Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"Inhaltsverzeichnis / Table of Contents","authors":"","doi":"10.1016/S1865-9217(24)00018-7","DOIUrl":"https://doi.org/10.1016/S1865-9217(24)00018-7","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000187/pdfft?md5=6c22d1f7413b9191003329f9c132167a&pid=1-s2.0-S1865921724000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140134869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Einflussfaktoren auf die Patientenkompetenz und die Versorgung einsatzgeschädigter, psychisch erkrankter Soldat*innen der Bundeswehr: eine Interviewstudie mit Betroffenen","authors":"Thomas Emser ,&nbsp;Katrin Hornung ,&nbsp;Johannes Jäger ,&nbsp;Antje Bühler ,&nbsp;Gerd-Dieter Willmund","doi":"10.1016/j.zefq.2023.10.007","DOIUrl":"10.1016/j.zefq.2023.10.007","url":null,"abstract":"<div><h3>Background</h3><p>The number of service members of the German armed forces suffering from deployment-related mental health problems is steadily rising. Preliminary studies have shown that less than 50 % seek professional help. There is little knowledge about the factors influencing the development of an adequate level of patient competence to cope with the complexity of the clinical picture and the care of people with operational disabilities in the interprofessional network.</p></div><div><h3>Methods</h3><p>The article presents data gathered by semi-structured, guided interviews from 14 affected individuals analyzing salient beliefs about the perceived factors influencing their patient competence and care through the interprofessional network of supporters inside and outside the German armed forces. Data evaluation was carried out by means of content-structuring, qualitative content analysis using the method of deductive-inductive category formation.</p></div><div><h3>Findings</h3><p>Based on the interviews conducted, we identified four groups of salient beliefs having an influence on patient competence: identify changes and limitations, recognize illness, redirect one’s life, help shape one‘s life again, and four groups of salient beliefs having an influence on care: intangible / material support, medical supplies, psychosocial support, third-party support. All main topics could be assigned to three levels of influence (individual, individual-contextual, contextual) and stored with a total of 70 topics (codes).</p></div><div><h3>Interpretation</h3><p>The development of an effective “social structure” was named by those affected as an important influencing factor. Family members, comrades, superiors, and military GPs appear to have a significant impact on patient competence and care. The respondents' opinions about the importance of internal factors such as the soldier's self-image and fear of stigmatization are consistent with previous findings. Structural factors like supply procedures were mentioned as specific German armed forces phenomena.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921723001927/pdfft?md5=673de2677f2754692dbb95f4e90c2688&pid=1-s2.0-S1865921723001927-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planetary health in medical guidelines – A workshop report from the conference of the evidence-based medicine network 2023","authors":"Benedikt Lenzer ,&nbsp;Jeannine Schübel ,&nbsp;Alina Herrmann ,&nbsp;Stefanie Bühn ,&nbsp;Cathleen Muche-Borowski","doi":"10.1016/j.zefq.2023.10.010","DOIUrl":"10.1016/j.zefq.2023.10.010","url":null,"abstract":"<div><h3>Introduction</h3><p>Guidelines may play an important role in the process of adopting a planetary health perspective in clinical medicine. Current issues relating to the integration of planetary health aspects in guidelines were discussed during a workshop at the German Network for Evidence-Based Medicine conference in 2023.</p></div><div><h3>Methods</h3><p>In a multidisciplinary workshop, 25 persons with an interest in guideline development selected important planetary health dimensions that could be promptly included in guidelines. Group discussions addressed the challenges of integrating planetary health aspects in guidelines and feasible solutions.</p></div><div><h3>Results</h3><p>Participants recommended to first integrate the dimensions <em>Environmental impacts</em>, <em>Prevention &amp; co-benefits</em> and <em>Choosing wisely</em> and provided corresponding rationales. Updating evidence to decision frameworks and including relevant climate outcomes (e.g., CO₂ equivalents) in clinical trials were regarded as crucial. Pragmatic steps to integrate planetary health aspects such as an adapted guideline layout and prioritization of recommendations were proposed.</p></div><div><h3>Discussion</h3><p>Changes in the guideline development processes are necessary to incorporate the planetary health perspective into guidelines. Capacity building for guideline developers and modifications to frameworks are important next steps. Public discussion and cooperation between guideline developing bodies are therefore essential to move beyond the results of this workshop.