The KV RegioMed program for structural migration in the Templin region is more than just a pilot project. It is not merely an attempt to use the given prevalence rates in a region – in the Uckermark region, specifically in the Templin area – to make predictions about diseases in the coming years and decades, but rather to draw conclusions about how healthcare restructuring should look in the foreseeable future in order to create a more targeted and thus better-suited regional healthcare system through inpatient and outpatient structural migration.
Current analyses of the population structure of the Templin region predict a population decline of 21,113,000 by 2030, accompanied by a significant shift in the age structure. An aging population, often suffering from chronic illnesses and multiple comorbidities, is contrasted by a decreasing number of younger people. Against this backdrop, and to illustrate the healthcare situation, a detailed analysis entitled "Regional Healthcare Needs in the Templin Region" was conducted in 2013 by the Brandenburg Association of Statutory Health Insurance Physicians, the Central Institute for Statutory Health Insurance Physicians (Zi), and the Independent Center for Empirical Market and Social Research (UCEF GmbH).
The study revealed that, with regard to both the age and gender structure as well as the average healthcare needs of patients, the region under investigation will face significant challenges to healthcare and public services within the next 10 to 15 years. The analysis of patient flows showed that the utilization of specialist medical care is highly heterogeneous. Particularly for cardiovascular diseases, which rank highly, a large proportion of medical treatments for patients from Templin are provided outside the Uckermark planning area or on an inpatient basis.
This presents an opportunity to simultaneously improve and streamline local healthcare provision. A significant shift in the age structure of the population is expected in the Templin region. An increase in the average age will lead to a rise in the required services per patient, placing Templin in the top third when compared to other Brandenburg regions in this regard. This development will also alter the morbidity profile. Diseases such as dementia and Parkinson's disease, which become more prevalent with age, will gain in importance. Finally, the existing centralized specialist care system, combined with the aging population and the associated increasing mobility, will make access to specialist services more difficult.
This poses a particular challenge as multimorbidity increases with age, necessitating a wide range of specialist medical services in different locations. Therefore, multidisciplinary and cross-sectoral coordination of medical treatment will be especially crucial in the future.
These forecasts regarding population and morbidity trends in the Templin area and the presented effects of demographic change on future care needs gave cause for action and thus led to the first step: the establishment of outpatient geriatric care in the Templin area in cooperation with inpatient geriatric care at the local hospital.
The KV RegioMed Center, which already offers outpatient geriatric, gastroenterological and cardiological care and has been financed through selective contracts since the beginning of the year, forms the basis for the next steps towards a comprehensive structural migration of inpatient and outpatient medical care in the region.
The establishment of an outpatient-inpatient bridging structure within the framework of the KV RegioMed Center is not sufficient on its own to completely resolve the local care structure deficits. Rather, further structural measures are needed, as described by AGENON Gesellschaft für Forschung und Entwicklung im Gesundheitswesen mbH (AGENON Society for Research and Development in Healthcare) in its 2014 feasibility study on the conditions for establishing a cross-sectoral care chain in geriatric medicine at the Templin location. Focusing on the question of whether a cross-sectoral care chain already exists, an inventory analysis was conducted in order to subsequently provide corresponding recommendations for action. Local stakeholders, such as medical care centers, general practitioners, and hospitals, were surveyed regarding the current state of geriatric care in the region and where they see a need for development. The area of nursing care must also be included in the analysis, as well as the possibilities of volunteer support, municipal services, and modern information and communication technologies. Among other things... It was determined that great emphasis must be placed on multi-professionalism in order to meet future supply needs.
The preliminary study, entitled "Empirical Analyses of Epidemiology, Reasons for Treatment, and Care in the Templin Area," commissioned by AOK Nordost and BarmerGEK and also conducted by AGENON, further investigated inpatient and outpatient healthcare utilization with regard to potential similarities in clinical presentations. The aim was to determine which current and future conditions should be the focus of care development, following the principle of outpatient before inpatient treatment. To this end, data such as the age and gender of the Templin area's resident population, the number of insured individuals with care levels, medication use, and travel distances were analyzed. The three most frequent conditions identified were: cardiovascular diseases (e.g., hypertension), endocrine diseases (e.g., diabetes mellitus), and musculoskeletal disorders (e.g., back pain, rheumatism).
The goal of the KV RegioMed program – structural migration in the Templin region – is to create equivalent medical care for all population groups in the Templin region. The described changes in population size and structure will generate significantly altered demand for outpatient, inpatient, nursing, social, and therapeutic services in the healthcare sector, necessitating far-reaching adjustments to healthcare offerings in the Templin region. A declining number of physicians willing to establish their own practices and increasing difficulties in filling positions in the inpatient sector, as well as in nursing, rehabilitation, and therapy, due to a lack of qualified personnel, present further challenges that the project addresses.
The „Innovative Health Care in Brandenburg“ – IGiB GbR, a working group consisting of the Association of Statutory Health Insurance Physicians of Brandenburg, the AOK Nordost and the BARMER GEK according to § 219 SGB V – has made it its mission to develop future-oriented care structures to secure and improve long-term, regional and comprehensive health care.
The project partners of the structural migration project in Templin, IGiB and Sana Kliniken Berlin-Brandenburg GmbH (the operator of the hospital in Templin), have agreed to further develop the current hospital site in Templin as an example of structural migration of medical care in a structurally weak rural region. The focus is on securing and improving the quality and efficiency of care through the interdisciplinary and cross-specialty, as well as multi-professional, integration of outpatient, inpatient, general practitioner, specialist, rehabilitative, and nursing care services, potentially also including social and, where applicable, supplementary volunteer services.
Particularly in structurally weak regions, the state, districts, and municipalities bear a special responsibility: creating the conditions for ensuring medical care as a task for society as a whole. Furthermore, the involvement of the Ministry of Labor, Social Affairs, Health, Women and Family is necessary in the context of a required restructuring of existing local hospital structures. With a view to creating a needs-based and cost-effective service structure, the inclusion of all local healthcare stakeholders is essential. The individual services and stakeholders must not be considered in isolation, but are required to operate within a cooperative and coordinated process and communication structure.
From: Lutz O. Freiberg / IGiB GbR
