Improving care coordination for patients with cardiac disease: Study protocol of the randomised controlled new healthcare programme (Cardiolotse)

Geiger, Isabel; Reber, K.; Darius, Harald; Holzgreve, Alfred; Karmann, Sebastian; Liersch, Sebastian; Stürtz, Anica; Riesner, Petra; Sundmacher, Leonie

doi:10.1016/j.cct.2021.106297

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Thus, to reduce the workload on physicians and to improve integrated care, recent studies tested innovative methods of healthcare delivery for people with multimorbidity and chronic diseases. 25–27 Using the evidence provided in this article combined with recent studies, 28 , 29 we recommend healthcare planners to further target the existing shortage of GPs and specifically consider regions with a greater likelihood of multimorbid patients next to other drivers such as age and socio-economic status (SES) to ensure continuous healthcare provision in such regions.…”

Section: Discussionmentioning

confidence: 94%

Regional variations in multimorbidity burden among office-based physicians in Germany

Geiger

Flemming

Schüttig

et al. 2023

European Journal of Public Health

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Background Multimorbidity is associated with higher utilization of healthcare services. However, many countries do not consider multimorbidity when estimating physician supply. The main aim of this study was to assess how regional multimorbidity levels can be integrated when estimating the need for office-based physician supply. Methods Claims data were used to measure and compare the proportions of multimorbid patients of GPs, ophthalmologists, orthopaedic specialists and neurologists, and examine spatial variations through Bernoulli cluster analysis of regional multimorbidity levels. To explore the interrelationship between current capacities and spatial occurrence of high-rate clusters, clusters were compared with the current supply of physicians. Results About 17 239 488 individuals out of approximately 67 million records were classified as multimorbid. Multimorbidity levels varied greatly between physician disciplines (31.5–60.1%). Bernoulli cluster analysis demonstrated that many high-rate areas were found for all specialized physicians, but clusters varied partially by size and location. The comparison with current physician supply at cluster level showed that more than a third of clusters with a significantly higher share of morbid patients seeing a GP are met, on an average, by GP supply below targeted values. In turn, clusters with significantly higher multimorbidity levels of specialized physicians were met, on an average, by supply that exceeded targeted values. Conclusion Our study offers an approach to how to include discipline-specific multimorbidity at area level when estimating physician supply and discusses its relevance. The outcomes of our article can be used by policymakers to advance current planning strategies and to improve the quality of office-based care.

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Section: Discussionmentioning

confidence: 94%

Regional variations in multimorbidity burden among office-based physicians in Germany

Geiger

Flemming

Schüttig

et al. 2023

European Journal of Public Health

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“…Dem Verständnis von Wendt folgend, übernehmen Patientenlotsen im Case Management-Prozess die folgenden Rollen [14] Insbesondere Patienten mit einem komplexen und/oder langfristigen Versorgungsbedarf können stark von einem solchen Case Management durch Patientenlotsen profitieren, da sie vergleichsweise häufig zwischen verschiedenen Behandlern und Versorgungsbereichen wechseln müssen oder mit sozialrechtlichen Fragen, beispielsweise zu Lohnersatz-, Pflege-, oder Rehabilitationsleistungen, konfrontiert sind [10]. Verschiedene Lotsenkonzepte, beispielweise im Bereich der Onkologie [15,16,17], oder der Kardiologie [18,19], wurden bzw. werden bereits in Modellprojekten erprobt und durch den Innovationsfonds gefördert mit dem Ziel, diese als integralen Bestandteil in die reguläre Versorgung zu überführen [16,19].…”

Section: Hintergrund Und Zielsetzungunclassified

“…Vorliegend war eine professionelle Perspektive auf den Forschungsgegenstand von Interesse, während die Patientenperspektive nicht explizit berücksichtigt wurde. Innerhalb der einzelnen Lotsenprojekte wird die Patientenperspektive regelmäßig mithilfe von Lebensqualitätsfragebögen ermittelt 15 , 17 , 18 . Die Perspektive von Patienten auf das hier entwickelte Kategoriensystem bietet sich als Untersuchungsgegenstand weiterer qualitativer Studien an.…”

Section: Limitationenunclassified

Management komplexer Behandlungsbedarfe durch Patientenlotsen – eine qualitative Studie zur Erfassung des Status quo in der GKV