</p></div><div><h3>Conclusion</h3><p>The aforementioned workshop underpins the strong interest to integrate planetary health aspects into guideline frameworks to eventually promote planetary health in clinical medicine.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921723001976/pdfft?md5=1963c55767b60e03157f438ffb836946&pid=1-s2.0-S1865921723001976-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wissen und Einstellung zur Speicherung und Nutzung von Gesundheitsdaten: Ergebnisse einer Bevölkerungsbefragung","authors":"Sonja Haug ,&nbsp;Rainer Schnell ,&nbsp;Georgios Raptis ,&nbsp;Caroline Dotter ,&nbsp;Karsten Weber","doi":"10.1016/j.zefq.2023.11.001","DOIUrl":"10.1016/j.zefq.2023.11.001","url":null,"abstract":"<div><h3>Objective</h3><p>The article tackles various issues arising in the context of the process of digitalization in the health sector. The communication and availability of health data, health registers, the electronic health record, consent procedures for the transfer of data and access to health data for research are considered.</p></div><div><h3>Methods</h3><p>The study is based on a computer-assisted telephone survey (dual-frame) of a random sample of adult people living in Germany. Data was collected in the period between June 01 and June 27, 2022 (n = 1,308).</p></div><div><h3>Results</h3><p>The level of knowledge concerning the transmission of health data to health insurers is good, whereas the existence of central death-, vaccination- and health registers as well as the access to health data by treating physicians is overestimated. The general acceptance of medical registers is very high. Half the population is unfamiliar with the electronic health record, and the willingness to use it is rather low. An opt-in procedure is preferred when transferring data, and more than eighty percent would release data in their electronic health file for research purposes. Three quarters would consent that their health data be handed over to general research, especially if reserach facilities were situated at German universities, under the condition that their data be treated confidentiallly. The willingness to release data correlates with the level of trust in the press as well as in universities and colleges and decreases when a data leak is considered to be serious.</p></div><div><h3>Discussion and conclusion</h3><p>In Germany, as in other European countries, we observe a great willingness of people to release health data for research purposes. However, the propensity to use the electronic health file is comparatively low, as is the acceptance of an opt-out procedure, which in the literature is considered a prerequisite for the successful implementation of electronic health records in other countries. Unsurprisingly, a general trust in research and government agencies that process health data is a key factor.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921723001952/pdfft?md5=9cff26102cd8ff5b0916cb07beb90ac7&pid=1-s2.0-S1865921723001952-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wahrgenommene Veränderungen der Belastungssituation ambulant Pflegender während der COVID-19-Pandemie: Ergebnisse einer Online-Befragung","authors":"Julia Petersen,&nbsp;Helene Müller,&nbsp;Marlen Melzer","doi":"10.1016/j.zefq.2023.10.005","DOIUrl":"10.1016/j.zefq.2023.10.005","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic posed major challenges to the health care system, particularly to nursing. Intensive care was often the focus of attention. However, home care nursing was also confronted with drastic changes, while it is largely unknown how the work situation changed for employees as a result of the pandemic – also depending on the sponsorship of home care nursing services.</p></div><div><h3>Methods</h3><p>A nationwide online survey of home-care nurses was conducted in May and June 2022. The Intensification of Job Demands Scale (IDS) and an open question regarding changes in the work situation due to the pandemic were used among other instruments.</p></div><div><h3>Results</h3><p>More than two-thirds of the 976 home-care nurses surveyed agreed with the respective statements regarding work intensification (e.<!--> <!-->g., taking fewer breaks, doing work activities at the same time, not having enough time). Additional factors for psychological workload during the pandemic primarily fell within the scope of work organization (e.<!--> <!-->g., staff absences due to illness and quarantine, vaccination related leaves and terminations, additional workload due to handling protective clothing). Employees of privately run care services experienced fewer COVID-19-related changes than home care nurses employed by non-profit providers.</p></div><div><h3>Conclusion</h3><p>In future crisis situations, good information management (e.<!--> <!-->g., uniform, consistent and comprehensible guidelines and recommendations for action) and ways to compensate for staff shortages should be created.