The 2nd Charité Healthcare Research Congress, like the first one last year organized by the “Platform – Charité Healthcare Research”, took place purely online, like so many events these days. Nevertheless, this conference format also offered a great deal of insight. On the one hand, through the satellite symposium on the first evening of the congress, which presented one of the Charité's many innovation fund projects from the “New Forms of Care” funding area, and on the other hand, through seven sessions taking place in parallel the next day. However, just like last year, the plenary session was particularly impressive. After the welcome from Prof. Dr. Martin Möckel, the current spokesman for the “Platform – Charité Health Care Research”, and greetings from Prof. Dr. Axel R. Pries (Dean of the Charité) and Prof. Dr. Martin E. Kreis (Board of Health Care at the Charité) spoke in his keynote speech by Prof. Dr. Reinhard Busse from the Technical University of Berlin on “Care in times of Covid-19: Has it changed the need for reform in the health system?”
>> “The healthcare researchers at the Charité have intensively participated in tenders and acquired third-party funding,” said the dean of the Charité, Prof. Dr. Axel R. Pries, in his welcoming speech, was more than satisfied with around 150 research projects in the area of health services research that were initiated by his company's researchers and are gradually being completed. According to the dean of the Charité, health services research has become a “very visible part and a very visible component of the research strategy at the Charité”. Which, Pries continues, is also appropriate because “care research has become increasingly important”. However, this did not only become clear due to the pandemic, because health services research has long been the research area “in which the developments and possibilities of medicine” are researched exactly where they actually reach patients.
“Why is health services research important, why is health services research important?” This rhetorical question was answered by Prof. Dr. Martin E. Kreis said: “As the Charité’s Health Care Director, I am aware that in the next few years we will be faced with significantly more demands from society, from patients, but also from their relatives, and especially from those who give us money – i.e. politicians and of course the health insurance companies.” All these stakeholders would create pressure to show “what we actually do with the resources that are made available to us”. However, Kreis does not mean the classic presentation of case numbers and treatment steps. In his opinion, in the future it will become more and more important to be able to show “what results in care in terms of results”. According to Kreis, you don't have to be a clairvoyant to anticipate that the transparency of the issues of quality and performance will increasingly take up more space in social discourse than before. Kreis: “In order to be able to answer these questions even approximately, it is imperative that we pay more attention to what the care really looks like, what necessary services have to be provided as part of the care, and - you shouldn't do that either overlooked – where there may be gaps in our system, where care is not being provided in an adequate manner and where we need to make improvements.”
That was just the perfect transition to the keynote lecture by Prof. Dr. Reinhard Busse, who heads the Health Care Management department at the Faculty of Economics and Management at the Technical University of Berlin. His presentation was titled “Care in times of Covid-19” and was intended to answer the following question: “Has the pandemic changed the need for reform in the health system?” Busse’s tour de force through current developments in the health care system, especially in the inpatient area, made it clear: The Hospital reform, which has been pushed into the background by the corona pandemic, is more urgent than ever. This is particularly visible in the high number of hospitals and hospital beds in Germany, which is fueled by the belief that proximity is the most important quality feature, indeed - as the German Hospital Association explicitly believes - an international quality indicator. “By the way, that’s not it,” said Busse, pointing out that quality is the most important feature of good health care.
To do this, Busse took a look at any day in Germany: with (as of 2018) 380,000 inpatients in hospital, 53,000 emergency room visits and inpatient hospital admissions, but 120,000 empty beds. If you take a closer look at the emergency room cases, you can also see that only 500 heart attack patients are treated in one day. “Heart attacks usually serve as an example of why we need so many hospitals so that everyone has access to the hospital as quickly as possible,” explained Busse and answered the question: “What use is it if the patient with a heart attack is in a hospital quickly? can neither diagnose nor treat it adequately?”
That is exactly the case in Germany. Although patients with heart attacks are treated in 1,378 hospitals, i.e. practically every hospital in Germany, it is shockingly noticeable that half of these hospitals are not adequately equipped for this at all. Only 613 of these hospitals have a cardiac catheter laboratory with 24/7 availability. The result can be seen in the heart attack mortality in the hospital. The latest data for 2017 would show that 13% of heart attack patients are transferred and 8.5 percent of heart attack patients treated in hospital die. Which is high in international comparison: Denmark 3.2% mortality, Netherlands 3.5%, Sweden 3.9% or France with 5.6%. It doesn't sound like much, but it's dramatic. Because: The difference of 8.5% heart attack mortality here compared to France means over 5,000 deaths, compared to the Danish level even 10,000. But people in this country still argue that we need so many hospitals because otherwise patients would have to travel too far.
Busse brought this example alongside that of pancreas and liver procedures only to demonstrate a “systematic structural problem”. However, something that Busse would actually have thought that knowledge of it would have already penetrated politics. But then Corona came and suddenly it would have been said: “The bus is talking nonsense, we need every bed.” He quoted from the editorial by Georg Baum, the then managing director of the German Hospital Association, who was at the beginning of the crisis in March last year The magazine “Das Hospital” wrote the following: “The world looks with envy at Germany’s hospitals. The standard repertoire of the local criticism community is no longer convincing. Too many, too expensive hospitals, unnecessary services, inadequate quality – that no longer works. Bertelsmann is wrong1. Comprehensive public services are more demanding than games on greenfields.”
