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The paper intends to do a scoping review of people with intellectual disabilities in emergency care where this group seems to face access barriers and discrimination. It analyses the conceptual and methodological framework for studies examining the former.A scoping review is conducted. The studies' quality is assessed via a checklist developed by the authors drawing on a compilation of common assessment tools for study quality.Fourteen quantitative studies fulfil the inclusion criteria for further analysis. Summary measures are extracted. Results are synthesized with Andersen's Behavioral Model of Health Service Use. Studies employ a combination of variables attributable to different aspects of population characteristics and health behavior.Most studies seek to quantify or predict emergency care overuse by people with intellectual disabilities. Future studies should also take patients' poor health or treatment outcomes and their perspectives into account.

BACKGROUND Electronic medical records (EMR) are considered a key component of the health care systems digital transformation. The implementation of an EMR promises various improvements e.g. in the availability of information, coordination of care, or patient safety and is required for big data analytics. To ensure those possibilities of an EMR, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. OBJECTIVE The purpose of the presented study is to compare the completeness of documentation in paper-based medical records and electronic medical records and to discuss the possible impact of an EMR on the completeness of documentation. METHODS A retrospective document analysis was conducted, comparing the completeness in paper-based medical records and EMRs. Data were collected before and after implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients of a three-week period each. Unpaired, two tailed t-tests, χ²-tests and Odds Ratios were calculated to analyze and compare the mean completeness of the two record types in general and of ten specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, weight). For this purpose, each of the ten items received a score of 1 if it was documented on the day of admission, otherwise it was scored as 0. RESULTS N=180 medical records became part of the analysis. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t(178)=-2.469; P=.014; d=-0.428). When looking at the significant changes of the ten items in detail, the documentation of diet (P CONCLUSIONS Implementing EMRs can influence the completeness of documentation with a possible change to both, an increased or decreased completeness. However, the mechanisms that determine those changes are often neglected. There are mechanisms that might facilitate an improved completeness of documentation and could relieve or increase the staffs’ burden, caused by documentation tasks. Research is needed to take advantage of these mechanisms and use them for mutual profit in the interests of all stakeholders. CLINICALTRIAL The project is registered at the German clinical trials register (DRKS00023343).

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.Ziel der vorliegenden Arbeit war es, Empfehlungen für ein Kerncurriculum für Masterstudiengänge der Versorgungsforschung zu erarbeiten. Hierzu wurde im ersten Schritt eine standardisierte Online-Befragung von Hochschullehrenden durchgeführt. Im zweiten Schritt wurden die Modulhandbücher der existierenden Studiengänge in Bezug auf ihre Lehr-Lerninhalte analysiert. Die Inhalte wurden im dritten Schritt ergänzt durch eine Literaturrecherche. Im letzten Schritt wurden die Empfehlungen innerhalb einer Expertenrunde final diskutiert. Die resultierenden Empfehlungen umfassen 13 Themen zu fünf Leitfragen mit 26 Unterthemen. Die Schwerpunktthemen stammen aus den Bereichen der Grundlagenwissenschaften im Kontext der Versorgungsforschung, des Gesundheitssystems und der Gesundheitspolitik, dem (empirischen) Versorgungsforschungsprozess und dem Wissenstransfer. Die vorliegenden Empfehlungen dürfen als Diskussionsgrundlage und Ausgangspunkt für Weiterentwicklungen verstanden werden. Die Erarbeitung von Empfehlungen ist ein fortlaufender Prozess und eine fortwährende Aufgabe der wissenschaftlichen Gemeinschaft, da sich die Kernkompetenzen von Versorgungsforschenden kontinuierlich neuen Forschungsgegenständen, neuen Forschungsmethoden und sich verändernden Rahmenbedingungen anpassen müssen.

