>> Excellent research centers and collaborative initiatives in the field of health services research have been founded and pooled in Hamburg over the last few years. The Center for Health Care Research (CHCR) was founded in 2006 as a scientific cooperation network between the University Hospital Hamburg-Eppendorf (UKE), the University of Hamburg and the Albertinen Hospital. The UKE also relies on health services research as one of five research projects chosen by the Science Council for the UKE
recommended research priorities. In addition to the CHCR, the Hamburg Center for Health Economics (HCHE), founded in 2011, another joint research center between the University of Hamburg and the UKE, deals with questions of health economics and health services research. The HCHE is one of four centers for health economics research nationwide that is funded by the BMBF over a period of eight years. These extraordinary infrastructural requirements offer a great opportunity to make a significant contribution to improving health care in the Hamburg metropolitan region.
In 2015, the Federal Ministry of Education and Research announced the funding priority “Structural development in health services research”. With the support of numerous partners from science, care, patient organizations and health insurance companies as well as health policy in the region, the CHCR successfully applied with the concept for setting up the HAM-NET.
The overarching goal of HAM-NET is to promote and coordinate healthcare research as well as to connect healthcare research and healthcare practice in the Hamburg metropolitan region. Specifically, the network has the following tasks:
1) Initiation of sustainable collaboration,
2) Linking health services research with all relevant actors,
3) Creating synergies between research and supply facilities,
4) promoting research activities,
5) opening new research fields,
6) Use of methodological and clinical expertise and
7) Promoting young scientists.
Second HAM-NET symposium
Part of the HAM-NET is also the annual organization of a one-day congress by the network. After the kick-off event in June 2017 on the topic of “care design”, HAM-NET invited people to the 2nd symposium in the Erikahaus at the UKE on May 31, 2018. Over 140 participants accepted the invitation, who were able to find out more about the network, exchange ideas with numerous players in the healthcare system and get to know current topics and projects in healthcare research.
Emergency care
The thematic focus of this year's symposium was emergency care. After the introduction by Prof. Dr. Dr. Martin Härter introduced Prof. Dr. Jonas Schreyögg (HCHE, member of the Council of Experts) presents the future of emergency care in Germany from the perspective of the Council of Experts for assessing developments in the healthcare system. According to the Council of Experts, the need for action arises primarily from the tripartite care (established doctors and statutory health insurance on-call service, emergency service). , emergency rooms in clinics), sharply increasing use of emergency rooms in clinics and the associated long waiting times, financial disincentives (e.g. RTW transport) and overload and dissatisfaction of the staff. The result is that care is often not adequately tailored to needs. The Expert Council's draft for integrated emergency care provides, among other things, for the establishment of integrated control centers with appointment allocation for both integrated emergency centers and general practitioners and the emergency services as an independent service area. In addition, the center should be set up according to a step-by-step concept and the integrated emergency center should act as a central contact point with its own remuneration and independent triage.
The head of the health authority, Dr. Matthias Gruhl, then presented the future of emergency care in Hamburg from the perspective of the Hamburg Authority for Health and Consumer Protection. Also Dr. Matthias Gruhl identified a need for action in the area of emergency care, especially in patient management. Direct patient control can be influenced by personal financial contributions, information, improved offers, difficulty of access and access restrictions. Some of these options, according to Dr. However, Gruhl has proven to be of little help in practice (such as the “practice entry fee” or long waiting times). After carrying out the PiNo study (= patients in the emergency rooms of northern German clinics: clientele, treatment paths and reasons for use), funded by the Hamburg Association of Statutory Health Insurance Physicians (KVH) and the Schleswig-Holstein Association of Statutory Health Insurance Physicians, a catalog of measures was implemented in Hamburg , which aims to better inform patients and expand the offering. In addition, an important aspect that must be taken into account when restructuring emergency care is the interests of the clinics. Because emergencies are, according to Dr. Gruhl is economically interesting for hospitals for several reasons:
1) No instructions are necessary
2) they are administratively manageable,
3) they allow flexibility in the utilization of the house,
4) they offer billing options for services outside of approved disciplines,
5) the quantity agreement can be circumvented and 6) MDK checks can be avoided.
Therefore, the implementation of the draft of the Council of Experts - also with a view to the coalition agreement - is expected to have serious effects on the health system. The number of emergency rooms would have to be reduced and hospitals will fight among themselves to maintain an integrated emergency center in order to maintain access to emergency patients. In order to get to grips with the challenges in emergency care, the authority believes that a more fundamental cross-sector approach should be developed that is not limited to emergency care.
In the subsequent discussion, in which, in addition to the speakers, Maren Puttfarcken (TK), Prof. Dr. Martin Scherer (UKE) and Walter Plassmann (KVH) were guests on the podium, the lectures were controversially discussed. Walter Plassmann, for example, pointed out that the KVH does not see the solution to the problems in setting up a uniform control center. Others welcomed the Council of Experts' proposal and the investment in better structures (integrated emergency centers, common telephone number and connection to other sectors). Prof. Dr. Scherer (UKE) emphasized the need for the KVH to evaluate such complex interventions and the recently introduced measures in order to make well-founded decisions on how to proceed. An evaluation by the KVH has already begun. With a view to health services research, Prof. Dr. Schreyögg points out that there is still a lot to do in the area of emergency care, as there is a lack of systematic evaluation - mind you, even in “good practice” countries like Denmark. Access to relevant data in this area can still be expanded in Germany.
After the keynotes and the discussion, the participants had the opportunity to find out about 35 ongoing health services research projects from the Hamburg region at the poster exhibition.
