Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"Struktur- und Verfahrensverbesserungen auf Rezept? Eine qualitative Analyse der Potenziale und Herausforderungen des pSVV-Konzepts bei Digitalen Gesundheitsanwendungen (DiGA)","authors":"Sara Gehder, Moritz Goeldner","doi":"10.1016/j.zefq.2024.11.003","DOIUrl":"10.1016/j.zefq.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>With the introduction of the Digital Healthcare Act (DVG) at the end of 2019, digital health applications (DiGA) were included in the statutory health insurance in Germany. DiGA are digital medical products whose primary function is based on digital technologies. In the definition of the approval process, the term “therapeutic benefit”, which is crucial to the evaluation of pharmaceuticals, was expanded to include the broader concept of “positive healthcare effect” (“pVE”). In particular, the concept of “patient-relevant structural and procedural improvements” (pSVV) has been introduced alongside the well-known “medical benefit” to facilitate market access for applications that specifically aim to strengthen the role of the patient in healthcare. Three and a half years after the implementation of DiGA, it has become evident that the concept of pSVV has not yet been adopted in the healthcare system to the extent intended by the legislation. As of July 1<sup>st</sup> 2024, only one of the 56 listed DiGA uses pSVV as a primary endpoint, with ten others using pSVV as a secondary endpoint.</div></div><div><h3>Method</h3><div>A qualitative approach was chosen to explore the new and under-researched topic of DiGA and, in particular, pSVV. The Grounded Theory method was applied in combination with the Gioia method, which is particularly suitable for analyzing innovative subject areas. The inductive approach allows for new concepts to be developed from the data of the study participants, thus supporting flexible and dynamic theory building. Decision-makers from groups including DiGA manufacturers with and without pSVV, manufacturers of digital medical products without DiGA approval, consultancies, and institutions involved in the DiGA approval process were included in the study by conducting semi-structured interviews. The evaluation was conducted through a multi-step analysis leading to the identification of first-order concepts, second-order themes, and aggregated dimensions. The developed data structure was supported by the presentation of relevant quotes as part of the <span><span>Anhang A</span></span>.</div></div><div><h3>Results</h3><div>The analysis indicates that refining the benefit definition for the pSVV categories defined in the DiGA guidelines is critical to the successful establishment of the pSVV concept. Additionally, further analysis of potential methods for demonstrating pSVV, suitable measurement tools, and the general inclusion of economic considerations in the benefit analysis appear sensible.</div></div><div><h3>Discussion</h3><div>The qualitative analysis demonstrates that refining the pSVV concept and defining appropriate measurement methods are essential for a successful implementation in the German healthcare system. An economic evaluation could bring objectivity to the debate on DiGA costs and contribute to transparency in the approval process. Further research and the involvement of key stakeholder","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 1-10"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848014","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":"Arbeitssituation von angestellten Hebammen in deutschen Kreißsälen – Implikationen für die Qualität und Sicherheit der Versorgung","authors":"Katja Stahl","doi":"10.1016/j.zefq.2024.11.007","DOIUrl":"10.1016/j.zefq.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Nursing research indicates a correlation between work environment and the quality and safety of nursing care. For intrapartum care there is evidence that continuous one-to-one support is associated with better perinatal outcomes and fewer interventions. Little is known about the work environment of midwives working in German maternity theatres.</div></div><div><h3>Aim</h3><div>To analyse the work environment in German maternity theatres from the midwife’s perspective.</div></div><div><h3>Methods</h3><div>Online survey among 1,599 midwives using a validated instrument adapted to the specific characteristics of midwifery care.</div></div><div><h3>Results</h3><div>The response rate for the survey was 44<!--> <!-->%. The number of patients has risen substantially over the last three years without an equivalent increase in staff numbers. Nearly two thirds of the midwives (65<!--> <!-->%) are responsible for three or more women simultaneously, most of the time; 35<!--> <!-->% are normally providing care for two women at the same time. There are significant differences between these two groups with regard to nearly all the work environment aspects analysed. The most pronounced differences were found with regard to not being able to accomplish tasks during regular working hours (64<!--> <!-->% vs. 33<!--> <!-->%; OR 3.7, 95% CI 3.0 to 4.6; <em>p</em> <!-->&lt;<!--> <!-->0.001), taking legally required breaks (5<!--> <!-->% vs. 19<!--> <!-->%; OR 4.2, 95% CI 2.9 to 5.9; <em>p</em> <!-->&lt;<!--> <!-->0.001), frequency of interruptions (96<!--> <!-->% vs. 88<!--> <!-->%; OR 3.5, 95% CI 2.3 to 5.4; <em>p</em> <!-->&lt;<!--> <!-->0.001), lack of time for individual care (90<!--> <!-->% vs. 63<!--> <!-->%; OR 5.6, 95% CI 4.2 to 7.4; <em>p</em> <!-->&lt;<!--> <!-->0.001), need for improving the personal interaction between midwives and obstetricians (28<!--> <!-->% vs. 20<!--> <!-->%; OR 1.6, 95% CI 1.2 to 2.0; <em>p</em> <!