Background The need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records. Methods eCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant observation, interviews, focus groups, time measurement, patient and employee questionnaires and a questionnaire to measure the level of digitalization. Furthermore, documents (patient records) as well as structural and administrative data are gathered. To analyze the interprofessional collaboration qualitative network analyses, reconstructive-hermeneutic analyses and document analyses are conducted. The workflow analyses, patient and employee assessment analyses and classification within the clinical adoption meta-model are conducted to provide insights into clinical workflows. Discussion This study will be the first to investigate the effects of introducing electronic patient records on interprofessional collaboration and clinical workflows from the perspective of healthcare professionals. Thereby, it will consider patients’ safety, legal and ethical concerns and quality of care. The results will help to understand the organization and thereby improve the performance of health services working with electronic patient records. Trial registration The study was registered at the German clinical trials register (DRKS00023343, Pre-Results) on November 17, 2020.

Multimorbidity poses various challenges, and previous research has indicated a causal relation with depression. As multimorbidity is not curable, the underlying mechanisms are of great interest. Po...

Zusammenfassung Ziel der Studie Ziel dieser Untersuchung war es, die derzeit akkreditierten Versorgungsforschungsstudiengänge in Deutschland im Hinblick auf ihre Strukturdaten und Inhalte zu analysieren. Methodik Im Rahmen eines deskriptiven qualitativen Designs wurden die aktuellen Studienverlaufspläne, die Modulhandbücher und die Steckbriefe akkreditierter Masterstudiengänge der Versorgungsforschung inhaltsanalytisch ausgewertet. Ergebnisse Die 6 analysierten Studiengänge zeigen sich hinsichtlich ihrer strukturellen Merkmale und lehr-lerninhaltlichen Ausrichtung in den wesentlichen Punkten als homogen. Ziel aller Studiengänge ist es, fach- und disziplinübergreifende personale und soziale Kompetenzen zu fördern, um Versorgungsbedarfe im Gesundheitswesen zu identifizieren, Innovationen der Versorgung zu entwickeln, zu initiieren, zu evaluieren und kritisch zu reflektieren. Schlussfolgerungen Trotz ähnlicher Lehr-Lerninhalte bestehen spezifische Ausrichtungen, für die sich die Studierenden vor dem Hintergrund ihrer individuellen Präferenzen entscheiden können. Diese Ergebnisse könnten unter Berücksichtigung aktueller Diskurse und weiterer Erkenntnisse als Grundlage für Empfehlungen zur Entwicklung eines Kerncurriculums dienen.

Objective Recent studies from Germany show that a small amount of breast and gynecological cancer patients participate in multidisciplinary tumor conferences (MTCs) at some cancer centers. One reason for the variation by center might be the providers' attitudes about and experiences with MTC patient participation (MTCpp), which has not been analyzed before. Therefore, it is the aim of this study to analyze the providers' expected or experienced feasibility concerning MTCpp at breast and gynecological cancer centers in Germany. Methods This paper presents cross-sectional qualitative interview data from the PINTU study. From April to December 2018, n=30 health-care providers from n=6 breast and gynecological cancer centers in North-Rhine-Westphalia, Germany, were interviewed. One-half of the providers had no experience and the other half had experience with MTCpp. Inductive and deductive coding was performed in order to capture the feasibility aspects of participation. Results MTCpp seems not to be feasible in routine cancer care following providers' expected barriers and negative experiences. However, MTCpp seems to be feasible for selected cancer patients following providers' expected opportunities and positive experiences. Our results show that both provider groups report positive and negative experiences or expectations. Conclusion The mixed findings regarding expected or experienced feasibility of MTCpp provide first insights into differences concerning MTCpp between organizations. Our results suggest that the providers' perceptions (expectations and experiences) influence the possibility for patients to participate in an MTC in a cancer center.

