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Networks for the treatment of people with diabetic foot syndrome (DFS) in North Rhine, Hamburg and Berlin have submitted joint documentation. This is known as the DFS register [1] and is used for quality assurance and the identification of new findings for better care for people with DFS [2, 3]. The networks have taken further quality assurance measures, including certification by the AG Fuß of the German Diabetes Society (DDG), annual internships, training for doctors and assistants, communication tools and quality circles. In particular, they have set up a learning system with shadowing and a completely transparent comparison of all treatment numbers and a discussion about it. They have cared for an increasing number of people with DFS since 2002, with a total of around 60,000 people at the end of 2016. The following health insurance companies support these efforts through selective contracts: AOK Nordost, AOK Rheinland/Hamburg, BARMER, Bundesknappschaft, mhplus BKK, DAK Gesundheit, IKK classic, KKH, pronova BKK and SVLFG. Similar models have been implemented in other regions. This overview compiles the results of all analyzes that have become public in Germany that have examined the effects of specialized care for people with DFS in networks. The evaluations range from surveys in the DFS register to population-based surveys by independent scientists.
24.07.2017
On April 9, 2013, the Cancer Early Detection and Registration Act (KFRG) came into force. This law takes up the central recommendations of the National Cancer Plan (Federal Ministry of Health 2012): in addition to the establishment of nationwide cancer registries, this includes, among other things, the review of age limits, the promotion of informed decision-making, the optimization of information materials and the accompanying evaluation of early detection measures . Organized early detection programs should be offered for colon and cervical cancer, to which health insurance companies invite people. The Federal Joint Committee (G-BA) was commissioned with the specific design of the KFRG.
24.07.2017
According to calculations by the World Health Organization (WHO), around 10% of children worldwide and around 6% of children in Europe are born prematurely (1). Births before the 37th week of pregnancy (week of pregnancy) are defined as premature births (2). In neonatal intensive care, preterm birth is still the most common cause of neonatal and early childhood morbidity and mortality and can lead to lifelong health and psychosocial impairments (3–5). The health economic consequences associated with premature birth are also considerable (6). There are many factors that can lead to premature birth. Previous abortions and premature births, the increasing age of first-time mothers and the higher incidence of multiple pregnancies due to previous fertility treatments can cause premature births (4,7,8). Maternal infections, such as bacterial vaginosis, have also been identified as a cause of premature births, although the pathophysiological connections are not yet fully understood (9,2,10,11). The early detection and treatment of bacterial vaginosis can be implemented and carried out relatively easily and therefore represents a promising possibility to prevent preterm birth and to reduce the resulting health and psychosocial consequences.
24.07.2017
In addition to care in the acute phase, the guideline-based therapy scheme includes maintenance therapy after the depressive episode has subsided and prophylaxis for future episodes. Psychotherapy and pharmacotherapy are demonstrably effective treatment methods. Of the large number of people with depression requiring treatment, however, only a minority, estimated at less than 10 percent, receive adequate treatment (DGPPN et al. 2015). There are many possible reasons for this: a lack of hope and reduced drive on the part of those affected to get help, delayed diagnosis, deviation from the therapeutic guidelines in everyday family doctor work, and an insufficient range of psychotherapy places and the associated long waiting times. In addition, there are often irrational reservations on the part of those affected or their relatives about antidepressants, shame and stigmatization of the disease in the social environment, etc. This results in an urgent need for action - also for the private insurance industry -, the supply deficits due to inadequate medical supply structures and as a result of the disease and society-related high To lower the access threshold of utilization for the individual patient.
24.07.2017
The number of people in Germany who suffer from obesity - i.e. have a body mass index (BMI) of over 30 kg/m2 - has been increasing continuously for years. Almost a quarter of the adult population now suffers from obesity (Mensink et al. 2013). Obesity is defined as an excessive increase in body fat. The body mass index (BMI) is used to assess whether obesity is present. One speaks of obesity when the BMI is at least 30 kg/m². The growing number of people who are overweight - sometimes significantly - is widely recognized as one of the greatest challenges for the health systems of industrialized countries. With regard to Germany, Konnopka and colleagues (2009) estimated the direct and indirect costs of overweight and obesity in 2002 at a total of 9.87 billion euros. In a recently published update of this study for 2008, medical costs of 16.80 billion euros (12.24 billion of which were only for obesity) were estimated (Lehnert et al. 2015).
