Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"Dünn in der Fläche? Regionale Disparitäten in der Hospiz- und Palliativversorgung in Deutschland","authors":"Beate Apolinarski ,&nbsp;Stephanie Stiel ,&nbsp;Franziska A. Herbst ,&nbsp;Siegfried Geyer","doi":"10.1016/j.zefq.2024.07.007","DOIUrl":"10.1016/j.zefq.2024.07.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Outpatient and inpatient hospice and palliative care services have been significantly expanded in Germany in recent decades and are increasingly being supplemented by day care services. However, the availability of these services varies greatly from region to region. The extent to which the availability of these care structures is matched by a regional need based on local population structures is as yet unknown.</div></div><div><h3>Methods</h3><div>In four Poisson regression models, the relationship between population indicators from the areas of demographics, employment, income, education and health and the number of offers of outpatient and inpatient hospice work and palliative care is exploratively examined. The cumulated data at district level is drawn from the INKAR database of the Federal Institute for Research on Building, Urban Affairs and Spatial Development on living conditions in Germany and from the guide of the German Association for Palliative Medicine. By means of logistic regression, factors influencing the establishment of day care services will also be identified.</div></div><div><h3>Results</h3><div>The analysis included 401 districts and cities in Germany. The number of inhabitants, settlement density, and the average age of inhabitants are the strongest predictors of the number of palliative care services. In metropolitan regions, both outpatient palliative care services and palliative care units tend to be more frequently available, while the number of outpatient hospice services and inpatient hospices increases in districts with a higher number of inhabitants regardless of settlement density. The regression model was unable to demonstrate a significant influence on the emergence of semi-inpatient care facilities, neither for the population indicators nor for the existing care structures.</div></div><div><h3>Discussion</h3><div>Regional population structures can only partially explain the geographically uneven distribution of hospice and palliative care services in districts and cities in Germany. Despite an increase in hospice and palliative care services, fewer hospice and palliative care structures are available in low population density regions that tend to have a higher share of older inhabitants.</div></div><div><h3>Conclusion</h3><div>Future health care planning should give more consideration to other population characteristics than to population size alone in order to improve care in regions with higher care needs that are, for example, due to a higher proportion of older residents. Subsequent studies should investigate which population characteristics can best describe the actual care needs.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Pages 53-62"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606835","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":"Erfahrungen und Ergebnisse bei der Integration von ePROs in die Routineversorgung eines onkologischen Spitzenzentrums: eine Analyse mithilfe des CFIR","authors":"Martin Eichler ,&nbsp;Leopold Hentschel ,&nbsp;Beate Hornemann ,&nbsp;Markus Schuler ,&nbsp;Stephan Richter ,&nbsp;Friedegund Meier ,&nbsp;Jürgen Weitz ,&nbsp;Klaus-Dieter Schaser ,&nbsp;Mechthild Krause ,&nbsp;Anke Mütherig ,&nbsp;Tina Thomas ,&nbsp;Sandra Weigmann-Faßbender ,&nbsp;Roman Schmädig ,&nbsp;Anke Rentsch ,&nbsp;Heike Vetter ,&nbsp;Matthias Kemmerer ,&nbsp;Gerhard Ehninger ,&nbsp;Maria Eberlein-Gonska ,&nbsp;Jochen Schmitt ,&nbsp;Martin Bornhäuser ,&nbsp;Christine Hofbauer","doi":"10.1016/j.zefq.2024.09.005","DOIUrl":"10.1016/j.zefq.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>To what extent and under what conditions electronically captured patient-reported outcomes (ePROs) can be used in routine medical care and contribute to improved patient care is a widely discussed question. In the field of oncology, few studies in Germany have focused this topic that go beyond the scope of time-limited studies.</div></div><div><h3>Method</h3><div>First, we present the centrally coordinated collection of ePROs in the routine care of a comprehensive cancer center of the German Cancer Aid in its development, and then describe its qualitative dimension. Subsequently, the intervention is discussed using the Consolidated Framework of Implementation Research.</div></div><div><h3>Results</h3><div>Since the implementation started in 2019, over 2,000 patients from the interdisciplinary outpatient clinic of the oncology center have been surveyed. The number of respondents varied between 19 and 65 per month. Over the five years of the reporting period, numerous adjustments have been made regarding content and usage purposes as well as technical and personnel structures. The consistent purpose of use was screening for supportive needs, initially related to psycho-oncology, later expanded to include sports therapy, smoking cessation programs, social and nutritional counseling. The instruments used varied accordingly; health-related quality of life and psychological stress were consistently surveyed.