Background With demographic change, the number of noncommunicable diseases, chronic diseases and multimorbidity is increasing, and so is the demand for health services. This represents a further challenge for the healthcare system. An adequate and efficient treatment of multimorbid patients requires a well-structured, informed and cross-indicated treatment. Therefore, a new form of coordinated, managed and cross-sectoral care for multimorbid patients - the “MamBo” care model - has been developed. Along with the implementation of MamBo, a process and outcome evaluation will be carried out, which is described in this study protocol. The aim of the study is to evaluate the care model according to its implementation process and effectiveness. Methods The MamBo-care model will be evaluated in multi-perspective terms. Thus, a process and outcome evaluation with several data sources will be conducted: (1) Annual focus groups and individual interviews with those involved in the process. (2) Various primary data, including surveys of patients, physicians and practice staff at the time of enrolment and 1 year later to enable pre-post comparison. (3) Claim data from the health insurance of the MamBo population in comparison to a comparative population, formed by the propensity score matching method. (4) Process data of the care management. The analysis of qualitative data will be carried out by content analysis according to Mayring. For the analysis of the quantitative data, multivariate analyses are planned. Discussion A new form of coordinated care has been introduced to improve intersectoral care of multimorbid patients and reduce the workload on physicians. The effects of the MamBo care model are being investigated for patients, physicians and the cost units. The results will form the basis for the decision whether the care model should be transferred to standard care and what needs to be taken into account for implementation. Trial registration The study was retrospectively registered in the German Register for Clinical Studies (DRKS00014047) on June 28, 2019.

ObjectivesPatients with autoimmune inflammatory rheumatic diseases (AIRD) often have lower vaccination coverage rates compared with the general population, despite being disproportionately affected by infectious complications. We aim to systematically review the literature regarding vaccination willingness and hesitancy in AIRD.MethodsA scoping review was conducted in PubMed, EMBASE and the Cochrane Library in June 2021. Study selection was performed by two independent reviewers and data were extracted using a standardised form. Risk of bias was assessed using instruments from McMaster University. Identified barriers were categorised into the WHO’s measuring behavioural and social drivers (BeSD) of vaccination conceptual model.ResultsThe search yielded 1644 hits of which 30 publications were included (cross-sectional studies based on interviews (n=27) and intervention studies (n=3)). The majority of studies reported barriers to influenza and pneumococcal vaccination only (n=9) or in combination with another vaccination (n=8) from the patients’ perspective. Only one study assessed the view of rheumatologists. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians. Patients mainly mentioned behavioural and social factors that negatively influenced their willingness to be vaccinated while physicians mentioned organisational deficits as major barriers.ConclusionsThe view on vaccination in patients with AIRD diverges between patients and rheumatologists. Our results show that in-depth counselling on vaccines is important for patients, whereas physicians need support in implementing specific immunisation recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in patients with AIRD.

Background The health care innovation “MamBo – people with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management” aims to improve the efficiency and quality of care for multimorbid patients by delegating tasks (e.g. taking over house calls or coordinating specialist appointments) to a monitoring and coordination assistant (MoniKa). Participating physicians are very important for the success of the health care innovation due to their direct involvement as practitioners and their task of enrolling patients. The aim of this part of the evaluation study is therefore to identify the physicians’ personal values, which influence the individual perception of the project’s advantages and thus possibly the acceptance and sustainable implementation of new care structures. Methods Two Focus groups (n = 4; n = 6) and three individual interviews with general practitioners and specialists who decided to implement the health care innovation within the first year were conducted. The semi-structured guidelines were developed by the research team. The interviews were analysed according to the content analysis by Mayring. We used the learning model of operant conditioning to place our study results in a theoretical context. Result Two central personal values of the participants, which determine the desired advantages of the health care innovation were identified: More patient-oriented and more economic-oriented values. Participants with more patient-oriented values quickly perceived advantages, which seems to be beneficial for the acceptance of the new care structures. Economic-oriented participants tended to be more critical. The benefits of the health care innovation, which was expressed, for example, in an improvement of the practice routine, has not yet been perceived by this group, or only to a limited extent. Conclusions The results suggest that the respective values of the participants define the individual perceived advantages and thus, the assessment of the success of the health care innovation in general. These findings could be used in the implementation process by increasing the motivation of the project participants through typified supervision. Trial registration The study has been registered in the German Clinical Trials Register (DRKS00014047).

