Search

Revision of the evaluation concept of Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment" developed in 2006.Analysis of available of data since 2006 to determine if the objectives of the health target and its sub-goals (awareness, prevention, diagnosis/indication/therapy, health care structure, patient empowerment, rehabilitation) were achieved.The 6 sub-goals were screened in terms of indicators of progress towards goal over the last decade, and then examined for accessible data sources.The sub-goal prevention yielded routine data from t0 onwards (start of activities). The other sub-goals awareness, diagnosis, and health care provided selective data sources, generated mostly by scientific studies. An important milestone within the sub-goal of diagnosis/indication/therapy was the development of the National Clinical Practice guideline for depression. Data were sparse in the areas rehabilitation and patient empowerment.The six sub-goals are still valid. Yet, the validity of the data in terms of the evaluation of the health target is limited mainly because of the cross-sectional designs of studies. Prospective systematic surveys are required to further evaluate the national health target and its implementation for both qualitative and quantitative longitudinal indicators.Überprüfung des in 2006 entwickelten Evaluationskonzepts zum Nationalen Gesundheitsziel: „Depressive Erkrankungen: verhindern, früher erkennen, nachhaltig behandeln“. ZIEL: Ziel ist es, verfügbare Erkenntnisse, Studien und Datenquellen der letzten 10 Jahre darzustellen und zu untersuchen, inwieweit die formulierten Teilziele erreicht wurden.Zur Bewertung wurde die 2006 entwickelte Aufteilung in Teilziele (Aufklärung; Prävention; Diagnostik, Indikationsstellung und Therapie; Versorgungsstruktur; Stärkung der Patienten und Rehabilitation) und der daraus abgeleiteten Maßnahmen genutzt, um den Grad der Zielerreichung zu beurteilen.Zum Bereich Prävention existierten bereits nach Verabschiedung der Gesundheitsziele relevante Datenquellen. Zu den Bereichen Aufklärung, Diagnostik und Indikationsstellung und Versorgungsstruktur liegen aus den letzten Jahren generierte Datenquellen vor, die im Wesentlichen von Kostenträgern und der Wissenschaft zur Verfügung gestellt wurden. Einen wichtigen Meilenstein stellte hier die S3-/Nationale Versorgungsleitlinie „Unipolare Depression“ im Rahmen des Aktionsfeldes Diagnostik/Indikationsstellung/Therapie dar. Am ehesten fanden sich Datenlücken für die Aktionsfelder Stärkung der Patienten und Rehabilitation.Die Teilziele haben weiterhin Gültigkeit. Dennoch ist die Aussagekraft der überwiegend querschnittlichen Quellen zur Bewertung bzw. Evaluation der Erreichung des im Fokus stehenden Gesundheitsziels sehr begrenzt. Nach den jetzigen Erfahrungen sollten für eine Evaluation longitudinale Indikatoren der Teilziele, die quantitativ gemessen und beobachtet werden können, von Indikatoren unterschieden werden, bei denen primär ein qualitativer Zugang angemessen ist.

Advance Care Planning in Swiss Nursing Homes: Results of a Focus Group Study Abstract. Advance Care Planning (ACP) is a standardized consultation process in which patients define their therapy goals for future medical treatments with the help of a qualified health care facilitator. This way, ACP increases the probability that patients' wishes are fulfilled in case of decisional incapacity. The aim of this study was to implement a previously tested Swiss ACP program in two Swiss nursing homes to better understand the resulting processes, chances and difficulties. For this purpose focus group interviews were conducted after first implementation steps. The results show that an ACP implementation needs and must be coordinated with an approach covering the entire health system.Zusammenfassung. Advance Care Planning (ACP) ist ein standardisierter Gesprächsprozess, bei dem Patienten mit Hilfe einer qualifizierten Gesundheitsfachperson ihre Therapieziele für zukünftige medizinische Behandlungen festlegen. Grundlage für die Vorausplanung nach ACP ist eine Standortbestimmung, in der die eigenen Wertvorstellungen und Einstellungen zum Leben, zu schwerer Krankheit und zum Sterben im gemeinsamen Gespräch dokumentiert werden. Das Konzept ACP stellt sicher, dass der Patientenwille auch im Falle der Urteilsunfähigkeit bekannt ist und umgesetzt werden kann. Ziel dieser Arbeit war es, ein in der Schweiz bereits evaluiertes ACP-Programm in zwei Alters- und Pflegeheimen zu implementieren und die dabei entstehenden Prozesse, Chancen und Schwierigkeiten besser zu verstehen. Zu diesem Zweck wurden nach den ersten Implementierungsschritten Fokusgruppeninterviews durchgeführt. Die Ergebnisse zeigen, dass eine ACP-Implementierung einen das gesamte Gesundheitssystem umfassenden Ansatz braucht und koordiniert werden muss.