</div></div><div><h3>Discussion</h3><div>Successful use of ePROs in oncological routine care requires personnel and technical resources as well as a high degree of adaptability. In our case, the complexity of a centrally coordinated ePRO collection within an interdisciplinary cancer center is of particular importance. Path dependencies arising from initial decisions, such as the survey software, need to be considered during implementation. Reservations about the intervention and the importance of opinion leaders for successful deployment have been observed. External conditions such as the certification system of oncology centers in Germany proved to be another relevant factor.</div></div><div><h3>Conclusion</h3><div>Overall, the analysis examines a segment of the ongoing digitization process of the hospital system directed towards needs-based, individualized patient care.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Pages 72-83"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644702","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":"Von Apokalyptischen Reitern, wohlfeilen Präventionsempfehlungen und wissenschaftlicher Politikberatung","authors":"Gabriele Meyer","doi":"10.1016/j.zefq.2024.10.004","DOIUrl":"10.1016/j.zefq.2024.10.004","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Pages 1-4"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695986","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":"Liste der Affiliierten Institute und Fachgesellschaften / List of Affiliations","authors":"","doi":"10.1016/S1865-9217(24)00245-9","DOIUrl":"10.1016/S1865-9217(24)00245-9","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Page OBC"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096021","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":"Einflüsse auf das Codieren von Diagnosen in der Hausarztpraxis – Eine qualitative Studie","authors":"Claudia Niehoff,&nbsp;Hannah Tebartz van Elst,&nbsp;Jost Steinhäuser","doi":"10.1016/j.zefq.2024.10.003","DOIUrl":"10.1016/j.zefq.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Coding diagnoses is part of a physician’s daily routine. Good coding quality has several functions; it is, for example, the basis for the remuneration of contract doctors. In the field of general medicine, this process can, however, pose a particular challenge, as diagnoses are naturally more often excluded than made. In addition, the process of diagnosing informs treatment.</div></div><div><h3>Methods</h3><div>23 semi-structured interviews were conducted with general practitioners from Schleswig-Holstein. The interviews were recorded with a dictaphone, pseudonymized, transcribed and then analyzed by content analysis according to Mayring.</div></div><div><h3>Results</h3><div>87 % (N = 20) of the participants were male, the mean age was 57 years, and the mean duration of work experience was 23 years. The ICD-10 (International Classification of Diseases) coding system was often criticized for not representing general medical practice and placing an increased administrative and time burden on physicians. At the same time, diagnostic pressure from external economic interests was perceived. Specifications of practice management systems or their additional programming options were used, among other things, to search for a code. Particular challenges arose in this context, e.g., complex clinical pictures and lack of time. Prescriptions without indication, among other things, have been made at the request of patients, due to a lack of time and concerns about doctor switching. In these cases, a diagnosis in the ICD-10 code that justified the therapy was sometimes used.</div></div><div><h3>Conclusions</h3><div>The path leading from clinical findings to therapy and finally to the appropriate diagnostic code is a complex one, and it involves various influencing factors, including non-medical factors. These influencing factors must be taken into account in future secondary data analyses. The ICD-10 is not the ideal choice for mapping these processes in general medicine.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Pages 29-36"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683052","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":"Machbarkeitsprüfung und Analysen der Leistungsnachweise zur gesundheitlichen Versorgungsplanung nach § 132g SGB V im Pflegeheim – Ergebnisse des Projekts „Gut-Leben“","authors":"Hannes Jacobs ,&nbsp;Anna Levke Brütt ,&nbsp;Anna Völkel ,&nbsp;Stephanie Stiel ,&nbsp;Tanja Schleef ,&nbsp;Sabrina Schütte ,&nbsp;Birte Burger ,&nbsp;Jona Theodor Stahmeyer ,&nbsp;Falk Hoffmann","doi":"10.1016/j.zefq.2024.10.006","DOIUrl":"10.1016/j.zefq.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>With the entry into force of sect. 132g of the Social Code Book [SGB] V in 2018, nursing homes and homes for persons with disabilities providing integration support in Germany can get reimbursed by the statutory health insurance funds for advance care planning (ACP) services. The aim of this feasibility study was to evaluate the number of service records to be submitted, examine the containing information about the consultation process, and assess their potential for research.