ZusammenfassungZiel der vorliegenden Arbeit war es, Empfehlungen für ein Kerncurriculum für Masterstudiengänge der Versorgungsforschung zu erarbeiten. Hierzu wurde im ersten Schritt eine standardisierte Online-Befragung von Hochschullehrenden durchgeführt. Im zweiten Schritt wurden die Modulhandbücher der existierenden Studiengänge in Bezug auf ihre Lehr-Lerninhalte analysiert. Die Inhalte wurden im dritten Schritt ergänzt durch eine Literaturrecherche. Im letzten Schritt wurden die Empfehlungen innerhalb einer Expertenrunde final diskutiert. Die resultierenden Empfehlungen umfassen 13 Themen zu fünf Leitfragen mit 26 Unterthemen. Die Schwerpunktthemen stammen aus den Bereichen der Grundlagenwissenschaften im Kontext der Versorgungsforschung, des Gesundheitssystems und der Gesundheitspolitik, dem (empirischen) Versorgungsforschungsprozess und dem Wissenstransfer. Die vorliegenden Empfehlungen dürfen als Diskussionsgrundlage und Ausgangspunkt für Weiterentwicklungen verstanden werden. Die Erarbeitung von Empfehlungen ist ein fortlaufender Prozess und eine fortwährende Aufgabe der wissenschaftlichen Gemeinschaft, da sich die Kernkompetenzen von Versorgungsforschenden kontinuierlich neuen Forschungsgegenständen, neuen Forschungsmethoden und sich verändernden Rahmenbedingungen anpassen müssen.

The Implementation Leadership Scale (ILS) was developed to assess leadership behavior with regard to being proactive, knowledgeable, supportive, or perseverant in implementing evidence-based practices (EBPs). As part of a study on the implementation of a digitally supported polypharmacy management application in primary care, the original ILS was translated and validated for use in the German language.This study aimed to translate the original ILS into German and evaluate its psychometric properties.The validation sample consisted of 198 primary care physicians in a cluster-randomized controlled trial in which the intervention group implemented a digitally supported clinical decision support system for polypharmacy management. The ILS was assessed using a 12-item scale. The study included a process evaluation with two evaluation waves between 2019 and 2021. The ILS was used within this process evaluation study to assess the leadership support with regard to the implementation of the polypharmacy management. The ILS was translated in a multi-step process, including pre-testing of the instrument and triple, back-and-forth translation of the instrument. We tested the reliability (Cronbach's alpha) and validity (construct and criterion-related validity) of the scale.The four-dimensional structure of the instrument was confirmed (comparative fit index = .97; root mean square error of approximation = .06). Convergent validity was demonstrated by correlations with organizational innovation climate, social capital, and workload, which was consistent with the proposed hypothesis. Criterion-related validity of the ILS was demonstrated by predicting the organizational readiness for change scores using structural equation modeling. The reliability of the scale was good (α = .875).The German version of the ILS created in this study is a reliable and valid measure. The original four-dimensional structure of the ILS was confirmed in a primary care setting. Further psychometric testing is needed to establish the validity and reliability of the ILS and to transfer it to other health care settings. It is a useful tool for identifying the areas for implementation leadership development. Further research is needed on how, why, and when distinct types of leadership behaviors have different effects on healthcare organizations in implementation processes.

Background To investigate patients’ perspectives on polypharmacy and the use of a digital decision support system to assist general practitioners (GPs) in performing medication reviews. Methods Qualitative interviews with patients or informal caregivers recruited from participants in a cluster-randomized controlled clinical trial (cRCT). The interviews were transcribed verbatim and analyzed using thematic analysis. Results We conducted 13 interviews and identified the following seven themes: the patients successfully integrated medication use in their everyday lives, used medication plans, had both good and bad personal experiences with their drugs, regarded their healthcare providers as the main source of medication-related information, discussed medication changes with their GPs, had trusting relationships with them, and viewed the use of digital decision support tools for medication reviews positively. No unwanted adverse effects were reported. Conclusions Despite drug-related problems, patients appeared to cope well with their medications. They also trusted their GPs, despite acknowledging polypharmacy to be a complex field for them. The use of a digital support system was appreciated and linked to the hope that reasons for selecting specific medication regimens would become more comprehensible. Further research with a more diverse sampling might add more patient perspectives. Trial registration ClinicalTrials.gov, NCT03430336. Registered on February 6, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01517-6.