24.07.2017
In recent years, expectations of health care research in Germany, especially from a health policy perspective, have increased enormously [4, 5]. The main reasons are not only general social developments, but also the need for comprehensive improvement efforts and the need for effective structural innovations. Health services research must therefore continuously and comprehensibly develop its conceptual foundations, as is the aim in the memoranda of the German Network for Health Care Research and in the completely revised 2nd edition of the “Textbook for Health Care Research” [2].
24.07.2017
On June 16, 2016, the G-BA created new framework conditions for low-threshold therapy offers with the structural reform of outpatient psychotherapy, which has been in effect since April 1, 2017. The declared aim of the reform is to make psychotherapeutic care more effective, including reducing waiting times. Psychotherapeutic consultations, acute psychotherapeutic treatment and relapse prevention as new elements of care are intended to ensure flexible, low-threshold and timely access to psychotherapy. Acute treatment plays an important role in the reform. It should be carried out as a short-term intervention with a maximum of 24 sessions lasting 25 minutes each (G-BA 2017, p.7). These “new care offers” will diversify the range of services for mentally ill people, i.e. expand the variety of offers in this care area. The G-BA is currently also examining the inclusion of systemic therapy in standard care, for which IQWIG, which was commissioned to do this, published a preliminary benefit assessment on August 16, 2016 (IQWIG 2016), while many health insurance companies are working with specialized providers such as Ge.on Case Management GmbH is already improving the care of mentally ill patients.1 In addition, there are a number of so-called digital mental health programs, some of which have also made the jump to reimbursement by statutory health insurance, for example Deprexis or Novego2, others will follow here. With an increasingly differentiated supply of care, knowledge of the study situation and, as a result, the control and coordination function of providers and health insurance companies is becoming increasingly relevant. Therefore, both the psychotherapeutic consultation hours on the part of the providers and the offering of managed care providers on the part of the consumers will assume a very central control function in the future. As part of this article, Ge.on Case Management GmbH has therefore investigated the question of what benefits of short-term psychotherapeutic interventions have so far been proven in randomized controlled trials (RCT), whether there are any statements about the cost-effectiveness of such procedures and how the care situation in Germany compares internationally represents comparison.
24.07.2017
Diabetes mellitus is a chronic metabolic disease in which the blood sugar concentration is permanently elevated due to limited insulin action or release (American Diabetes Association 2012). In the long term, diabetes increases the risk of concomitant and secondary diseases such as cardiovascular diseases, retinal damage and diabetic foot syndrome. As a "widespread disease" with a large number of sufferers, diabetes mellitus is of considerable relevance to public health. On an individual level, the disease is associated with restrictions on quality of life and life expectancy; on a societal level, it is associated with high costs for the healthcare system (Koster et al. 2012).
24.07.2017
The method paper from the Institute for Quality and Transparency in Health Care (IQTIG), which is now available in a first draft, is an important document for the discussion of the topic in the coming years. However, this paper gives rise to serious criticism on numerous levels. In its basic assumptions, it remains tied to a traditional understanding of quality that is focused on the ex post quality control of results. Elements of continuous quality improvement with the integration of the quality concept into the process of service provision at the institutional and system level have largely been pushed into the background. In the paternalistic tradition, the concept of patient-centeredness is one-sidedly related to the quality of results; the quality dimensions discussed are reduced to questions of legitimacy and statistical evaluability. The concept of linear measurement of quality through quality indicators is represented. Contrary to the common international and health care research opinion, indicators are not used as highly sensitive monitoring instruments, but as classic measuring instruments that are simultaneously used to record quality problems and for identification of “excellent” quality. The terms reliability and validity of indicators are not used accurately; it is even claimed that there is no meaningful application of the term validity to quality indicators. In addition, there are other technical errors, so indicators are assigned an evaluation function and the term quality assurance is not differentiated from the term quality improvement and from instruments such as pay for performance.
03.04.2017
Kommentar von Prof. Dr. med. Franz Porzsolt, Klinische Ökonomik und Versorgungsforschung an der Klinik für Allgemein- und Viszeralchirurgie am Universitätsklinikum Ulm