-->=<!--> <!-->0.001), lack of support from hospital management (92<!--> <!-->% vs. 83<!--> <!-->%; OR 2.2, 95% CI 1.6 to 3.1; <em>p</em> <!-->&lt;<!--> <!-->0.001) and the intention to leave the employer (60% vs. 40%; OR 2.2, 95% CI 1.8 to 2.7; <em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>The current work environment of midwives in German maternity theatres does not allow for one-to-one-care during labour. If the necessary increase in midwifery staff is to be effective, it needs to be accompanied by an improved work environment. Further research into the work environment of midwives, likely predictors and associations with perinatal outcomes is urgently needed.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 19-27"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822738","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":"Delphi-Studie: Evaluation des neuen Berufsbildes „Chief Digital Officer” in deutschen Krankenhäusern","authors":"Katrin Spohn ,&nbsp;Daniela Aufermann ,&nbsp;Philipp Gregor Albert ,&nbsp;Narmin Dzhabbarova ,&nbsp;Christin Frühling ,&nbsp;Antonina Jakob ,&nbsp;Timo Neunaber ,&nbsp;Felix Hoffmann","doi":"10.1016/j.zefq.2024.10.008","DOIUrl":"10.1016/j.zefq.2024.10.008","url":null,"abstract":"<div><h3>Introduction</h3><div>The main objective of the present study was to analyze the new job profile “Chief Digital Officer (CDO) in German hospitals”. Here, best practices for the introduction of the job profile should be determined and the need for a CDO position to execute the digital transformation should be evaluated.</div></div><div><h3>Methods</h3><div>A standardized three-stage online Delphi process (expert consensus finding) followed by a roundtable discussion was performed, including 16 experts.</div></div><div><h3>Results</h3><div>The survey showed that most CDOs have been employed as CDOs in a hospital for a maximum of two years. Just over half of these hospitals already have a digitization strategy. Lack of human resources, underfunding of projects, lack of willingness to change among operational staff and management as well as legal hurdles have been reported as the primary problems in digital transformation. In addition to project management skills, CDOs should also have change management expertise and the ability to abstract and simplify complex processes. They should have a high level of knowledge about everyday work and technical content of interdisciplinary health professions. A CDO can be considered as the fourth pillar of responsibility, in addition to the business, medical and nursing director at the management level, and should be responsible in this role for the implementation of digital transformation.</div></div><div><h3>Discussion</h3><div>This study was able to show which activities CDOs are involved in and which coping strategies they use to handle the hurdles.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 49-56"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910987","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":"Dermatologische Diagnostik bei Patient*innen mit „skin of color“ – Wie sicher fühlen sich deutsche Dermatolog*innen?","authors":"Can Alpagut ,&nbsp;Christian Volberg ,&nbsp;Michael Hertl ,&nbsp;Lisa Krönig ,&nbsp;Martin Gschnell","doi":"10.1016/j.zefq.2024.11.011","DOIUrl":"10.1016/j.zefq.2024.11.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnosis in dermatology is primarily based on the assessment and description of the clinical appearance of the skin. The German medical literature focuses almost exclusively on white skin, so it is questionable whether this one-sided training is sufficient to do justice to all patients since the diversity of skin types increases.</div></div><div><h3>Methods</h3><div>Online survey among German dermatologists regarding training and experience in the diagnosis of dark skin, difficulties in recognizing dermatoses and the desire for training and further education in skin diseases of “skin of color”.</div></div><div><h3>Results</h3><div>A total of 236 responses were received. 65 % of participants felt unsure to very unsure about recognizing skin conditions in people with dark skin. Training in the recognition of skin types IV–VI was rated as poor to very poor by 76 %, and 73 % rated the current literature on the diagnosis of dark skin as poor to very poor. 89 % reported that they have difficulties in diagnosing skin diseases in dark skin in their daily practice.</div></div><div><h3>Conclusion</h3><div>There is uncertainty among German dermatologists in the diagnosis of skin diseases in people with dark skin. This diagnostic uncertainty may lead to poorer treatment outcomes. More training opportunities should be offered to improve skills in the diagnosis and treatment of skin diseases in skin of color and the associated care.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 28-35"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915910","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":"Abschlusseditorial","authors":"Beate Müller","doi":"10.1016/j.zefq.2024.12.005","DOIUrl":"10.1016/j.zefq.2024.12.005","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 88-89"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967202","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":"Advances in Shared Decision Making in Brazil: The role of patient autonomy in curriculum reform, health system and clinical care","authors":"Mirhelen Mendes de Abreu ,&nbsp;Melanie Noël Maia ,&nbsp;Alexandre Oliveira Telles ,&nbsp;Renata Oliveira Maciel dos Santos ,&nbsp;Maria Katia Gomes ,&nbsp;Ana Luisa Rocha Mallet ,&nbsp;Lúcia Maria Soares de Azevedo","doi":"10.1016/j.zefq.2024.11.006","DOIUrl":"10.1016/j.zefq.2024.11.006","url":null,"abstract":"<div><div>Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian <em>status quo</em> of decision support tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 90-93"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819420","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":"Measurement of non-invasive rectal and ear temperature in inpatients ≥ 18 years old: A cross-sectional comparative study","authors":"Lone Jørgensen ,&nbsp;Birgitte Boll ,&nbsp;Kristina Fischer Rosenkilde ,&nbsp;Niels Henrik Bruun ,&nbsp;Preben Ulrich Pedersen ,&nbsp;Marianne Wetendorff Nørgaard","doi":"10.1016/j.zefq.2024.11.005","DOIUrl":"10.1016/j.zefq.2024.11.