Objective Breast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients’ satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation. Methods Data of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses. Results The majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge. Conclusion As hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient’s rating of LOS. Practice Implications The study results underscore the importance of ensuring the quality and thoroughness of the discharge process.

BACKGROUND Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge. PURPOSE The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers. METHODOLOGY The data were collected between February 1 and July 31, 2014-2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses. RESULTS Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge. CONCLUSION The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources. PRACTICE IMPLICATIONS Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently.

This study provides insights into the longitudinal relation between multimorbidity, mental wellbeing, and social support. The analysis used the German Sociomedical Panel of Employees, a study of the German working population aged 40 to 54. In the context of multimorbidity, this population has been little studied. Multimorbidity is significantly associated with reduced mental wellbeing and social support, whereas social support increases mental wellbeing. We argue that, especially among the working population, multimorbidity reduces perceived social support and decreases mental wellbeing. We elaborate on the mediation process empirically by comparing two distinct structural equation models: a cross-lagged panel mediation model that models a potential reverse-causality between social support and mental wellbeing; and a synchronous mediation model that allows for more immediate mediation. Both models estimated significant mediation. The relative size of the mediation effect, however, varied widely based on the added mediational paths (8.57% vs. 28%). Fit statistics for both models were good, and the comparison did not favour either model. We conclude that theoretical reasoning must prevail over empirical testing. The cross-lagged model implies a more longitudinal (lagged) mediation process for social support. However, we suggest an immediate, flexible mediation as more plausible. Nevertheless, we suggest that cross-lagged models, when given a data structure and time gaps, reflect the social processes adequately., Highlights • Provide insights on multimorbidity in the working population aged 40–54. • Multimorbidity reduces social support and mental wellbeing. • Comparison of longitudinal mediation models using structural equation modelling. • Cross-lagged panel mediation model estimates a proportion mediated of 8.57%. • Synchronous effect model estimates proportion mediated of about 28%.

Background The health care innovation "MamBo – people with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management” aims to improve the efficiency and quality of care for multimorbid patients by delegating tasks (e.g. taking over house calls or coordinating specialist appointments) to a monitoring and coordination assistant (MoniKa). Participating physicians are very important for the success of the health care innovation due to their direct involvement as practitioners and their task of enrolling patients. The aim of this part of the evaluation study is therefore to identify the physician’s personal values, which influence the individual perception of the project’s advantages and thus possibly the acceptance and sustainable implementation of new care structures. Methods Two Focus groups (n = 4; n = 6) and three individual interviews with general practitioners and specialists who decided to implement the health care innovation within the first year were conducted. The semi-structured guidelines were developed by the research team. The interviews were analysed according to the content analysis by Mayring. We used the learning model of operant conditioning to place our study results in a theoretical context. Result Two central personal values of the participants, which determine the desired advantages of the health care innovation were identified: More patient-oriented and more economic-oriented values. Participants with more patient-oriented values quickly perceived advantages, which seems to be beneficial for the acceptance of the new care structures. Economic-oriented participants tended to be more critical. The benefits of the health care innovation, which was expressed, for example, in an improvement of the practice routine, has not yet been perceived by this group, or only to a limited extent. Conclusion The results suggest that the respective values of the participants define the individual perceived advantages and thus, the assessment of the success of the health care innovation in general. These findings could be used in the implementation process by increasing the motivation of the project participants through typified supervision. Trial registration: The study has been registered in the German Clinical Trials Register (DRKS00014047).

