Gesundheitswesen最新文献

{"title":"Assessing the time required for qualitative analysis: A comparative methodological study of coding interview data in health services research.","authors":"Charlotte Ullrich, Michel Wensing, Nadja Klafke, Thomas Fleischhauer, Sabrina Brinkmöller, Regina Poß-Doering, Christine Arnold","doi":"10.1055/a-2512-8004","DOIUrl":"https://doi.org/10.1055/a-2512-8004","url":null,"abstract":"<p><p>A reliable estimation of required resources is essential for sound research. So far, there have only been a few studies on researchers' time investment in qualitative studies. The aim of this study, therefore, was to provide an empirical account of the estimation of timescales of qualitative analysis.In this methodological study, time expenditure was documented and compared for the focused coding of transcripts of semi-structured interviews within five qualitative studies in health services research. Data were analyzed descriptively by means of absolute frequencies.Across studies, focused coding was assessed in 94 interviews with a total interview duration of 52 hours and 44 minutes. The number of interviews per study ranged from n=11 to n=27, with a mean duration of 36 minutes. Total coding time amounted to 76 hours, with a mean of 32 min per interview. Coding time per interview time ratio ranged from 0.75 to 1.52 minutes. On average, the time spent on focused coding roughly corresponds to the duration of the interviews. Focused coding tended to get quicker over time, though variation among studies was high.The results of this study provide a reference for estimating timescales of qualitative analysis and highlights the importance of considering factors such as composition of data and researchers' experience and involvement. In a specific research project, this effort must be balanced against the objective of the analysis, including the desired accuracy, detail and depth. Further research is needed to specify how specific parameters (i. e. nature of the study population, method of data analysis and use of concepts and theories) affect coding in qualitative analysis.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reasons for non-reproducibility of sociomedical assessments of performance capability in disability pension expert opinion reports].","authors":"Christian Wuchter-Czerwony, Maike Rabura, Jörg Gehrke","doi":"10.1055/a-2568-3857","DOIUrl":"https://doi.org/10.1055/a-2568-3857","url":null,"abstract":"<p><p>The German pension insurance continuously supervises the quality of disability pension expert opinion reports by a standardized peer review process. The current study analyses the concrete reasons of the peers for non-reproducibility of sociomedical judgments concerning performance capability in these expert opinion reports.Free-text comments documented by peers in the peer review process 2021 of the German pension insurance with respect to shortcomings in the reproducibility of sociomedical judgments (n=569) were evaluated in a structured-inductive manner using Mayring's qualitative content analysis.Contentwise the reasons for the non-reproducibility of sociomedical judgments in these expert opinion reports comprise recurrent shortcomings in anamnesis/clinical assessment, specifically with respect to confirmation of diagnosis, as well as gaps/inconsistencies in the chain of arguments concerning sociomedical evaluation of performance capability.Identification of these reasons concretizes the complexity of the sociomedical evaluation process, allows sharpening of the content expectations towards the expert consultants and further sensitizes readers to assessment of the sociomedical key aspects in expert reports.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Organizational context for the work of emergency departments in Germany: status quo, assessment of effects, and need for change for optimized care].","authors":"Martina Schmiedhofer, Daniela Krüger, Martin Möckel, Cornelia Henschke, Lena Ansmann, Anna Slagman","doi":"10.1055/a-2550-9472","DOIUrl":"https://doi.org/10.1055/a-2550-9472","url":null,"abstract":"<p><p>The functioning of emergency departments (ED) is considered an indicator of the effectiveness and efficiency of the healthcare system. In Germany, there is increasing pressure to improve emergency care. EDs are relatively autonomous organizational units that interact with other levels within and outside the hospital organization. Based on a model of organization-related care research, the current state of emergency care is described and barriers to and facilitators of change are discussed.A narrative review was used that includes literature sources on organizational impacts on the functioning of EDs. Publications were considered that, in addition to the interface perspective, have a relevance to the current state as well as to the proposed changes from the legislature and other actors. These were assigned to the respective organizational levels and (potential) effects were described. The macro-meso-micro model of organization-related health services research serves as a heuristic.Insufficient consideration of interdependencies and interfaces between organizational actors and levels of emergency care facilitates friction and hinders care innovation. At