate) of death cases could benefit from palliative care. The estimation, based on Murtagh’s refined method, results in 78.0 % of death cases potentially being eligible for palliative care. The percentage of potential palliative care candidates is conditioned by age. Based on the Murtagh Method, in the age category between 30 and 39 years, a potential demand for palliative care can be found for 40.4 % percent of all deaths occurring in this age category, with this number increasing to 80.3 % in the age bracket of 80 years and over. CONCLUSION: An estimation of the size of the population in need is essential for healthcare planning. Therefore, our data serve as a guide and starting point for further research

Emergency Medical Care of People with Intellectual Disabilities: A Scoping Review

Purpose: The paper intends to do a scoping review of people with intellectual disabilities in emergency care where this group seems to face access barriers and discrimination. It analyses the conceptual and methodological framework for studies examining the former.Methods: A scoping review is conducted. The studies' quality is assessed via a checklist developed by the authors drawing on a compilation of common assessment tools for study quality.Results: Fourteen quantitative studies fulfil the inclusion criteria for further analysis. Summary measures are extracted. Results are synthesized with Andersen's Behavioral Model of Health Service Use. Studies employ a combination of variables attributable to different aspects of population characteristics and health behavior.Conclusion: Most studies seek to quantify or predict emergency care overuse by people with intellectual disabilities. Future studies should also take patients' poor health or treatment outcomes and their perspectives into account

Does Value Stream Mapping affect the structure, process, and outcome quality in care facilities? A systematic review

Background: Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities. Methods: A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered. Results: Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing. Conclusions: For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results has to be considered

Does positive affect mediate the association of multimorbidity on depressive symptoms?

Objectives Multimorbidity poses various challenges, and previous research has indicated a causal relation with depression. As multimorbidity is not curable, the underlying mechanisms are of great interest. Positive affect is a major resource for coping with chronic conditions and for the prevention of depression. Long-term multimorbidity, however, may deplete positive affect. The purpose of this paper is to investigate the role of positive affect in the association between multimorbidity and depressive symptoms. Method We used four consecutive waves (2008, 2011, 2014, 2017) of the nationally representative German Ageing Survey (DEAS) with a total of 1,558 older adults aged 40 and over. To account for time-varying confounding, exposure-induced mediator-outcome confounding, and reciprocities, we applied the mediational g-formula with inverse-probability weighting techniques. We also tested for exposure-mediator interaction to adjust for differences in mediation across the duration of multimorbidity. Results We confirmed a positive longitudinal relation between multimorbidity and depressive symptoms, both of which were negatively associated with while positive affect. The model without interaction indicated a share mediated of ca. 18.3% on the total effect of multimorbidity on depressive symptoms. Addition of interaction led to substantial differences for multimorbidity duration and levels of positive affect. Associations for long-term multimorbidity (at least two survey waves) were more substantial, and the share mediated doubled (>40%). Additionally, the direct effect of multimorbidity on depressive symptoms diminished for short-term multimorbidity. Conclusion Strengthening positive affect could reduce depressive symptoms in those facing multimorbidity. This study also discusses methodological challenges in performing longitudinal mediation analysis. We advise researchers to consider the mediational g-formula and exposure-mediator interaction

Report from an ongoing research project: The Cologne Research and Development Network (CoRe-Net) and the value-based approach to healthcare

With the BMBF's funding program Structural Development in Health Services Research the Cologne Research and Development Network CoRe-Net is being set up by various partners from both clinical practice and health services research. The network focuses on the further development of healthcare according to the concept of learning organizations. On the basis of three research projects, the Cologne network CoRe-Net aims to establish itself in a sustainable manner and analyze healthcare delivery for two vulnerable patient groups. The two groups include a) deceased patients in Cologne and b) people suffering from heart disease and an associated mental comorbidity. The Cologne network CoRe-Net is based on M.E. Porter's value-based healthcare approach

The size of the population potentially in need of palliative care in Germany - an estimation based on death registration data

Background: No data exist on the size of the population potentially in need of palliative care in Germany. The aim of this study is to estimate the size of the German population that may benefit from palliative care. Method: Based on existing population-based methods (Rosenwax and Murtagh), German death registration data were analyzed and contrasted with international results. The data include all death cases in 2013 in Germany. Results: According to the method Rosenwax defined, between 40.7 % (minimal estimate) and 96.1 % (maximal estimate) of death cases could benefit from palliative care. The estimation, based on Murtagh's refined method, results in 78.0 % of death cases potentially being eligible for palliative care. The percentage of potential palliative care candidates is conditioned by age. Based on the Murtagh Method, in the age category between 30 and 39 years, a potential demand for palliative care can be found for 40.4 % percent of all deaths occurring in this age category, with this number increasing to 80.3 % in the age bracket of 80 years and over. Conclusion: An estimation of the size of the population in need is essential for healthcare planning. Therefore, our data serve as a guide and starting point for further research

Associations between hospital structures, processes and patient experiences of preparation for discharge in breast cancer centers: A multilevel analysis

Background Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge. Purpose The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers. Methodology The data were collected between February 1 and July 31, 2014-2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses. Results Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge. Conclusion The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources. Practice Implications Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently

When do physicians perceive the success of a new care model differently?

Background The health care innovation MamBo - people with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management aims to improve the efficiency and quality of care for multimorbid patients by delegating tasks (e.g. taking over house calls or coordinating specialist appointments) to a monitoring and coordination assistant (MoniKa). Participating physicians are very important for the success of the health care innovation due to their direct involvement as practitioners and their task of enrolling patients. The aim of this part of the evaluation study is therefore to identify the physicians' personal values, which influence the individual perception of the project's advantages and thus possibly the acceptance and sustainable implementation of new care structures. Methods Two Focus groups (n = 4; n = 6) and three individual interviews with general practitioners and specialists who decided to implement the health care innovation within the first year were conducted. The semi-structured guidelines were developed by the research team. The interviews were analysed according to the content analysis by Mayring. We used the learning model of operant conditioning to place our study results in a theoretical context. Result Two central personal values of the participants, which determine the desired advantages of the health care innovation were identified: More patient-oriented and more economic-oriented values. Participants with more patient-oriented values quickly perceived advantages, which seems to be beneficial for the acceptance of the new care structures. Economic-oriented participants tended to be more critical. The benefits of the health care innovation, which was expressed, for example, in an improvement of the practice routine, has not yet been perceived by this group, or only to a limited extent. Conclusions The results suggest that the respective values of the participants define the individual perceived advantages and thus, the assessment of the success of the health care innovation in general. These findings could be used in the implementation process by increasing the motivation of the project participants through typified supervision