The aim of this study was to analyse accredited study programmes of health services research in Germany at Master's degree level regarding their structural data and content.Using a descriptive qualitative design, all included plans of study courses, module handbooks and descriptions of the Master's degree programmes were analysed.The Master's degree programmes were similar in their structural elements as well as in their content of education. They aim at enhancing competences related to the areas of health services research to identify health care needs and to develop, initiate, evaluate and critically assess innovative care strategies across disciplines.Although the content is similar, the study programmes focus on specific aspects that allow students to choose a certain programme depending on their preferences. A next step can be the development of a core curriculum that takes into consideration further findings and the discourse of different stakeholders.Ziel dieser Untersuchung war es, die derzeit akkreditierten Versorgungsforschungsstudiengänge in Deutschland im Hinblick auf ihre Strukturdaten und Inhalte zu analysieren.Im Rahmen eines deskriptiven qualitativen Designs wurden die aktuellen Studienverlaufspläne, die Modulhandbücher und die Steckbriefe akkreditierter Masterstudiengänge der Versorgungsforschung inhaltsanalytisch ausgewertet.Die 6 analysierten Studiengänge zeigen sich hinsichtlich ihrer strukturellen Merkmale und lehr-lerninhaltlichen Ausrichtung in den wesentlichen Punkten als homogen. Ziel aller Studiengänge ist es, fach- und disziplinübergreifende personale und soziale Kompetenzen zu fördern, um Versorgungsbedarfe im Gesundheitswesen zu identifizieren, Innovationen der Versorgung zu entwickeln, zu initiieren, zu evaluieren und kritisch zu reflektieren.Trotz ähnlicher Lehr-Lerninhalte bestehen spezifische Ausrichtungen, für die sich die Studierenden vor dem Hintergrund ihrer individuellen Präferenzen entscheiden können. Diese Ergebnisse könnten unter Berücksichtigung aktueller Diskurse und weiterer Erkenntnisse als Grundlage für Empfehlungen zur Entwicklung eines Kerncurriculums dienen.

Zusammenfassung Im Rahmen der BMBF-Ausschreibung „Strukturaufbau in der Versorgungsforschung“ wird das Kolner Kompetenznetzwerk CoRe-Net von verschiedenen Partnern aus der Versorgungspraxis und der Versorgungsforschung aufgebaut. Der Fokus des Netzwerkes liegt auf der Versorgungsentwicklung nach dem Konzept der lernenden Organisationen. Anhand dreier Forschungsprojekte wird sich das Kolner Kompetenznetz nachhaltig etablieren und fur zwei vulnerable Patientengruppen die Versorgungsgestaltung in Koln betrachten. Bei den Patientengruppen handelt es sich um a) verstorbene Patientinnen und Patienten in Koln und b) Menschen mit einer chronischen Herzerkrankung und einer psychischen Begleiterkrankung. Das Kolner Kompetenznetzwerk CoRe-Net orientiert sich am Value-based Healthcare-Ansatz nach M.E. Porter.

Purpose In order to design a patient-centered discharge process, the entire process is visualized in Value Stream Mapping. The duration of the process steps and waiting times are measured and presented. As a team, health professionals discuss problems and agree on suitable solutions. Methods After applying Value Stream Mapping, we conducted eight interviews in 2018, four with physicians and four with breast care nurses. We used the Consolidated Framework for Implementation Research to develop the interview guide and to identify categories for content analysis. To identify the differences in attitude and experience between the occupational groups, we conducted a framework analysis. Results Each team of health professionals developed action steps to optimize the discharge process. Obstacles became apparent in the implementation of these action steps. The lack of adequate staff and complex structures were identified as the main factors. These hierarchical structures also prevented a patient-centered discharge process independent of patient-centered care by health professionals. Self-efficacy varied more among breast care nurses than physicians. The group of physicians perceives standardization in the discharge process critically and therefore assumes limitations in transferring Value Stream Mapping to hospitals. The breast care nurses were open in their attitude. Financial incentives contribute to the acceptance of the method. Conclusion Value Stream Mapping is a simple way to uncover waste and develop applicable action steps. Since the implementation of the action steps was hindered by hierarchical problems and a lack of resources, management involvement and a hospital-wide approach could be beneficial.

