Original article
Small children's clinics in Mecklenburg-Western Pomerania are affected or threatened by closures, even though the number of chronically ill children, for example with diabetes, asthma and obesity, is increasing. One in six children now suffers from a chronic health disorder [1]. Both economic factors, such as problematic remuneration via the DRG system, as well as personnel factors influence the clinical operations of small children's hospitals. On a personnel level, the clinics compete with each other for assistants and specialists - but also in competition with a branch for specialists. In this competition, small departments, regardless of specialty, have a disadvantage in their attractiveness in that a much higher frequency of service by doctors is necessary to maintain care. In order to maintain a 24-hour service system, a high level of personnel is required. In the case of smaller departments, these maintenance costs are largely independent of how many planned beds they hold, as a base of qualified staff is necessary. If the number of cases increases while personnel costs remain the same, a better profit situation can be assumed [2]. Minimum staffing limits for medical staff equivalent to the minimum nursing staff limits only exist in the form of the “specialist standards” and in perinatal centers, the “cash cows” of inpatient pediatric and adolescent medicine, which are only available at large clinics.
22.07.2022
Die Medikalisierungs- und die Kompressionsthese sind zwei „konkurrierende“ Ansätze in Bezug auf die Frage, in welchem Gesundheitszustand ein längeres Leben, insbesondere die Lebensjahre in höherem Alter verbracht werden. Neben der individuellen Bedeutung von Quantität und Qualität der Lebensjahre ist die Relevanz dieser Frage für das Gesundheitswesen hoch, denn nicht nur in der Vergangenheit ist die Zahl bzw. auch der Anteil der älteren Menschen gestiegen, es wird im Kontext des demografischen Wandels ein weiterer Anstieg, auch der Lebenserwartung, prognostiziert – und die Auswirkungen auf die Versorgungsbedarfe bzw. Ausgaben im Gesundheitswesen können beträchtlich sein.
22.07.2022
In the mid-1980s, an interdisciplinary group of researchers from California began to investigate a phenomenon that is extraordinary from the perspective of organizational research: organizations that have the potential to produce catastrophic errors on a daily basis, but (almost) never do so over long periods of time. By studying nuclear power plants, military aircraft carriers and civil aviation, the research group identified design principles and practices that enable the high reliability of these organizations (e.g. Weick 1987; Roberts 1990). This is due to the culture and respective routines of classic high-reliability organizations (HROs). Designing interventions based on principles of high reliability theory is also more than obvious for healthcare organizations that strive for high reliability with a view to patient safety and avoiding errors, among other things. However, it is questionable whether the requirements of classic HROs also apply to healthcare organizations.
22.07.2022
The topic of healthcare is considered varied and multifaceted. The reason for this is not only medical and nursing technology developments, but also changing demands on the part of the insured, which (of course!) affect the treatment, therapy and care regimes and the underlying provision and financing of care. This means that not only the supply itself, but also its development potential is in the public eye. The innovations are accompanied by new or changed regulations that have to be administered by the service providers and also the cost bearers. The costs of this administration are referred to as transaction costs and are variable in various arrangements on the one hand, but also over time on the other, and are therefore considered to be influenceable. The corresponding arrangements can be accessed on the market, i.e. from an external service provider (for a fee), or can be carried out in your own hierarchy (hierarchically, i.e. in your own company). In the Anglo-Saxon world, a distinction is made between “market transaction costs” and “managerial transaction costs”. The transaction cost theory itself is - similar to the theory of property rights - an important part of the new institutional economics.
22.07.2022
Covid-19: What is the current infectious situation? Like the rest of Europe and the rest of the world, Germany is currently transitioning into the endemic-epidemic phase of the SARS-CoV-2 pandemic. The currently dominant virus variants (Omicron BA4 and BA5) are characterized by a very high level of contagiousness and, at the same time, a very low disease burden. Even among the very elderly residents of nursing homes, who are considered particularly vulnerable, the severity of the disease and the hospitalization rate decreased significantly under the Omicron variant and after the vaccination campaign; mortality compared to 2020 even increased by more than 90%. The currently dominant variants have led to a significant increase in infections among those vaccinated and those who have recovered, with some clinical signs of a flu-like infection, without this being associated with a noticeable overload on the healthcare system and critical infrastructure. The few cases of overload reported were not a result of increased use of intensive care resources, but rather the consequence of isolation measures for staff that were ordered regardless of any symptoms.