Brandt¹,

Salm²

2021

Gesundheitsökonomie & Qualitätsmanagement

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Zusammenfassung Zielsetzung Seit mehreren Jahren werden Lotsenansätze zur patientenorientierten Versorgungskoordination in unterschiedlichen Modellprojekten erprobt. Diese Studie soll beantworten, welche projektübergreifenden Erkenntnisse hinsichtlich Zugangsvoraussetzungen, organisatorischer Rahmenbedingungen und Zielgruppen gewonnen werden konnten und welche Implikationen sich hieraus für den Transfer in die bundesweite Regelversorgung ergeben. Methodik Die erforderlichen Daten wurden in einem qualitativ-explorativen Forschungsdesign erhoben. Es wurden leitfadengestützte Interviews mit 14 einschlägigen Experten geführt, aufgezeichnet, transkribiert und mittels qualitativer Inhaltsanalyse ausgewertet. Ergebnisse Haupteinsatzgebiet laut den Experten sind komplexe Behandlungssettings sowie Patientengruppen mit besonderem Unterstützungsbedarf. Neben einer Ausbildung und Berufserfahrung im Bereich der Humandienstleistungen, ist eine sozialrechtliche Schulung als Zugangsvoraussetzung sinnvoll. Auch eine klare Definition und Abgrenzung des Tätigkeitsprofils sowie eine Verzahnung mit der ambulanten und stationären Versorgung wurden mehrfach als hilfreich genannt. Die Experten waren sich weitestgehend darüber einig, dass Patientenlotsen strukturell in der GKV angesiedelt werden sollten. Eine Finanzierungsbeteiligung anderer Sozialversicherungssysteme sei aufgrund inhaltlicher Überschneidungen jedoch angemessen. Schlussfolgerung Patientenlotsen unterstützen bedürftige Patienten bei der Koordination komplexer Versorgungsbedarfe und leisten damit einen Beitrag zur Verbesserung von Effektivität und Effizienz der Gesundheitsversorgung. Nachdem eine Vielzahl von praktischen Erkenntnissen zum Einsatz von Patientenlotsen in entsprechenden Modellprojekten gewonnen werden konnte, erscheint eine Übertragung in die bundesweite Regelversorgung nun geboten.

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“…Additionally, collaboration between general practitioners and hospital physicians is essential, so that the healthcare chain is efficiently organised. 4 In the need for change, the "not invented here syndrome" may play a role. Healthcare organisations might not be willing to adopt a model that was not developed internally but imposed upon them by outsiders.…”

Section: Introductionmentioning

confidence: 99%

“…Payers may be more focused on managing costs and ensuring that they are paying for high‐quality and effective care, while providers may be focused on increasing revenues and delivering high‐quality care. Additionally, collaboration between general practitioners and hospital physicians is essential, so that the healthcare chain is efficiently organised 4 . In the need for change, the “not invented here syndrome” may play a role.…”

Section: Introductionmentioning

confidence: 99%

How to facilitate the introduction of value‐based payment models?

Leao,

Pavlova,

Groot

2023

Health Planning & Management

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Value‐based payment (VBP) models are designed and implemented to improve outcomes at the same or lower costs. Their adoption requires significant changes in the way healthcare organisations and insurance companies operate. Usually, before VBP models are widely implemented, pilot projects are conducted. Payers need to have a comprehensive set of requirements to enter into agreements with healthcare organisations on these pilots. In this short communication, we outline key elements reported in the literature, inside and outside healthcare organisations, as well as within the contract, that need to be considered in a pilot VBP model. Discussions regarding the introduction of VBP models may be strongly affected by external contextual factors, including regulations, which are outside the control of healthcare organisations. It requires collaboration between organisations, including primary care organisations and hospitals, while within organisations, it frequently requires creating multidisciplinary teams. The focus is on ensuring transparency, collaboration, and shared decision‐making, realised by standardising communication processes and regular meetings. Additionally, effective leadership is needed, in which leaders set goals and priorities, as well as manage change. In the contractual agreements between payers and healthcare organisations, outcome measures need to be adequately defined and measured, including individual patient outcomes and composite scores, as well as absolute and relative performance measures. These measures should be tested periodically and catered to the organisations adopting the model. Also, incentives should have adequate size and frequency and be intrinsic and extrinsic. The consideration of these sets of key elements by the payers is essential when implementing VBP model pilot projects.

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Improving care coordination for patients with cardiac disease: Study protocol of the randomised controlled new healthcare programme (Cardiolotse)

Cited by 5 publications

References 19 publications

Regional variations in multimorbidity burden among office-based physicians in Germany

Regional variations in multimorbidity burden among office-based physicians in Germany

Management komplexer Behandlungsbedarfe durch Patientenlotsen – eine qualitative Studie zur Erfassung des Status quo in der GKV

How to facilitate the introduction of value‐based payment models?

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