The introduction of requirements for a minimum intake capacity of trauma patients by the German Trauma Society (DGU) into the so-called white book of treatment of seriously injured patients, is helpful for a sufficient preparation for threats and for dealing with mass casualties for trauma centers as well as for the emergency medical services (EMS). In the hospital information database provided by the Federation of German Medical Directors of Emergency Medical Services, more than 1300 hospitals are currently listed. This information supports the allocation of trauma patients from the field to the appropriate trauma center. Currently, without any coordination requirements, the current 626 trauma centers in Germany are able to immediately handle 6260 patients. This number could be doubled by activating the local hospital action plan, where a priority plan is set up. Additionally, the implementation of a nationwide flexible standardized communication structure between the dispatch center of the ambulance service and the hospitals, would improve daily care as well as the management of threats and mass casualties. It is the obligation of the local medical director of the EMS, to maintain and update the hospital database. Providing the information in the database with the hospital resources and the flexible standard communication structure, is appropriate to improve the daily collaboration and the preparation for mass casualties.

Background: An existing dementia special care unit should be evaluated. In order to build a sound foundation of the evaluation a deep theoretical understanding of the implemented intervention is needed, which has not been explicated yet. One possibility to achieve this is the development of a program theory. Aim: The aim is to present a method to develop a program theory for the existing living and care concept of the dementia special care unit, which is used in a larger project to evaluate the concept theory-drivenly. Method: The evaluation is embedded in the framework of van Belle et al. (2010) and an action model and a change model (Chen, 2015) is created. For the specification of the change model the contribution analysis (Mayne, 2011) is applied. Data were collected in workshops with the developers and the nurses of the dementia special care unit and a literature research concerning interventions and outcomes was carried out. The results were synthesized in a consens workshop. Results: The action model describes the interventions of the dementia special care unit, the implementers, the organization and the context. The change model compromises the mechanisms through which interventions achieve outcomes. Conclusions: The results of the program theory can be employed to choose data collection methods and instruments for the evaluation. On the basis of the results of the evaluation the program theory can be refined and adapted.

Prevalence rates for eating disorders remained stable over the years despite the implementation of numerous prevention strategies. This may be due to discrepancies between research and practice and scientific findings are not fully applied to the care of risk groups. The school-based programs PriMa and Torera for primary prevention of eating disorders have been delivered in Thuringian schools since 2004. A current survey provides information on barriers and facilitators for a long-term implementation in the school routine.Using the "Consolidated Framework for Implementation Research", factors which impact the implementation process are discussed.Impeding factors for a long-term implementation are missing framework conditions, staff turnover and a lack of financial support from politicians. Possible solutions could be the establishment of extra time in the curriculum, the employment of individuals responsible for prevention and a close network between all people involved.According to the Society for Prevention Research, discussing implementation factors builds the last part of comprehensive program evaluations. We illustrate the barriers for the integration of evidence-based prevention programs in daily school life. It is important to implement new structures prior to the implementation of resource-intensive new prevention programs in order to increase the effectiveness of said programs and enable long-term implementation.Obwohl eine Reihe effektiver Präventionsstrategien für Essstörungen existieren, bleiben die Prävalenzzahlen konstant. Es ist somit von einer Lücke zwischen Forschung und Praxis auszugehen, die sich darin äußert, dass wissenschaftliche Erkenntnisse nicht in vollem Umfang zur Versorgung von Risikogruppen genutzt werden. Die schulbasierten Programme PriMa und Torera zur Primärprävention von Essstörungen werden seit 2004 an Thüringer Schulen durchgeführt. Eine aktuelle Befragung gibt Auskunft über Barrieren und Chancen für eine langfristige Implementation in den Schulalltag.Unter Verwendung des „Consolidated Framework for Implementation Research“ werden Faktoren diskutiert, die Einfluss auf den Implementationsprozess nehmen.Besonders hinderlich für eine langfristige Implementation erscheinen fehlende feste Rahmenbedingungen für die Präventionsdurchführung, Mitarbeiterfluktuation und mangelnde finanzielle Unterstützung durch politische Entscheidungsträger. Lösungsansätze umfassen die Schaffung zeitlicher Möglichkeiten im Lehrplan, den Einsatz von Präventionsverantwortlichen sowie die stärkere Vernetzung aller Präventionsbeteiligter mit regelmäßigen Weiterbildungen.Gemäß den Richtlinien der Society for Prevention Research, bildet die Diskussion implementationsrelevanter Faktoren den letzten Bestandteil einer umfassenden Programmevaluation. Sie verdeutlicht die Schwierigkeiten der Integration evidenzbasierter, praxisbewährter Präventionsprogramme in den Schulalltag. Damit stellt sich nicht zuletzt die Frage, wie viele Ressourcen noch in die Entwicklung von Präventionsprogrammen investiert werden sollen, bevor Strukturen geschaffen werden, die eine langfristige Durchführung ermöglichen, um bedeutsamen Einfluss auf die Zielgruppen zu nehmen.