</div></div><div><h3>Methods</h3><div>We analyzed aggregated data from a large German statutory health insurance fund (AOK Lower Saxony) for 2018–2022 on the contracts concluded for ACP. In addition, anonymized service records from nursing homes and homes for persons with disabilities providing integration support from 2020 to 2022 (no records available for 2018 and 2019) were evaluated descriptively. These records contained information on the type and duration of the consultation process, as well as the number of consultations conducted. Furthermore, facility-specific information was available for facilities with at least one service record, including the number of care places and the number of consultants meeting the qualification requirements of sect. 132g SGB V.</div></div><div><h3>Results</h3><div>In 2018–2022, n = 101 ACP contracts were concluded between the n = 1,415 nursing homes located in Lower Saxony and the state associations representing the interests of the health insurance providers (homes for integration support: n = 104). For the years with service records available (2020–2022), n = 134 contracts were signed. Of these facilities, n = 50 (37 %) had at least one service record, and only one facility (2 %) had more than one facilitator. Of the total n = 230 service records, 97 % documented a first-time consultant process. The process had a mean duration of 33 days and included an average of 2.9 consultant sessions. 13 % of the processes were completed in one day and almost 90 % after three months.</div></div><div><h3>Discussion/Conclusion</h3><div>We found a low number of (1) signed ACP contracts, (2) facilitators in the facilities, and (3) service records available at the health insurance company. However, service records are only one part of ACP. This is why, overall, service records in their current form appear to be of poor usability in the context of both scientific research and the further development of ACP.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Pages 84-91"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711029","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":"Herausgeberkollegium / Editorial Board","authors":"","doi":"10.1016/S1865-9217(24)00250-2","DOIUrl":"10.1016/S1865-9217(24)00250-2","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Page iii"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104767","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":"Editorial: Practicing what we Teach, Researching what we Practice, Teaching what we Research: The natural triad of an applied science.","authors":"Filipa Ventura, Dora Neves, Rosa Silva","doi":"10.1016/j.zefq.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.08.004","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146578","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":"Surgical patients’ assessment of healthcare encounters after elective surgery: A descriptive study","authors":"Lisbeth Uhrenfeldt ,&nbsp;Preben Ulrich Pedersen ,&nbsp;Mona Kyndi Pedersen ,&nbsp;Kari Ingstad","doi":"10.1016/j.zefq.2024.08.001","DOIUrl":"10.1016/j.zefq.2024.08.001","url":null,"abstract":"<div><h3>Introduction</h3><div>A Norwegian-Danish research team identified a gap in research regarding how surgical patients felt about their post-operative care needs being met in hospitals. A study was subsequently developed to understand their subjective assessments of how they value the perceived fulfilment of their actual care needs. The study was further informed by international calls to focus on the fundamentals of care practice. Our aim was to determine the extent to which surgical patients receiving elective treatment experience the physical environment, atmosphere and collaboration with staff as supportive of their care and treatment, and what this means for them after treatment. In addition, we aimed to document the extent to which patients experienced being understood and having influence in their care.</div></div><div><h3>Methods</h3><div>A descriptive observation study using a cross-sectional design. The validated <em>Perioperative User Participation Perspectives</em> (POUP) questionnaire was completed on the day of discharge by 194 adult (male and female) patients (mean age: 56 years) who had undergone elective surgery on gynaecological, internal medicine or orthopaedic wards. Agreement between the subjective importance of nursing care for patients and the perceived reality was determined.</div></div><div><h3>Results</h3><div>Agreement regarding the physical environment, a clean bed and clean surroundings was between 91.7 and 96.2%, and agreement with regard to a good relational atmosphere with staff it was 94.2 to 96.7%. In terms of the relational aspects of care, being understood and having influence the agreement was calculated to be 89.4 to 94.4%. However, 42.6% of the patients reported they were involved in drawing up a care plan. For those patients who valued collaborating in their care planning the congruency was 80%.</div></div><div><h3>Conclusion</h3><div>A conducive atmosphere and a keen eye for the patients’ wishes and needs is of particular importance at the time of discharge after elective surgery.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"189 ","pages":"Pages 15-23"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113313","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":"Editorial: Herausforderung Seltene Erkrankungen","authors":"Thomas Kaiser","doi":"10.1016/j.zefq.2024.07.004","DOIUrl":"10.1016/j.zefq.2024.07.004","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"189 ","pages":"Page 63"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358647","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}