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921723001915/pdfft?md5=dcfbebd2ba5b80eac5b4a63a2cc9c53c&pid=1-s2.0-S1865921723001915-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entwicklung von Kriterien für die prospektive Einschätzung des Aktualisierungsbedarfs von Leitlinienempfehlungen: AGIL-Kriterien","authors":"Waldemar Siemens ,&nbsp;Sonja Mahler ,&nbsp;Corinna Schaefer ,&nbsp;Monika Nothacker ,&nbsp;Vanessa Piechotta ,&nbsp;Peggy Prien ,&nbsp;Sabine Schüler ,&nbsp;Sabine Schwarz ,&nbsp;Susanne Blödt ,&nbsp;Iris Thielemann ,&nbsp;Thomas Harder ,&nbsp;Philipp Kapp ,&nbsp;Valérie Labonté ,&nbsp;Joerg J. Meerpohl ,&nbsp;Cordula Braun","doi":"10.1016/j.zefq.2023.11.006","DOIUrl":"10.1016/j.zefq.2023.11.006","url":null,"abstract":"<div><h3>Background</h3><p>Evidence-based guideline and vaccination recommendations should continuously be updated to appropriately support health care decisions. However, resources for updating guidelines are often limited.</p><p>The aim of this project was to develop a list of criteria for the <em>prospective</em> assessment of the need for updating individual guideline or vaccination recommendations, which can be applied from the time a guideline or guideline update is finalised.</p></div><div><h3>Methods</h3><p>In this article we describe the development of the AGIL criteria (<strong>A</strong>ssessment of <strong>G</strong>u<strong>i</strong>de<strong>l</strong>ines for Updating Recommendations). The AGIL criteria were developed by experienced scientists and experts in the field of guideline development in a multi-step process. The five steps included: 1) development of an initial list of criteria by the project team; 2) online survey of guideline experts on the initial version of the criteria list; 3) revision of the criteria list based on the results of the online survey; 4) workshop on the criteria list at the EbM Congress 2023; 5) creation of version 1.0 of the AGIL criteria based on the workshop results.</p></div><div><h3>Results</h3><p>The initial list included the following three criteria: 1) relevance of the question 2) availability of new relevant evidence, and 3) impact of potentially new evidence.</p><p>The response rate of the online survey for fully completed questionnaires was 31.0<!--> <!-->% (N<!--> <!-->=<!--> <!-->195; 630 guideline experts were contacted by email). For 90.3<!--> <!-->% (n<!--> <!-->=<!--> <!-->176) of the respondents, the criteria list included all essential aspects for assessing the need for updating guideline recommendations. More than three quarters of respondents rated the importance of the three criteria as “very important” or “important” (criteria 1–3: 75.3<!--> <!-->%, 86.1<!--> <!-->%, 85.2<!--> <!-->%) and – with the exception of criterion 1 – comprehensibility as “very comprehensible” or “comprehensible” (criteria 1–3: 58.4<!--> <!-->%, 75.9<!--> <!-->%, 78.5<!--> <!-->%).</p><p>The results of the online survey and the workshop generally confirmed the three criteria with their two sub-questions. The incorporation of all feedback resulted in the AGIL criteria (version 1.0), recapping: 1) relevance of the question regarding a) PICO components and b) other factors, e.<!--> <!-->g. epidemiological aspects; 2) availability of new evidence a) on health-related benefits and harms and b) on other decision factors, e.<!--> <!-->g. feasibility, acceptability; 3) impact of new evidence a) on the certainty of evidence on which the recommendation is based and b) on the present recommendation, e.<!--> <!-->g. strength of recommendation.</p></div><div><h3>Discussion</h3><p>The moderate response rate of the online survey may have limited its representativeness. Nevertheless, we consider the response rate to be s","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921723002179/pdfft?md5=6eae300fcbfcf8f7532a3bb9fd33aaf4&pid=1-s2.0-S1865921723002179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139491730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stationäre Frührehabilitation nach endovaskulärer und offener Versorgung eines Bauchaortenaneurysmas bei über 65-Jährigen: Indikation und langfristiges Outcome☆","authors":"Katrin Herrlett ,&nbsp;Jasmin Epple ,&nbsp;Neelam Lingwal ,&nbsp;Thomas Schmitz-Rixen ,&nbsp;Dittmar Böckler ,&nbsp;Reinhart T. Grundmann","doi":"10.1016/j.zefq.2023.10.008","DOIUrl":"10.1016/j.zefq.2023.10.008","url":null,"abstract":"<div><h3>Background</h3><p>In Germany, there is no data available on the frequency of inpatient rehabilitation (IR) after elective endovascular (EVAR) and open (OAR) abdominal aortic aneurysm (AAA) repair.</p></div><div><h3>Objective</h3><p>To report for the first time on the outcome of patients 65 years and older and thus of retirement age with and without IR after AAA repair in a retrospective analysis of routine data from all eleven regional companies of the AOK health insurance fund (AOK-Gesundheit).