Advances in the rescue chain and first aid of polytrauma patients, which have consequently increased their chance of survival, have led to an increase in demands for rehabilitation. However, there is still a large hole in the continuity of rehabilitation between acute patient care and in-patient rehabilitation, the so-called "rehab-hole". The consequences are untapped rehabilitation potential, loss of strength, endurance and motivation as well as impairment of function of the patient.Based on the phase model of neurological/neurosurgical rehabilitation, we propose a step model for the rehabilitation of polytrauma patients that ensures an uninterrupted chain of rehabilitation. After acute patient care (phase a) and a potentially required early patient rehabilitation (phase b), trauma rehabilitation should seamlessly continue on to phase c. The implementation of phase c after acute patient rehabilitation requires changes in the structure of "orthopaedic" rehabilitation clinics and financial support due the large consumption of resources by more complexly injured patients in this phase. The subsequent rehabilitation in phase d is well established and complies with current rehabilitation measures (AHB, BGSW). Further rehabilitation measures may be essential for social and occupational reintegration of the patient (phase e), depending on the complexity of their injuries after the accident. For patients with long-lasting results after an accident, it is crucial to implement continuous follow-ups (phase f) to ensure a better long-term outcome.In order to implement this phase model it is necessary to establish specialized facilities that meet the particular requirements needed for phase c. This tri-phased treatment model in trauma centres can therefore be used in trauma rehabilitation. In addition to the already established local and regional rehabilitation centres, nationwide trauma rehabilitation centres have adopted phase c rehabilitation.

At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers.As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics. In 2015, a geriatric trauma center certification in the form of a conglomerate network structure was agreed upon for the first time in Germany. For this purpose, the requirements for certification were observed. Both structure and organization were defined in a manual according to DIN EN ISO 9001:2015.Between 2008 and 2016, an increase of 70% was seen in geriatric trauma cases in our hospital, with a rise of up to 360% in specific diagnoses. The necessary standards and regulations were compiled and evaluated from our hospitals. After successful certification, improvements were necessary, followed by a planned re-audit. These were prepared by multiprofessional interdisciplinary teams and implemented at all locations.A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.

Background: There is a need for discussing influencing factors of the implementation of critical incident reporting systems in long term care. Objective of this publication is to describe the value of Reporting and Learning Systems and to discuss concrete recommendations for implementation based on the Consolidated Framework for Implementation Research. Influencing factors of successful implementation: A successful implementation is related to a systematic approach and several success factors. The following factors of implementation after analysis with Consolidated Framework for Implementation Research are relevant: (i) a standardised and straightforward design, (ii) the consideration of external stimuli, (iii) the development of a positive organisational and safety culture that facilitates implementation by providing resources, (iv) the consideration of needs, knowledge and individual processes of change, and (v) repeated evaluation of the implementation process. Outlook: A particular focus should be applied to visible interventions. Safety culture will be reinforced by enabling personalized reports. However, today it is needed to face current barriers. It is recommended to develop and to test instruments that measure implementation and to investigate the success of sustainable implementation.

The European Clinical Trials Regulation 536/2014 and the corresponding national legal transitions will require close cooperation between the federal higher authorities and ethics committees in the assessment of clinical trial applications involving medicinal products in humans. In preparation for this, a pilot project was launched to simulate the future processes of the regulation in line with current legal requirements and in order to give applicants, authorities and ethics committees the opportunity to familiarise themselves with the new procedures.The aim of this paper is to examine all pilot project procedures of the first year since starting the pilot project at the end of 2015.All 20 pilot projects completed in the first year were analysed for adherence to deadlines and results of the assessments.Within the time limits specified in the EU regulation, 17 of 20 procedures were fully completed. In two cases, the sponsors slightly exceeded the additional delivery period. In one case, the sponsor withdrew the application within the pilot procedure. All 20 applications were processed jointly by the federal authorities and ethics committees, and in all cases a coordinated assessment report was successfully compiled on time. All 20 applications were approved, five of which were subject to suspensive conditions.Compliance with the deadlines set by federal authorities and ethics committee shows that the technical infrastructures and processes established in the pilot procedure are fully functional. The cooperation between the federal higher authorities and ethics committees was very successful from the perspective of the parties involved.

Migrants utilize rehabilitative care less frequently than the majority population in Germany. They also have less favorable treatment outcomes. Little is known about migrant-sensitive measures implemented by rehabilitation hospitals in order to provide a more patient-centered health care for this population group.The aim of the present study was to examine which measures of migrant-sensitive health care are used by rehabilitation hospitals in North Rhine-Westphalia and Schleswig-Holstein and to identify potential barriers that may affect the implementation of such measures.We surveyed the administrative and medical management of all 122 orthopedic rehabilitation hospitals in North Rhine-Westphalia and Schleswig-Holstein by means of a postal questionnaire. The questionnaire comprised, amongst others, questions on the implementation of migrant-sensitive measures in accommodation and health care provision. After one postal reminder, a total of 55 hospitals responded to the survey.Of the hospitals surveyed, 83.6% consider migrant-sensitive health care to be important or partially important. Only a few migrant-sensitive measures are employed by hospitals. Thirty percent of all hospitals do not use measures of migrant-sensitive health care at all. Perceived barriers preventing an implementation of these measures are limited financial resources (71.0%) as well as structural (32.7%) and organizational (38.2%) problems.Rehabilitation hospitals are willing to implement measures of migrant-sensitive health care. Structural and organizational support is necessary in order to overcome existing implementation barriers. In addition, measures need to be cost-effective.