24.06.2022
„Was wir aus unseren Daten nicht herauslesen können, sind die damit verbundenen Einschränkungen von Lebensqualität und sozialer Teilhabe, Leiden, Schmerzen oder bleibende Schäden, die verhindert hätten werden können.“ Das sagt Daniela Teichert, Vorstandsvorsitzende der AOK Nordost, die im ersten „Titelinterview“ mit „Monitor Versorgungsforschung“ einen wichtigen, aber oft verdrängten Aspekt der Digitalisierung anspricht: die Qualitätssicherung. Es sei – so Teichert – zu hoffen, dass unser neuer Gesundheitsminister das Datennutzungsgesetz auf den Weg bringt, in dem vorgeschrieben werden sollte, dass Transparenz nicht nur schön ist, sondern auch genutzt werden muss, um die Qualität der Versorgung weiter nach vorne zu bringen.
19.05.2022
From what she herself calls a "one-woman show" as a digital change manager at Essen University Hospital, Dr. Anke Diehl's path led her to becoming the hospital's Chief Transformation Officer. Now, she has also been appointed one of the seven members of the "National Expert Panel for Interoperability in Healthcare," or Interop Council, appointed by the Federal Ministry of Health (BMG). According to Diehl, Germany is still struggling with interoperability: Currently, the transfer of data from one hospital to another is only possible in cases of co-treatment. Regarding data from the healthcare process, Germany is "still at the very beginning" when it comes to interoperability, because everyone pursues their own particular interests, maintains their own projects, and politicians allow this to happen.
19.05.2022
As General Manager DACH (Germany, Austria, Switzerland) of GE Healthcare – a company with around 45,000 employees and global sales of $20 billion – Christian Bernhard is currently preparing what is probably the largest spin-off that has ever existed in the medical sector: Er speaks in an interview with “Monitor Healthcare Research” about the current challenge of moving from the state of “through electrification” to that of “digitalization”, right up to the vision of the possible use of artificial intelligence, which creates “something completely new” and that Workflow and knowledge management can be revolutionized if – according to Bernhard – “it is used correctly and, of course, always in compliance with data protection regulations”.
19.05.2022
The final DGIM talk, held as part of the "Health Innovation Day," addressed the meta-topic of digitalization, and thus—as moderator Prof. Dr. med. Friedrich Köhler (Head of the Center for Cardiovascular Telemedicine at the Charité in Berlin) put it—the question of "how we can use better procedures to improve medicine for the benefit of our patients." Prof. Köhler called the Federal Joint Committee's (G-BA) decision that telemonitoring of patients with heart failure can be provided and billed as an outpatient service a "milestone in digital medicine in Germany." In his presentation "Telemedicine in Chronic Heart Failure," Prof. Dr. med. Sebastian Spethmann (Medical Clinic A at the Brandenburg Medical School and member of the DGIM Digital Health Services Research Working Group) gave an overview of the long journey "from clinical trials to standard care" and the resulting opportunities for the care of affected patients and the healthcare system.
19.05.2022
On December 15, 2020, the G-BA decided that patients with heart failure can also receive telemedical care as part of standard care. Accordingly, the Extended Evaluation Committee changed the EBM and decided on the corresponding fee schedule positions. This means that telemonitoring can be prescribed by general practitioners for patients with heart failure. Telemedicine centers can be operated by practicing cardiologists with KV approval for pacemaker interrogation and billed to the KV. The KBV and the National Association of Statutory Health Insurance Funds have decided on an agreement on quality assurance measures in accordance with Section 135 Para. 2 SGB V on telemonitoring for heart failure (“QS-V TmHi”) as Annex 3 of the Federal Doctors Agreement (BMV-Ä). What this means for the use of telemonitoring in the area was discussed by “Monitor Healthcare Research” with Prof. Dr. Martin W. Bergmann from Cardiologicum Hamburg, a subsidiary of the Sanecum Group.