</p></div><div><h3>Methods</h3><p>Anonymized data of 16,358 patients 65 years and older with intact abdominal aortic aneurysm treated with EVAR (n = 12,960) or OAR (n = 3,398) between 01/01/2010 and 12/31/2016 were analyzed. Patients with postoperative IR (n = 1,531) were compared to those without postoperative IR (n = 14,827) with respect to general patient characteristics, comorbidities, perioperative and postoperative outcomes, and survival. The average follow-up of patients with postoperative and without postoperative IR was 49.9 months and 51.8 months, respectively.</p></div><div><h3>Results</h3><p>5.4<!--> <!-->% of EVAR patients, but 24.6<!--> <!-->% of OAR patients were referred to IR (p &lt; 0.001). Patients with IR were sicker than those without IR. Parameters significantly influencing the use of IR included OAR vs EVAR (Odds Ratio [OR] 6.03), condition after cerebral infarction (OR 1.53), and women vs men (OR 1.49). Perioperative influencing parameters were cerebral infarction (OR 2.40), blood transfusions (OR 2.21) and complex critical care (OR 2.15). After nine years, the Kaplan-Meier estimated survival was 41.9<!--> <!-->% for patients with vs 43.4<!--> <!-->% for those without IR in the EVAR group (p = 0.178). For OAR, it was 50.2<!--> <!-->% for patients with IR vs 49.8<!--> <!-->% for patients without IR (p = 0.006). In multivariate regression analysis, postoperative IR had a significant effect on long-term survival in OAR but not in EVAR patients.</p></div><div><h3>Conclusion</h3><p>There are no generally binding guidelines for the indication of IR after AAA repair. It should therefore be a requirement for the future that the fitness of each patient with elective AAA repair be determined with a score before and after the procedure in order to make indications for AHB more comparable. The score should be documented in the hospital discharge letter.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience report of two living systematic Cochrane reviews on COVID-19","authors":"Carina Wagner ,&nbsp;Caroline Hirsch ,&nbsp;Waldemar Siemens ,&nbsp;Philipp Kapp ,&nbsp;Claire Iannizzi","doi":"10.1016/j.zefq.2023.11.004","DOIUrl":"10.1016/j.zefq.2023.11.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Up-to-date systematic reviews (SRs) are essential for making evidence-based decisions. During the 2019 coronavirus (COVID-19) pandemic, there was a particular need for up-to-date evidence, making the living systematic review (LSR) approach an appropriate review type. However, this approach poses certain challenges.</p></div><div><h3>Objective and outline</h3><p>We aim to provide practice insights and report challenges that we faced while conducting two Cochrane LSRs on COVID-19 treatments with (i) convalescent plasma and (ii) systemic corticosteroids. We address our objective with an experience report and share challenges of the following components based on Iannizzi et al. (2022): study design, publication types, intervention/comparator, outcomes, search strategy, review updates and transparent reporting of differences between review updates.</p></div><div><h3>Results</h3><p>Regarding the study design, the plasma LSR included different study designs because RCT data were not available at the beginning of the pandemic, whereas for the corticosteroids LSR, which started several months later, RCT data were already available. The challenges in both LSRs included the publication types (preprints were included with caution) and the intervention/comparator, for instance the unavailability of standard of care for either LSR, or SARS-CoV-2 variants occurrence. Further challenges in both LSRs occurred in the components “outcome sets” (which had to be adjusted) and “literature search”. The decision criteria for updating were based on important studies and available resources in both LSRs and policy relevance in the plasma LSR. Transparent reporting of the differences between the various update versions were discussed for both LSRs.</p></div><div><h3>Discussion and conclusion</h3><p>In summary, there are similarities and differences regarding challenges of review components for both LSRs. It is important to keep in mind that the two LSR examples presented here were conducted in the wake of the COVID-19 pandemic. Therefore, many of the challenges are attributable to the pandemic and are not specific to LSRs, such as constant adjustments of the outcome sets or changes in the database search. Nevertheless, we believe that some of these aspects are helpful for LSR authors and are applicable to other LSRs outside the pandemic context, particularly in areas where new evidence is rapidly emerging.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921723002155/pdfft?md5=d0cb5188bf67631dd68f5bcd2f51d75d&pid=1-s2.0-S1865921723002155-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a comprehensive clinical risk management system in a university hospital","authors":"Wolfgang Buchberger ,&nbsp;Marten Schmied ,&nbsp;Michael Schomaker ,&nbsp;Anca del Rio ,&nbsp;Uwe Siebert","doi":"10.1016/j.zefq.2023.11.008","DOIUrl":"10.1016/j.zefq.2023.11.008","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Adverse events during hospital </span>treatment are common and can lead to serious harm. This study reports the implementation of a comprehensive </span>clinical risk management system in a university hospital and assesses the impact of clinical risk management on patient harms.