Background: Analysing adverse events is an effective patient safety measure. Aim: We show, how clinical nurse specialists have been enabled to analyse adverse events with the „Learning from Defects-Tool“ (LFD-Tool). Method: Our multi-component implementation strategy addressed both, the safety knowledge of clinical nurse specialists and their attitude towards patient safety. The culture of practice development was taken into account. Results: Clinical nurse specialists relate competency building on patient safety due to the application of the LFD-tool. Applying the tool, fosters the reflection of adverse events in care teams. Conclusion: Applying the „Learning from Defects-Tool“ promotes work-based learning. Analysing adverse events with the „Learning from Defects-Tool“ contributes to the safety culture in a hospital.

The EU Clinical Trial Regulation 536/2014 (CTR) and its implementation in Germany led to substantial changes of the established, well-accepted and effective system of reviewing clinical trial applications by ethics committees (ECs), which impair their independence. For the first time, the German federal legislator specified in detail the composition, functioning, tasks and responsibilities of ECs. ECs have to be registered with the federal drug authority BfArM and if an EC does not perform properly the registration can be withdrawn. In addition, the drug authorities may override the negative opinion expressed by an EC. The ECs will also lose their financial autonomy as the fees will be fixed by the federal government. The tasks and responsibilities of the ECs remain almost entirely unchanged, however. The ECs remain involved in the assessment of both parts of the application dossier. Part I is assessed together with the drug authorities, the drug authorities having the lead. The assessment of part II remains the sole responsibility of the EC. As the deadlines for the assessment became rather short, in particular for multinational trials, and the communication with the sponsor will be in writing only, the established procedures of ECs have to be modified. Up to now it was common to verbally discuss problematic issues with the sponsor. The CTR is focused on written communication with the sponsor via the EU portal. ECs, their office staff and chairpersons will need considerable professionalism and respective training. The future workflow requires substantial IT support. The ECs and the Association of Medical Ethics Committees in Germany will do their utmost to protect efficiently the research subjects and to promote Germany as a major destination for clinical research.

The upcoming Regulation EU 536/2014 for clinical trials of medicinal products for human use requires multinational cooperation in the assessment of clinical trial applications by the member states concerned as well as one single decision per member state concerned, supported by the new EU Portal and database system. The implementation makes national reorganisation of the processes necessary, especially coordination and cooperation between the national competent authorities and the ethics committees, necessary.A brief overview of implementation status with regard to national law adaptations, (re-) organisation, information technology systems as well as national or multinational pilot projects in 7 of 28 member states is given.Within these member states some national laws have been adapted already, while others will be soon. The national reorganisation covers mostly administrative organisation and coordination especially within the ethics committees. Overall, it is foreseen that a reduced number of ethics committees will be involved in the approval of clinical trials on medicinal products within the member states.Most of the seven member states expect that in addition to the new EU Portal/database system a national IT system for national cooperation and interaction will be necessary. Therefore, an interface within the EU system for national systems is essential.In order to test the new processes some member states are running national pilot projects or are planning them. In addition, almost all participate in the voluntary multinational assessment of clinical trials on medicinal products, which had existed since 2009, a few also in cooperation with their ethics committees.The member states are confident that all national processes will be in place when the EU regulation becomes applicable.