the macro level of the healthcare system, structures, responsibilities and financing are regulated, which significantly impact functioning at the meso and micro levels. At the meso-level of the hospital, the role of the ED is influenced by the difficulty of controlling patient flows and the lack of Diagnoses Related Groups (DRGs) to cover the costs for outpatient emergency care. The micro-level of the ED has to prioritize treatment and is confronted with the challenges of \"exit blocks\" when there are indications for patient transfer. Previous reform efforts did not take this organizational complexity into account.Reform proposals must take into account the organizational complexity and interests that arises from interfaces, interactions and stakeholder interests. Organization-related health services research can examine the contextual conditions that affect emergency care in order to derive recommendations for health care innovations.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfer of a telemedicine intervention for mental disorders: a comparison between RCT results and regional routine care.","authors":"Aletta Boerkoel, Ulrike Stentzel, Hans Jörgen Grabe, Deborah Janowitz, Wolfgang Hoffmann, Neeltje van den Berg","doi":"10.1055/a-2508-8861","DOIUrl":"https://doi.org/10.1055/a-2508-8861","url":null,"abstract":"<p><p>Telemedicine for the treatment of depression and anxiety disorders was found to be successful in a randomised controlled trial (RCT); this intervention was then implemented in routine care in the Western Pomerania region in Germany. This made it possible to investigate the effectiveness of the intervention under routine care conditions and compare it with the results of the RCT.For this retrospective controlled analysis, data from routine care (2011-2022) were analysed together with data from the previous RCT (2009-2010). A three-arm comparison (routine care, previous RCT intervention group, previous RCT control group) on the primary outcome of symptom severity (BSI-18) and a longitudinal analysis of the routine care data were conducted. The telemedical intervention was conducted in the university hospital's psychiatric outpatient clinic in north-eastern Germany. All adult patients with an ICD-10 diagnosis of depression, anxiety or somatoform disorders could participate after discharge from the hospital. The telemedicine sessions included structured verbal questionnaires and conversational therapy concerning treatment goals and tasks. Repeated measures Welch ANOVA with the BSI-18 Global Severity Index and subscales (depression, anxiety and somatisation) was performed. A multivariate regression was conducted on the longitudinal regular care data.The n=254 subjects in the telemedical care in routine care arm (181 women, mean [95%CI] age 45.5 [44.0-47.1] years; 6-month follow-up) showed a BSI-18 score improvement M=- 4.1 [-5.3,-2.9], F(2)=3.50, p<0.05 compared to the preceding RCT intervention arms (61 women, mean [95%CI] age 44.7 [41.7-47.6] years. Telemedical care showed a significant difference in BSI-18 scores over a 10-year follow-up: M=- 3.9 [-5.4,-2.5], p<0.0001.The positive results of the 2009 RCT were replicable in routine care. The more patient-centred approach resulted in improved outcomes in this telemedical intervention.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Duplicate capacities for specialized care: Contributions of the SHI-accredited and hospital-based physicians to selected parameters of specialist care].","authors":"Ursula Hahn, Joerg Koch, Ulrich Kellner","doi":"10.1055/a-2557-5437","DOIUrl":"10.1055/a-2557-5437","url":null,"abstract":"<p><p>Specialist care in Germany is provided by hospitals as well as by independent physicians with their own practices authorized to provide care within the framework of the Statutory Health Insurance (SHI). This duplicate capacities for specialized care, and in particular the SHI-specialist track has come under criticis. Based on publicly accessible secondary data sources (Federal Statistical Office, National Association of SHI Physicians and German Medical Association), this study analyzes and quantifies the relevance of the two tracks along the parameters density of the regional (number of facilities) and specialist (number of specialized departments and specialist practices) care network, distribution of specialists and case numbers. Differences by specialty and changes between 2012 and 2022 are determined according to the distribution of specialists to tracks. In 2022 the SHI-specialist track dominated in terms of the number of medical facilities (96% of all were attributed to them) and specialized departments und specialist practices (89%), with 86% of all outpatient / inpatient cases and 90% of all outpatient cases being handled by them. Slightly less than 50% were accounted for by outpatient specialists (by headcount) or full-time equivalents of SHI-specialists. The distribution of physicians varied greatly according to specialties, while the relative proportions by tracks compared to 2012 remained largely constant. As the data sources are not harmonized, conversions and compromises were partly necessary for processing and interpretation the parameter-specific data. However, in the interests of transparency, extrapolation and weighting (also with regard to differences in workload treating outpatients or inpatients) were avoided. Distortions resulting from availability and handling of the date are named by type and direction. However, they are subordinate compared to the data unambiguously interpretable. The dimensions of the reported results can be regarded as robust. Considering the clear dominance of the SHI-specialist track, centralization of specialist care at hospitals would be accompanied by considerable challenges. Prior to demanding reform, criticism of the duplicate capacities for specialized care should be substantiated by data, while its potential advantages is acknowledged in the scientific discussion.