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Body temperature measurement is a fundamental requirement for clinical decisions in nursing care, medical diagnosis, and treatment. Therefore, it is pivotal that body temperature measurements are accurate and precise.</div></div><div><h3>Aims</h3><div>To test the diagnostic accuracy of an ear temperature screening procedure among adult hospitalized patients. Further aims were to test the precision of the measurements being carried out by trained registered nurses compared with daily routine practice and to investigate patients’ preferences for different measurement methods.</div></div><div><h3>Methods</h3><div>In Aalborg University Hospital, 274 patients were included in a cross-sectional comparative study. Each patient had four temperature measurements and responded to a survey regarding their preference for measurement. Bland–Altman analysis was used to evaluate the difference between ear- and rectal measurements. Sensitivity and specificity were evaluated at different cut-off points.</div></div><div><h3>Results</h3><div>The ear temperature was 0.1 to 0.2 °C lower than rectal temperature. At a cut-off point at 37.5 °C an ear thermometer is accurate and can be used for screening, while higher cut-off points risk missing patients with fever. There was no significant difference in the mean temperature measured by a trained registered nurse or other staff members and patients. Patients preferred ear measurements to rectal measurements.</div></div><div><h3>Conclusion</h3><div>The tested ear thermometer is accurate for screening fever in an adult population during hospital admission. Using ear measurement as a screening tool can contribute to a less resource-demanding care activity and a more convenient alternative to rectal measurements in hospitalised patients.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 36-41"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824691","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":"Potenzial telemedizinischer Anwendungen zur Verbesserung einer flächendeckenden Gesundheitsversorgung am Beispiel der Teledermatologie","authors":"Anne Kis,&nbsp;Christina Sorbe,&nbsp;Matthias Augustin,&nbsp;Marina Otten,&nbsp;Jobst Augustin","doi":"10.1016/j.zefq.2024.11.012","DOIUrl":"10.1016/j.zefq.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Telemedicine applications are perceived as having great potential to address regional health service deficits. However, it is unclear to what extent telemedicine can actually contribute to ensuring care in medically underserved regions. The aim of this study is to prospectively identify underserved regions and to investigate the potential of telemedicine applications using teledermatology as an example.</div></div><div><h3>Methods</h3><div>Well-served regions were identified using selected indicators. Points were awarded for each indicator and added up to form two scores. The results were analyzed for spatial autocorrelation (Moran’s I), and visualized as a bivariate choropleth map. Data on broadband availability (BMVI) and descriptive statistics (Spearman’s Rho, Beeswarm plots) were used to analyze the potential for telemedicine applications. All analyses were carried out at county level.</div></div><div><h3>Results</h3><div>Out of 401 counties, 159 can be classified as vulnerable because of their supply situation. They are mainly located in the north-west part of Germany. Locally, there are infrastructure deficits, i. e. insufficient bandwidth for telemedicine applications. Spearman’s Rho shows negative correlations between broadband availability and the scores obtained (ρ: –0.654/–0.229, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The results indicate a consolidation of regional disparities. If the identified regions are inhabited by patients with limited mobility and by socially disadvantaged patients, there is a risk of “double gaps in care”. In the context of an increasing demand and workload, barriers to telemedicine should be removed, especially in the identified areas, and alternative care models should be implemented.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages 11-18"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915883","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":"Liste der Affiliierten Institute und Fachgesellschaften / List of Affiliations","authors":"","doi":"10.1016/S1865-9217(25)00040-6","DOIUrl":"10.1016/S1865-9217(25)00040-6","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Page OBC"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436950","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":"Inhaltsverzeichnis / Table of Contents","authors":"","doi":"10.1016/S1865-9217(25)00037-6","DOIUrl":"10.1016/S1865-9217(25)00037-6","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"192 ","pages":"Pages iii-iv"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437067","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}