Background Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients’ value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities. Methods A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian’s model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered. Results Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing. Conclusions For a final conclusion about Value Stream Mapping’s effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review’s conclusion, the limitation of including heterogeneous and potentially biased results has to be considered. Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0563-y) contains supplementary material, which is available to authorized users.

IntroductionPatients with end-stage kidney failure can be treated either by transplant or by dialysis, which can be administered as haemodialysis (HD) or peritoneal dialysis (PD). Although they are equivalent therapeutic options in terms of mortality, the percentage of patients in Germany treated with PD is currently very low (∼6%) compared with other countries. The aim of our study is to analyse the factors behind this percentage and their relevance to the choice of dialysis treatment in Germany. This includes analyses of regional disparities in the provision of care for dialysis patients as well as the evaluations of costs and the influence of reimbursement structures. This approach should provide further insights to explain the variation in the usage of PD and HD and will help to define starting points for future interventions.Methods and analysisA mixed-methods approach will be applied to several data sources, including administrative data (ambulatory physicians’ claim data, statutory health insurance claim data), quality assurance data from one of the largest German dialysis providers Kuratorium für Dialyse (KfH) and qualitative and quantitative survey data (patients, nephrologists and dialysis nurses). Qualitative data will be analysed content-analytically. Based on the quantitative data, multivariable analyses will be performed and, where possible, hierarchical models will be tested. This multidimensional approach will enable us to account for the different factors influencing the penetration of PD in Germany.Ethics and disseminationEthics approval (17-299) has been obtained from the Ethics Committee of the Medical Faculty of the University of Cologne on 25 April 2018. National and international dissemination will be accomplished by informing healthcare practitioners, patients and professional organisations and other stakeholders via conferences, scientific and non-scientific publications and seminars.Trial registration numberDRKS00012555; Pre-Results.

Susanne Fuß und Ute Karbach geben praxisnahe Anleitungen zur Transkription von wissenschaftlichen Interviews für die qualitative Sozialforschung. Das Grundlagen-Handbuch führt in die Praxis der sozialwissenschaftlichen Transkription ein. Es richtet sich an Studierende oder wissenschaftlich tätige Personen, die zum ersten Mal Interviews oder Gruppendiskussionen zur sozialwissenschaftlichen Analyse transkribieren. Der Band stellt die Grundlagen der Transkription und deren Anwendung vor, zeigt die Vor- und Nachteile von Spracherkennungs- und Transkriptionssoftware und gibt Tipps für Problemfälle.

Eleven months after being interviewed in a study on unmet needs of severely affected multiple sclerosis patients, one participant died by assisted suicide. We reanalyzed the data to find out if our 15 study patients might have brought up the topic of death and dying during episodic interviews that had not primarily addressed this issue. Secondary analysis with regard to the thematic field of death and dying revealed that patients unsolicited brought up this issue within the following categories: “Passing over death and dying,” “Death is not relevant to me,” “We want to keep up the life challenge,” “Death as an option,” and “Wish to have the opportunity to address end of life issues.” We conclude that the topic of death and dying is of importance to these patients, as they spontaneously mentioned it in multiple varieties. Health professionals should individually acknowledge patients' needs to address death and dying.

The third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research.

Zusammenfassung: Das Gesetz zur Verbesserung der Versorgungsstrukturen in der gesetzlichen Krankenversicherung (GKV-VStG) zielt auf die Sicherung einer wohnortnahen, flächendeckenden und bedarfsgerechten medizinischen Versorgung. Das Ziel ist somit, das Versorgungsangebot am Bedarf auszurichten. Der Begriff „Bedarf“ wird im Bereich der Gesundheitsversorgung sehr häufig genutzt und dabei unterschiedlich definiert. Ziel dieser Arbeit ist es, unterschiedliche Aspekte von „Bedarf“ aufzuzeigen und Handlungsfelder zu identifizieren.