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect evaluation of an online training package to strengthen methodological and diagnostic skills in the application of SOPESS: A cluster randomised trial (KOMET-SEU project)].","authors":"Christiane Diefenbach, Dorothée Malonga Makosi, Julia Christin Jaščenoka, Jochem König, Michael S Urschitz","doi":"10.1055/a-2525-3082","DOIUrl":"https://doi.org/10.1055/a-2525-3082","url":null,"abstract":"<p><p>As part of the KOMET-SEU project, an online training package for the child and youth health service was developed to strengthen the skills regarding the implementation of the social-paediatric screening SOPESS and to increase the quality and utilisation of SOPESS data. Evaluation of the process showed that the target group assessed the training package in positive terms. The aim of the present study was to evaluate the effects of the training package on skills and behaviour of employees of the child and youth health service.In a cluster randomised controlled trial, 34 public health departments in North Rhine-Westphalia and Rhineland-Palatinate were assigned to either an intervention or a waiting list control group. Effectiveness of the intervention was assessed using examiner competence (secondary outcome measure) and examiner behaviour (two primary outcome measures). The outcome measures were collected based on 94 items on a 4-point Likert scale using online questionnaires before and after the introduction of the training package. Linear mixed model analyses, adjusted for potential co-predictors, were conducted to examine the intervention effects.The analysis sample comprised 248 employees of the child and youth health service. With already high baseline levels in the outcome measures, there were no significant global intervention effects on examiner competence (B=0.15; SE=0.09; p=0.08) and examiner behaviour (B=- 0.01; SE=0.08; p=0.91 and B=0.06; SE=0.09; p=0.49). Only a tendency towards stronger effects in subgroups of examiners with little SOPESS experience was discernible.Despite good use and positive assessment by the target group, the training package led to a strengthening of skills and changes in the behaviour only of examiners with little experience. Whether this is sufficient to increase the quality and utilisation of the SOPESS data in the long term remains to be seen.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Barriers to and facilitating factors in school entry examination with SOPESS: Development of an online training to enhance basic diagnostic skills (KOMET-SEU project)].","authors":"Julia Christin Jaščenoka, Jenny Maurer, Tina Sierpinski, Christiane Diefenbach, Monika Daseking","doi":"10.1055/a-2550-4308","DOIUrl":"https://doi.org/10.1055/a-2550-4308","url":null,"abstract":"<p><p>The preschool health examination makes a significant contribution in terms of both individual and population medicine to positively shaping the long-term future of children starting school. To gain optimal benefit from the examination data, it is necessary that the examination process with SOPESS (social pediatric screening) is standardized. However, practical experience from the public health service has shown that the data collected to date indicates medium to high method-related heterogeneity at the level of the SOPESS raw value totals, which can have a negative impact on the validity of the data.The aim is to identify barriers to and facilitating factors for the implementation of SOPESS and to reduce method-related heterogeneity by providing a customized training measure. This project was realized in two studies. In study 1, 56 employees from 21 child and adolescent health service departments were interviewed by telephone about possible barriersto and facilitating factors in the implementation of SOPESS. These results were then used to design an online training to strengthen basic diagnostic skills, which was tested in study 2 with 25 persons in an initial application phase (piloting) and evaluated and adapted regarding various factors (e. g. practical relevance and suggestions for improvement).In Study 1, a central cause of the method-related heterogeneity was identified as the deviation of those carrying out the tests from the standardized test instructions. In the evaluation, there were uncertainties in the assessment of the visuomotor tasks. A video-based presentation of a standardized examination could prove to be beneficial to enhance the basic diagnostic skills of the examiners in the long term. In study 2, the results of the piloting of the online training were positive: Almost all persons (22 of 25) rated the online training as relevant to practice regarding the implementation and evaluation of the SOPESS and believed it would improve the quality of implementation of the SOPESS.The online training was then comprehensively evaluated in an application phase in North Rhine-Westphalia and Rhineland-Palatinate. Following completion of the evaluation phase, the online training is to be adapted and offered on a broad scale to enhance the diagnostic skills of employees in the departments of child and adolescent health service in the long-term, and support the collection of valid data as part of preschool health examination.