The collection of clinical treatment data in registry databases is an important aspect of health services research. It allows for a critical evaluation of the safety, efficacy and cost-effectiveness of clinical treatment concepts in large patient populations. The findings of registry research represent real-world patients and treatment structures as they are not limited by strict inclusion criteria or unrealistic conditions as applied in prospective clinical trials. The implementation of the German Thorax Registry has enabled the collection and analysis of data on the interdisciplinary care (thoracic surgery, anaesthesiology, intensive care, pain management) of patients undergoing thoracic surgery. Under the auspices of the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Thoracic Surgery, a registry of the Hospital of the University Witten/Herdecke-Cologne, purely surgical at first, was expanded in close cooperation with the University Hospital of Freiburg. After a comprehensive data protection concept was drafted and a test phase completed, the German Thorax Registry was officially launched in January 2016. Most notably, participating hospitals profit from the registry's "benchmarking" services. "Benchmarking", i.e. the comparison of treatment quality between different hospitals, enables participants to identify individual profiles, strengths and weaknesses on a nation-wide level and follow their own progress over the course of several years. An online database for data entry and benchmarking is always accessible (www.thoraxregister.de). In October 2016, the spectrum of participants was expanded to include all hospitals performing at least 50 thoracic operations a year.Die Erhebung klinischer Behandlungsdaten in Registerdatenbanken hat seit Jahren einen hohen Stellenwert in der Versorgungsforschung. Hierdurch kann bspw. eine kritische Prüfung der Sicherheit, Wirksamkeit und Wirtschaftlichkeit klinischer Behandlungskonzepte an großen Untersuchungskollektiven erfolgen. Die erhobenen Erkenntnisse aus der Registerforschung entsprechen der tatsächlichen Patientenklientel und dem Versorgungsalltag der teilnehmenden Kliniken. Sie sind nicht durch strenge Einschlusskriterien oder realitätsferne Rahmenbedingungen klinischer prospektiver Studien beschränkt. Durch die Implementierung des Deutschen Thoraxregisters wurde erstmalig die Möglichkeit geschaffen, die interdisziplinäre Betreuung (Thoraxchirurgie, Anästhesiologie, Intensivmedizin, Schmerztherapie) von Patienten mit operativen Eingriffen am Thorax ganzheitlich in einer Datenbank zu erfassen und auszuwerten. Unter der Schirmherrschaft der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Deutschen Gesellschaft für Thoraxchirurgie (DGT) wurde ein ursprünglich rein thoraxchirurgisches Register des Klinikums der Universität Witten/Herdecke-Köln in enger Kooperation mit dem Universitätsklinikum Freiburg erweitert. Nach Ausarbeitung eines umfangreichen Datenschutzkonzepts und Abschluss der Pilotphase wurde das Deutsche Thoraxregister als erstes perioperatives, interdisziplinäres Behandlungsregister im Januar 2016 offiziell implementiert. Neben der reinen Registerforschung, profitieren die teilnehmenden Kliniken vor allem durch die „benchmarking“-Funktionen. Das „benchmarking“, also der Vergleich der Behandlungsqualität verschiedener Kliniken, erlaubt es, individuelle Profile, Stärken und Schwächen im nationalen Vergleich zu identifizieren und eigene Fortschritte über mehrere Jahre zu verfolgen. Das Eingabe- und Benchmarkportal ist jederzeit online verfügbar (www.thoraxregister.de). Seit Oktober 2016 wurde das Teilnehmerspektrum erweitert, sodass sämtliche Kliniken mit mindestens 50 thoraxchirurgischen Eingriffen im Jahr teilnahmeberechtigt sind.

Internet- and mobile-based health interventions (IMIs) e. g. in the form of internet-based aftercare can supplement existing treatments of inpatient rehabilitation. Acceptance presents a key precondition to the utilization and clinical implementation of new technologies and was examined in patients and health professionals with qualitative research methods.In 3 inpatient rehabilitation clinics with various diagnostic and age groups, we interviewed n=15 patients individually and n=29 health professionals of various occupational groups in focus groups based on the 'Unified Theory of Acceptance and Use of Technology'.Benefits of online-aftercare were seen in the access to health information, motivation to health promotion or in monitoring or correcting health behavior. Occupational stress was not seen as an area of application. Reservations were expressed in terms of lack of trust in online contact. Overall, acceptance was higher in patients in comparison to health professionals.Barriers of uptake or application of IMIs in rehabilitation exceed technical and demographic aspects and provide important information for specific facilitation of acceptance of patients as well as health professionals.Internet- und mobilbasierte Gesundheitsinterventionen (IMIs) können z. B. in Form von Nachsorgeangeboten das Behandlungsangebot der Rehabilitation erweitern. Für die Implementierung ist jedoch deren Akzeptanz eine wesentliche Voraussetzung, die daher bei Rehabilitanden und Mitarbeitern qualitativ untersucht wurde.In 3 Rehabilitationskliniken mit verschiedenen Indikationen und Altersgruppen wurden n=15 Rehabilitanden in Einzelinterviews und n=29 Mitarbeiter verschiedener Berufsgruppen in Fokusgruppen nach einem semi-strukturierten Leitfaden auf Basis der “Unified Theory of Acceptance and Use of Technology“ interviewt.Vorteile einer Online-Nachsorge wurden in den Möglichkeiten zur Aufbereitung von Informationen, Motivation, Verlaufsbeobachtung und Korrektur von Gesundheitsverhalten gesehen, weniger als ein Anwendungsbereich bei beruflichen Problemlagen. Vorbehalte zeigten sich v. a. bezüglich der therapeutischen Beziehung. Tendenziell war die Akzeptanz bei Rehabilitanden höher als bei Mitarbeitern.Die gefundenen Barrieren der Inanspruchnahme bzw. Anwendung von IMIs gehen über technische und demografische Aspekte hinaus. Sie sind wichtige Informationen für die gezielte Förderung der Akzeptanz sowohl bei Rehabilitanden wie auch bei Mitarbeitern.

Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available.Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference.Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks.For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators.The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.

The aim of the project is a cost analysis of 2 different strategies "train-the-trainer-seminar" (ttt-seminar) and "implementation guideline" (ig) in the implementation of a standardised patient education program in the inpatient rehabilitation of patients with chronic back pain. The implementation strategies were assigned by chance to 10 rehabilitation clinics. Expenditure of time was evaluated by questionnaire. Additionally materials and travel expenses were calculated. The total implementation costs accounted 4 582 € for the ttt-seminar and were about one third (35%) higher than the costs for the ig-strategy. The higher total implementation costs can basically be attributed to higher personnel costs due to the time-consuming seminar. However, in the ig-strategy postprocessing costs were 23.5% higher than in the ttt-strategy.Ziel der Arbeit ist die Ermittlung der Kosten der alternativen Implementierungsstrategien „Train-the-Trainer-Seminar“ (TTT) und „schriftlicher Leitfaden“ (LF) einer standardisierten Rückenschulung in der medizinischen Rehabilitation. Die Implementierungsstrategien wurden in 10 Rehabilitationskliniken zufällig zugewiesen und der Zeitaufwand mittels Erhebungsbögen erfasst. Zudem wurden die Kosten für Sachmittel sowie Reisekosten berücksichtigt. Die klinikbezogenen Gesamtkosten der Implementierung liegen beim TTT-Seminar mit 4 582 € um ein Drittel (35%) höher als die Gesamtkosten der LF-Strategie. Die höheren Kosten der Implementierung über ein TTT-Seminar waren insbesondere auf den höheren personellen Ressourcenverbrauch durch das zeitintensive Seminar zurückzuführen. Für die LF-Gruppe zeigt sich allerdings ein wesentlich höherer Kostenanteil für die Nachbereitung der Programminhalte (23,5%).

Published in 2009, the German S3 guidelines on dementia define a milestone in quality improvement of the diagnostics and treatment of dementia. In clinical practice patients suffering from dementia are primarily treated by physicians in private practice; therefore, this study examined how the guidelines are implemented in outpatient clinical settings. Furthermore, it aimed at the identification of behavioral determinants that govern the actual diagnostic and therapeutic approach in clinical practice.Physicians involved in the primary care of dementia patients were asked to participate in a nationwide internet survey. The questionnaire covered aspects on the diagnostic and therapeutic care of dementia patients as recommended by the S3 guidelines. Behavioral determinants of the implementation of the guidelines (e. g. treatment decisions) were derived from an established psychological prediction model.Out of a total of 2755 physicians contacted, the data of 225 participants could be used in this study. The diagnostic recommendations of the S3 guidelines were implemented in satisfactory measures (e.g. combined cognitive screening in at least 68%, cerebral neuroimaging in at least 93% and specific laboratory diagnostics in at least 27% of cases); however, only two thirds of the patients with indications for a guideline-conform therapy were treated in accordance with the S3 guidelines. There was a substantial prescription of non-recommended drugs and a notable long-term use of antipsychotic drugs (prescription by at least 14% of non-neurological medical specialists and by 8% of neurologists and psychiatrists). When considering the behavioral determinants in the implementation of the guidelines, normative assumptions ("my colleagues and patients expect me to comply with the guidelines") surprisingly had the highest impact, which was then followed by attitudes towards the behavior ("utilization of the guidelines improves diagnostics and therapy").The German S3 guidelines on dementia were satisfactorily implemented in outpatient clinical practice; however, deficits existed in the frequency of the pharmaceutical treatment of patients with indications for therapy, the prescription of non-recommended drugs and the relatively common use of permanent neuroleptic medications. Interestingly, the motivation for implementation of the guidelines was not primarily influenced by the physicians' personal convictions but mainly stimulated by the expectations of others.

Background: Hygiene deficits can cause hospital-acquired infections. To meet this public health problem the Robert Koch-Institute advocates the employment of infection control link nurses (ICLN). Aim: This study aimed to evaluate the experiences of ICLNs working in the University Hospital of Cologne. Method: A cross-sectional survey of all ICLNs (n = 64) working at the University Hospital of Cologne was carried out by a self developed questionaire. The data were assessed descriptively. Results: The return rate was 45.3 % (n = 29). The ICLNs were very satisfied with the ICLN training and felt well prepared for their task. The collaboration with other nursing staff, their head nurse and the Department of Hygiene was also positively evaluated. However, only one third of the respondents was satisfied with their working conditions and only half of them indicated feeling that the efforts they made so far were successful. This study also found that, many of the legal intended services were rarely performed. The study identified two barriers to implementation of ICLNs. On the one hand, the release from other routine nursing duties and on the other hand a lack of acceptance of the role by physicians. Conclusions: The task ahead is to find ways to exempt ICLNs from other duties and to involve the physicians more intensely in the implementation of ICLNs.

In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care.