New forms of care in Hamburg
The following program item “New forms of care in Hamburg” provided an in-depth insight into three large and ambitious projects that received funding from the Innovation Fund in the first wave.
Maren Puttfarcken and Prof. Dr. Wolfgang von Renteln-Kruse (Albertinen-Haus) presented the project “NetzWerk GesundAktiv - a cross-sector support and care network for older people in the Hamburg-Eimsbüttel district (NWGA)”. As part of the project, a cross-sector support and care network is being set up in the district, which aims to provide answers to demographic challenges by incorporating medical-geriatric skills and digital solutions. The aim of the project is to enable older people to live independently and self-determinedly in their own four walls for as long as possible. The target group are older people (usually 70 years and older) with an increased risk of needing help or care or with care level 1 to 3. The project initially starts in the Hamburg-Eimsbüttel district with a total of 1,000 participants (those insured with the participating health insurance companies). . The funding runs for four years with a maximum funding of 8.9 million euros and the consortium is managed by TK. The research department at the Albertinen-Haus carries out the structural and process analysis using the data from the coordinating office and the acceptance analysis using anonymized GKV routine data. Bielefeld University is conducting an effectiveness analysis and health economic evaluation as part of a control group comparison.
Alexander Fischer (Gesundheit für Billstedt/Horn UG) presented the INVEST Billstedt/Horn project (Hamburg Billstedt/Horn as a prototype for integrated full health care in deprived metropolitan regions) and the country's first health kiosk. The aim of the project is to improve the health opportunities of people in the Hamburg districts of Billstedt and Horn. To this end, the partners are building a patient-oriented and cross-sector health network that is aimed at increasing patient involvement, relieving the burden on doctors, using resources in a targeted manner and increasing the quality of care. Health for Billstedt/Horn UG controls the integrated care project, which is supported by the Innovation Fund with up to 6.3 million euros. The project, together with the numerous actors, focuses primarily on three areas:
1) health management,
2) supply management and
3) IT or networking.
Health management includes a newly built health kiosk as a “point of care”, risk factor management and measures to strengthen self-management. Care management includes cross-sector treatment programs, care coordinators in the family doctor's office and measures in the area of nursing. The networking consists of the IT exchange between the network members, the electronic patient file as well as the use of health apps and a health portal for patients.
Finally, Prof. Dr. Martin Lambert (UKE) presented the new form of care “RECOVER model of cross-sector coordinated, severity-graded, evidence-based care for mental illnesses”. The project aims to close the gaps in the care of mentally ill people with its holistic approach by providing controlled and centrally coordinated care for patients from the initial contact through the treatment period through to reintegration into everyday life. The consortium management of the project lies with the UKE and is supported by numerous partners from the Hamburg and Steinburg Itzehoe regions. The central component of the project is the so-called AID and CARE team
plays an important role in the RECOVER model. In the AID function, the team takes on comprehensive biopsychosocial interdisciplinary (initial) diagnostics, indications, treatment planning and managed care (implementation of the cross-sector treatment plan) and in the CARE function, acute treatment in the home environment (cross-sector, outreach crisis intervention - shortening and replacing wards) . The teams are not only multi-professional (doctors, psychologists, nursing, social workers, recovery assistants), but also interdisciplinary (adult psychiatry, child and adolescent psychiatry, psychosomatics, general medicine, sexual medicine/forensics, supported employment).
In addition to the AID/CARE team, the e-mental health platform eRECOVER, which consists of a portal and a therapy room, plays an important role. There are general ones on the portal
Find information about eDiagnostics, eTherapy, eLearning and much more. The data-protected therapy room contains the therapist and patient administration, the patient files and the offers for patients (e-consultation, e-diagnosis).
gnostics, eTherapy and eLearning).
The symposium concluded with the “Meet the Experts” program item, which was intended for the exchange and networking of all relevant players in the healthcare system (patient organizations, health insurance companies, professional associations, providers, authorities as well as the healthcare industry and supply companies).
research). The offer was aimed particularly at young people from different institutions in order to make low-threshold contacts and get to know different institutions and people.
Overall, the series of events and the network's activities in the Hamburg region fall on fertile ground. Thanks to structural and financial support for health care research at the federal level and especially in the Hamburg region, the time is currently extremely good to create evidence and initiate well-founded changes in health care. With regard to the innovation fund, the Hamburg region is involved in well over 30 projects on new forms of care and health care research or in the role of leading a consortium. This requires a high level of healthcare expertise and cooperation between various disciplines and actors in the healthcare system, which can be adequately bundled and coordinated by the network. <<
Authors:
Dipl. Soz. Daniel Bremer1 2,
Coordinator CHCR and HAM-NET, UKE
Prof. Dr. Susanne Busch2,
Department of Nursing and Management, Hamburg University of Applied Sciences (HAW)
Frank Liedtke2,
Barmer, Hamburg State Representative
Dr. Andreas Meusch2,
Representative of the Board of Directors for Strategic Issues in the Healthcare System, TK
Prof. Dr. Olaf von dem Knesebeck1 2,
Institute for Medical Sociology, UKE
Prof. Dr. Bernd Löwe1 2,
Institute and Polyclinic for Psychosomatic Medicine and Psychotherapy, UKE
Prof. Dr. Martin Scherer1 2,
Institute and Polyclinic for General Medicine, UKE
Prof. Dr. Dr. Martin Härter1 2,
Institute and the Polyclinic for Medical Psychology, UKE
1 = Center for Health Care Research (CHCR)
2 = Hamburg Network for Healthcare Research (HAM-NET)