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Use of qualitative evidence syntheses in health services research in German-speaking countries: results of an online survey].","authors":"Angélique Herrler, Veronika Lentsch, Yvonne Eisenmann, Ralph Möhler","doi":"10.1055/a-2549-0493","DOIUrl":"https://doi.org/10.1055/a-2549-0493","url":null,"abstract":"<p><p>Qualitative evidence syntheses (QES) can answer qualitative research questions across different studies and thus offer an important part in the collection of evidence. While QES are a common set of methods internationally, they appear to be little used in health services research in the German-speaking countries to date.The aim of the study was to analyse the current use of QES in health services research in the German-speaking countries in order to draw conclusions for their establishment.An online survey was conducted by the subgroup Qualitative Evidence Syntheses in the German Network Health Services Research. The survey was aimed at health services researchers in German-speaking countries. Among other things, experiences with QES as well as barriers and support factors during implementation were surveyed. The data were analysed using descriptive statistics and content-structuring qualitative content analysis.A total of n=103 people took part in the survey, n=45 of whom had already been involved in QES. They had used QES to analyse the perspectives of target groups, to describe and evaluate health care, to (further) develop models and concepts and to implement and evaluate interventions. The participants referred to the high added value of QES, particularly due to its practical relevance, as well as to methodological difficulties in implementation and the desire for better training programmes.Qualitative evidence syntheses offer a potential that is still underutilised in health services research and can be particularly useful in the development and evaluation of interventions and the investigation of contexts and complexity.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Predetermined breaking points and recommendations for action in development of digital prevention services in public health: a practical example].","authors":"Peter Bickmann, Ingo Froböse, Christopher Grieben","doi":"10.1055/a-2549-0446","DOIUrl":"https://doi.org/10.1055/a-2549-0446","url":null,"abstract":"<p><p>Digital prevention is essential for a sustainable healthcare system in Germany, with health insurance companies playing a key role. Despite promising approaches in research, studies indicate that hybrid and digital prevention solutions are often short-lived, pointing to systematic challenges. This paper presents the development of a prevention app commissioned by a German health insurance company. The app promotes a health-oriented lifestyle through an integrated chatbot. The scientifically accompanied development process highlights the importance of user participation and emphasizes the challenges of the long-term implementation of digital prevention solutions. These include project communication, scientific monitoring, data protection requirements, and the technical infrastructure of the health insurance company. Practical insights provide recommendations for the development and a structural model for future projects is proposed. It focuses on the effective integration of expert knowledge from various fields, such as prevention and software development. This collaboration is more crucial than ever for the future use of AI in health prevention.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Fifty years of psychiatric reform in Germany: East and West].","authors":"Dyrk Zedlick, Jörg Holke, Matthias Rosemann, Klaus Obert","doi":"10.1055/a-2549-0658","DOIUrl":"https://doi.org/10.1055/a-2549-0658","url":null,"abstract":"<p><p>The development of psychiatric reform in Germany over the last 50 years has been characterized by a heterogeneity that should not be underestimated, as can also be observed in other European countries. The fact that the reform process in both the \"old\" Federal Republic of Germany and the former German Democratic Republic began quite belatedly was also due to the consequences of \"euthanasia\" during the National Socialist era and the delayed social and professional reappraisal of euthanasia. This article traces the major lines of development of the reform and outlines some of the current challenges in mental health services, especially community psychiatry.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}