Guided Internet- and mobile-based interventions (IMIs) are an effective and scientifically sound treatment option for depression. Meta-analyses revealed effect sizes comparable to those found for face-to-face treatment as well as pharmacotherapy. Today, most IMIs are based on cognitive behavioral therapy (CBT). While IMIs are well established in healthcare systems of many countries worldwide, Germany is still lagging behind. However, there are an increasing number of model projects trying to implement IMIs into routine healthcare for depression in Germany. Both, service providers and recipients would benefit from transparent quality assurance and data safety guidelines.

The Psychiatry Enquête turned 40 years old last year. The S3 guideline "Psychosocial therapies for severe mental illness" is considered to be the last milestone of the reform to date. This paper highlights new impulses resulting from the S3 guideline for psychiatric care and provides an outlook on the update, expected in 2017. Many of the interventions reported in the S3 guideline are now supported by a broader evidence base.

The implementation of robot-assisted surgery requires a multi disciplinary approach with appropriate training and cooperation of surgical, anesthetic and technical staff. Besides acquiring the technical skills and getting used to complex technique, patient selection and an appropriate frequency of procedures are required to avoid complications.

Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment.The establishment of the geriatric care network (e.g. promoting networking acceptance and implementation) was formatively evaluated, e. g. with qualitative methods. Data were acquired by guideline-based interviews with experts and analyzed by qualitative content analysis according to Mayring.Structural effects included forming a cross-sectoral and interdisciplinary network for a functioning care network and a geriatric care pathway. The practical work of case managers (CM) is essential for communication with patients, family members and care providers as well as integrating providers into the network. A critical factor was working together with general practitioners and the close cooperation with the hospital's department of geriatric. The quality of care is improved because of exchange of information between sectors and continuity in the course of care.In the District of Lippe the quality of care was improved and structures of care were integrated by the network according to the needs of the target group. The integrative perspective was achieved in particular by the geriatric care pathway and integration of providers into the communication and care process; however, the scope of this care model could not be extended into routine care due to the rigid and subdivided health care system.

Supplementary pain-related recommendations for the treatment of chronic pain in children and adolescents are an essential component of multimodal pain treatment. Studies are scarce regarding adherence to these recommendations and their effectiveness.The aim of this study was to evaluate patient adherence to pain-related recommendations and their effectiveness 12 months after initial presentation of children and adolescents with chronic pain to a pediatric outpatient pain clinic.A total of 413 patients were assessed using a structured telephone interview. The assessment included pain characteristics during the last 4 weeks as well as information regarding the implementation of the pain-related recommendations and the effectiveness. Due to different recommendations given to migraine patients this subgroup was dealt with separately.Patients reported significant improvements 12 months after the initial presentation and 29.5 % of the patients were pain free. Adherence levels and estimated effectiveness regarding recommendations, such as change of lifestyle, multimodal inpatient treatment and use of medication were high. Other recommendations, such as active relaxation and outpatient psychotherapy had low adherence levels and low estimated effectiveness. Migraine patients had a significantly higher adherence rate and estimated effectiveness regarding the recommendation use of medication than non-migraine patients.The adherence level as well as the estimated effectiveness regarding the majority of pain-related recommendations was high. Some recommendations had low adherence rates and low estimated effectiveness. These results can help to further improve the performance of outpatient clinics for children and adolescents with chronic pain.