</p></div><div><h3>Methods</h3><p>The clinical risk management system was rolled out over a period of eight years and consisted of a training of interdisciplinary risk management teams, external and internal risk audits, and the implementation of a critical incident reporting system (CIRS). The risks identified during the audits were analyzed according to the type, severity, and implementation of preventive measures. Other key figures of the risk management system were obtained from the annual risk reports. The number of liability cases was used as primary outcome measurement.</p></div><div><h3>Results</h3><p>Of the 1,104 risks identified during the risk audits, 56.2<!--> <!-->% were related to organization, 21.3<!--> <!-->% to documentation, 15.3<!--> <!-->% to treatment, and 7.2<!--> <!-->% to patient information and consent. The highest proportion of serious risks was found in the category organization (22.7<!--> <!-->%), the lowest in the category documentation (13.6<!--> <!-->%). Critical incident reporting identified between 241 and 370 critical incidents per year, for which in 79.5<!--> <!-->% to 83% preventive measures were implemented within twelve months. The frequency of incident reports per department correlated with the number of active risk managers and risk team meetings.</p><p>Compared with the years prior to the introduction of the clinical risk management system, an average annual reduction of harms by 60.1<!--> <!-->% (95% CI: 57.1; 63.1) was observed two years after the implementation was completed. On average, the rate of harms dropped by 5<!--> <!-->% per year for each 10<!--> <!-->% increase in roll-out of the clinical risk management system (incidence rate ratio: 0.95; 95% CI: 0.93; 0.97) .</p></div><div><h3>Conclusion</h3><p>The results of this project demonstrate the effectiveness of clinical risk management in detecting treatment-related risks and in reducing harm to patients.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Was wird unter einer Public-Health-Intervention verstanden? Ergebnisse eines Delphi-Prozesses im deutschsprachigen Raum","authors":"Jessica Dieudonné ,&nbsp;Lisa Jantzen ,&nbsp;Michelle Sanwald ,&nbsp;Michaela Trompke ,&nbsp;Dawid Pieper ,&nbsp;Constance Stegbauer ,&nbsp;Gerald Willms ,&nbsp;Barbara Buchberger ,&nbsp;Roland Brian Büchter ,&nbsp;Stefanie Bühn ,&nbsp;Florian Fischer ,&nbsp;Katharina Klein ,&nbsp;Joseph Kuhn ,&nbsp;Melanie Messer ,&nbsp;Uta Wegewitz ,&nbsp;Marlen Niederberger","doi":"10.1016/j.zefq.2023.05.022","DOIUrl":"10.1016/j.zefq.2023.05.022","url":null,"abstract":"<div><h3>Background</h3><p>Internationally, a variety of definitions for public health interventions (PHI) exist. In the German-speaking countries, however, a definition is still outstanding. Therefore, the aim of this study was to derive consensus criteria for the definition of PHI from the expert perspective of science and practice.</p></div><div><h3>Methods</h3><p>A Delphi survey with two online rounds was conducted from December 2022 to February 2023. Six criteria were formulated by a working group and posed for consensus: 1) the intention of the intervention, 2) potential conflicts of interest of the initiators of the intervention, 3) primary vs. secondary/tertiary prevention, 4) costs, 5) targeting, and 6) the reach of the intervention. In both Delphi rounds, experts from academia and practice were recruited through relevant networks and associations throughout the German-speaking world. The judgments were asked about standardized rating scales with the possibility of open justification.</p></div><div><h3>Results</h3><p>In the first Delphi round, n = 52 and in the second round n = 43 experts from research, care and administration/management in health care participated. Consensus was reached on four of the six criteria after the second Delphi round: the intention of the intervention, possible conflicts of interest of the initiators of the intervention, primary vs. secondary/tertiary prevention, and the scope of the intervention. From the perspective of the experts interviewed, these are the criteria that distinguish PHI.</p></div><div><h3>Discussion and conclusion</h3><p>Based on the consensus criteria, PHI can be defined more concretely. Thus, the results contribute to a better inter- and transdisciplinary understanding. Ideally, the criteria will make it easier to assign interventions to the public health sector in the future, even if a precise examination will be necessary in individual cases, among other things because the experts disagreed on the criteria of costs and how to address the target group.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10062986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}