Busse counters: Anyone who could count would realize that there are 500,000 hospital beds in Germany, which is why Covid hospitals set up in exhibition halls are certainly not needed in this country. However, Corona is the “litmus test”, but also the data enabler, because before the pandemic it was almost impossible to get the relevant figures from InEK in a timely manner. Now his team would have received not only the data for 2019, but also the data for 2020, which before the pandemic would not have been available until 2022.
The evaluation possible using this data shows that in 2019, before the pandemic, a quarter of the beds in the DRG hospitals - which charge flat rates per case - were free. Busse: “We always thought that this was the case with 20% because the Federal Statistical Office reported DRG hospitals and psychiatric hospitals together.” But now you not only need normal hospital beds, but especially intensive care beds and, in any case, trained staff for them . Here, too, according to Busse's statement, around 30% of the beds in the intensive care units were free in 2019, i.e. before Corona, and around 10% in psychiatric hospitals.
Then the pandemic came. And the number of additional free beds has increased significantly - due to the decline in elective operations - from a quarter to around a third of free beds (see p. 20/21). The following applies: “In the country's biggest health crisis, the hospitals were empty like they have never been before.” Busse: “I don't know whether you want to call it the creation of legends, but every hospital is now saying how important they are in the world pandemic.”
His figures also show that in 2020 only around one in 30 beds per day was occupied by Covid-19 patients. The sheer number makes it even clearer: of the around 17 million inpatient cases in 2020, just 172,000 Covid cases were in inpatient treatment, which corresponds almost exactly to a single percent of all inpatient cases.
But how many were there exactly? The InEK numbers provided to buses do not reflect this exactly, as the data used here reports cases and not patients. It is also not possible to examine individual hospital cases because, for example, the Charité appears as a single hospital in the data.
However, based on the AOK figures available to him, Busse estimates that of the reported 172,000 inpatient Covid cases in 2020, over 101% were transferred. This means that there are around 155,000 patients behind the 172,000 cases. There were even more transfer cases among ventilated patients: 30%. According to Busse, this is an “unheard of number of transferred cases”. This meant that “almost one in three” were transferred, often to houses with more experience. For comparison: According to Busse's figures, around 13 percent of patients with heart attacks are transferred.
Busse sees this as a sign that small hospitals were often overwhelmed when it came to caring for serious Covid-19 cases, otherwise these patients would not have been transferred to larger hospitals so frequently. But that can only be an assumption, because the InEK data does not reveal why and where exactly these patients were transferred. <<
from:
MVF editor-in-chief Peter Stegmaier
ANNOTEM – Acute neurological care in Northeast Germany with telemedical support. Results on the establishment of a teleneurological network in Northeast Germany. Presented by: Dr. Hebun Erdur, Clinic for Neurology with Experimental Neurology
Survivorship Clinic – Consultation hours for long-term survivors with gynecological tumors. Presented by: Dr. Hannah Woopen, Clinic for Gynecology with Center for Oncological Surgery (CVK)
Abdominal Pain Unit: Standardized structured care for patients with traumatic abdominal pain in the emergency department (APU). Presented by: Dr. Lukas Helbig, emergency and acute medicine (CCM/CVK)
PRO B – an RCT to evaluate the effects of intensified PRO monitoring in metastatic breast cancer patients. Presented by: Dr. Maria M. Karsten, Clinic for Gynecology with Charité Breast Center (CCM)
KORE – A prospective, multicenter, open study to implement and analyze the effects of an innovative perioperative treatment process to reduce complications in patients
inside with OVARIal carcinoma (KORE-OVAR innovation). Presented by: Dr. Gülhan Inci, Clinic for Gynecology with Center for Oncological Surgery (CVK)
PREP-GO - Prehabilitation of elderly patients with frailty syndrome before elective surgery - Study protocol of a randomized, controlled, endpoint investigator blinded, multicenter intervention study. Presented by: Prof. Dr. Dr. Stefan Schaller, Clinic for Anesthesiology with a focus on surgical intensive care medicine (CCM/CVK)
SMARTGEM – Effectiveness of smartphone-assisted migraine therapy – a randomized controlled trial. Presented by: PD Dr. Lars Neeb, Clinic for Neurology with Experimental Neurology
TRANSLATE NAME – Implementation of new diagnostic methods for patients with rare diseases: experiences and results from the innovation fund project. Presented by: Prof. Dr. Heiko Krude, Institute for Experimental Pediatric Endocrinology
conneCT CF – Coaching and telemonitoring for patients with cystic fibrosis. Presented by: Dr. Stephanie Thee, Department of Pediatrics mS Pulmonology and Immunology with Intensive Care Medicine
ERIC – Tele-intensive care: Scaling in the pandemic and beyond. Presented by: Dr. Björn Weiß, Clinic for Anesthesiology with a focus on surgical intensive care medicine (CCM/CVK)
Further sessions:
1: Gaining knowledge through the use of secondary data
2: Experiences of stakeholders in the healthcare sector – challenges and opportunities
3: Patient perspective and orientation
4: Health services research on traumatic paraplegia
5: Use and benefits of digital technologies
6: Analyzes of the supply situation in the Berlin-Brandenburg region
7: Medical care for old people and people in need of care