Objective: With this article we want to support teachers and curriculum planners to be aware of and apply knowledge and recommendations of organisational (OD), curriculums (CD) and human resource development (HRD) ideas already in the planning phase of a project. Taking these into account can influence the process of change successfully and controlled during the introduction and establishment of curricula in the field of communication and social skills in medical education. Approach and Results: In the context of a multi-stage developmental process, a recommendation on CD for "Communicative and social competencies" was developed. The basis for it was made during two workshops of the GMA-committee "Communicative and social competencies" and supplemented by the available literature and the experience of communication experts. The "Undeloher Recommendation" (see attachment [mma:Attachment.pdf]) includes a compilation of recommendations and guiding questions, which is geared to the various phases of CD. Additionally, general approaches and recommendations of organisational and human resource development were integrated, which turned out to be particularly relevant in the process of CD. Thus, the "Undeloher recommendation" includes an orientation for each phase of the curriculum development process, the organisation and the staff in order to successfully implement a longitudinal curriculum. In addition to theoretical models the long-term discussion process and the personal experiences of a variety of curriculum planners and teachers have been integrated. Conclusion: The "Undeloher recommendation" can support the implementation processes of curricula in communication and social skills during development and realisation. Its application was reviewed in the context of workshops based on concrete examples. The participating teachers and curriculum planners assessed it to be very helpful. The recommendation goes beyond of what has been described in terms of content models in the CD so fare. In particular, the organisational and human resource development related aspects such as the formation of a steering committee and recommendations for the phase of sustainability., Zielsetzung: Ziel dieser Arbeit ist es, Lehrenden und Curriculumsplanern die Bedeutung der Curriculums- (CE), Personal- (PE) und Organisationsentwicklung (OE), bereits in der Planungsphase eines Projekts aufzuzeigen. Diese können dann gezielt genutzt werden um Veränderungsprozesse bei der Einführung und Etablierung von Curricula im Bereich kommunikativer und sozialer Kompetenzen im Medizinstudium erfolgreich zu beeinflussen und zu steuern. Vorgehen und Ergebnisse: Im Rahmen eines mehrstufigen Entwicklungsprozesses, in dem insbesondere zwei interfakultäre Workshops des GMA-Ausschusses „Kommunikative und soziale Kompetenzen“ im Zentrum standen, wurde aufbauend auf die verfügbare Literatur und den Erfahrungen von Kommunikationsexperten eine Empfehlung zur CE im Bereich „Kommunikativer und sozialer Kompetenzen“ erarbeitet. Die „Undeloher-Empfehlung“ (siehe Anhang [mma:Attachment.pdf]) beinhaltet eine Zusammenstellung von Empfehlungen und Leitfragen, die sich an den verschiedenen Phasen der CE orientiert. Zusätzlich wurden allgemeine Herangehensweisen und Empfehlungen der Organisations- und Personalorganisation integriert, die sich im Prozess der CE als besonders relevant herausstellten. Damit beinhaltet die „Undeloher-Empfehlung“ für jede einzelne Phase der Curriculumsentwicklung eine Orientierung, was in bezug auf das Curriculum, die Organisation und das Personal für eine erfolgreiche Implementierung von longitudinalen Curricula zu beachten ist. Neben theoretischen Modellen fließen insbesondere der langjährige Diskussionsprozess und die persönlichen Erfahrungen einer Vielzahl von Curriculumsplanern und Lehrenden ein. Fazit: Die „Undeloher-Empfehlung“ kann die Vorbereitung und Begleitung von Implementierungsprozessen von Curricula im Bereich kommunikative und soziale Kompetenzen unterstützen. Ihre Anwendung wurde im Rahmen der Workshops auf konkrete Beispiele überprüft und wurde von den beteiligten Lehrenden und Curriculumsplanern als sehr hilfreich eingeschätzt. Sie geht insbesondere mit organisations- und personalbezogenen Aspekten wie der Bildung einer Steuerungsgruppe und Empfehlungen für die Phase der Verstetigung über das hinaus, was bisher inhaltlich an Modellen in der CE beschrieben wurde., GMS Zeitschrift für Medizinische Ausbildung; 32(5):Doc50

In 2009 palliative medicine was integrated into the undergraduate curriculum as cross-disciplinary subject 13 and is now part of mandatory education in German medical faculties (MF). Surveys across German MFs have shown an inhomogeneous development of this cross-disciplinary subject. The aim of this study was to assess the current state and the needs in terms of assessments in the cross-disciplinary subject 13 at German MFs.Palliative care coordinators at German MFs were surveyed by using a standardized telephone interview. Closed-ended questions were analyzed by descriptive analysis and open-ended questions by content analysis.A total of 34 out of 36 MFs participated. Multiple choice tests were the major form of assessment (94.1%) and 9 MFs planned to implement another form of assessment, mainly an objective structured clinical examination (OSCE) station (55.5%). The majority of the MFs (91.2%) had no blueprint to develop assessments but conducted a review (78.8%) afterwards. A successful implementation of the assessment was mostly achieved when the concept of the assessment was felt to be suitable. The lack of human resources was found to be the most relevant obstacle for the implementation of a practical assessment format.The major form of assessment in palliative care is still a written examination, especially multiple choice tests. This format is considered to be of limited value for assessing communicative competencies and attitudes in palliative medical care. Further steps should include the development of a competence-based assessment that is also feasible for smaller MFs with limited resources.

The introduction of pain medicine (cross-sectional subject 14, QF 14) into the Human Medicine study program is a great opportunity. A knowledge gap concerning the treatment of pain patients outside of specialized pain centers has been recognized for many years. This gap might be closed or at least reduced by a compulsory curriculum in pain medicine. If implementation of new lessons for QF 14 is not possible, pain medicine could be represented by labelled elements in the existing curriculum, in order to highlight the field. The core curriculum must now be converted into appropriate teaching and test formats. Due to the autonomy and heterogeneity of German medical faculties, no uniform solution will be achieved. In contrast, this diversity and the entirely new implementation of the cross-sectional subject will allow structured evaluation of different teaching and examination formats with respect to teaching outcome in benchmarking investigations in the coming semesters. Practically experienced lecturers and theory-driven medical educationalists are called upon to get involved with the development, implementation, and evaluation of pain medicine in undergraduate education in Germany. Teaching enthusiasts are encouraged to dedicate themselves to the strenuous, but stimulating task of implementing QF 14. The Deutsche Schmerzgesellschaft (German Pain Society) will offer support for this.