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BackgroundMeasuring objective resource-use quantities is important for generating valid cost estimates in economic evaluations. In the absence of acknowledged guidelines, measurement methods are often chosen based on practicality rather than methodological evidence. Furthermore, few resource-use measurement (RUM) instruments focus on the measurement of resource use in multiple societal sectors and their development process is rarely described. Thorn and colleagues proposed a stepwise approach to the development of RUM instruments, which has been used for developing cost questionnaires for specific trials. However, it remains unclear how this approach can be translated into practice and whether it is applicable to the development of generic self-reported RUM instruments and instruments measuring resource use in multiple sectors. This study provides a detailed description of the practical application of this stepwise approach to the development of a multi-sectoral RUM instrument developed within the ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) project.MethodsFor the development of the PECUNIA RUM, the methodological approach was based on best practice guidelines. The process included six steps, including the definition of the instrument attributes, identification of cost-driving elements in each sector, review of methodological literature and development of a harmonized cross-sectorial approach, development of questionnaire modules and their subsequent harmonization.ResultsThe selected development approach was, overall, applicable to the development of the PECUNIA RUM. However, due to the complexity of the development of a multi-sectoral RUM instrument, additional steps such as establishing a uniform methodological basis, harmonization of questionnaire modules and involvement of a broader range of stakeholders (healthcare professionals, sector-specific experts, health economists) were needed.ConclusionThis is the first study that transparently describes the development process of a generic multi-sectoral RUM instrument in health economics and provides insights into the methodological aspects and overall validity of its development process.

Hintergrund und Stand (inter)nationaler Forschung: Für ältere Menschen mit Pflegebedürftigkeit, die zu Hause gepflegt werden, besteht das Risiko einer Verschlechterung der Mundgesundheit. Mit zunehmender Gebrechlichkeit und nachlassender Mobilität verringert sich die Zahl der Zahnarztbesuche. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund und Stand (inter)nationaler Forschung: Die Empfehlungen der S3-Leitlinie zu Autismus-Spektrum-Störungen (ASS) im Kindes-, Jugend- und Erwachsenenalter mit Schwerpunkt Therapie (2021) geben Hinweise darauf, dass in Deutschland ein Bedarf an empirischen Studien zu Versorgungsmodellen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund und Stand (inter)nationaler Forschung: Erwachsene mit Autismus-Spektrum-Störung (ASS) ohne Intelligenzminderung werden in der medizinisch-therapeutischen Versorgung oftmals nicht hinreichend berücksichtigt. Laut internationaler Literatur bestehen Versorgungsbarrieren auf: (i) individueller [zum vollständigen Text gelangen Sie über die oben angegebene URL]

The project will employ a mixed-methods approach to assess current barriers and facilitators for adults with Autism Spectrum Disorders (ASD) with respect to mental healthcare in Germany. During the first project phase, current barriers or needs and facilitators will be assessed at three levels (at the individual level, at the structural or organizational level of the healthcare system, and at the professional level of clinicians or healthcare service providers) and from three stakeholder perspectives (i.e., participants with ASD, relatives/caregivers, clinicians). For this purpose, both qualitative data (i.e., semi-structured focus groups and one-on-one interviews) as well as quantitative data (i.e., online surveys and questionnaires) will be assessed. Furthermore, costs due to medical and non-medical service utilization of ASD will be estimated and compared to utilization costs of individuals without ASD. Results and emerging themes will be used to develop a concept suitable for providing improved and extended mental healthcare for adults with ASD. This concept aims to include individual ASD patient parameters in order to provide a stepped-care approach and will include recommendations for patients, relatives and professionals. During the second project phase, the developed concept and its potential implementation within the German healthcare system will be evaluated qualitatively and quantitatively, again by assessments in different stakeholder groups (i.e., participants with ASD, relatives and clinicians) and formally analyzed with respect to cost-effectiveness and implementation chances. Our research project aims to strengthen a participatory research approach by including patients, relatives and professionals at all project stages. This includes project employees as well as cooperation with relevant associations. The study has been approved by the Local Psychological Ethics Commission at the Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (date: 12/02/2020).

Background In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. Methods The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory—European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. Results Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen’s kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. Conclusions While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. Trial Registration German Clinical Trials Register DRKS00005035. Registered 03/06/2013.

Hintergrund: Ambulant pflegebedürftige Menschen benötigen häufig eine komplexe Versorgung in ihrer Häuslichkeit. Die Abstimmung zwischen Pflegediensten, Hausärzt*innen, Therapeut*innen und pflegenden Angehörigen ist oft unzureichend, was die Patientensicherheit [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund und Stand (inter)nationaler Forschung: Autismus-Spektrum-Störungen (ASS) gehören gemäß ICD-10 und DSM-5 zu den tiefgreifenden Entwicklungsstörungen, die weitestgehend ohne Remission bis ins Erwachsenenalter verlaufen. Aktuell scheinen in der deutschen Routineversorgung[zum vollständigen Text gelangen Sie über die oben angegebene URL], 19. Deutscher Kongress für Versorgungsforschung (DKVF)

Objectives Pain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity. Methods Selection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery). Results From 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being. Conclusions Patients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support.

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p