Original article
Kommentar von Dr. Dr. Klaus Piwernetz (medimaxx health management GmbH, München) und Univ.-Prof. Dr. Dr. h.c. Edmund A. M. Neugebauer (Senior-Professor Versorgungsforschung an der Medizinischen Hochschule Brandenburgeil): "Wer A sagt, muss auch B sagen"
22.09.2021
Commentary by Father Klaus Mertes SJ, former rector of the Canisius College in Berlin, then director of the international Jesuit college in St. Blasien
22.09.2021
Comment from Johannes Bauernfeind, CEO of AOK Baden-Württemberg
22.09.2021
The concept of quality has become increasingly important in the healthcare sector in recent years. One area of healthcare that has specific quality requirements is palliative care (PC). PC refers to the age-independent, active and holistic care of seriously ill people, especially at the end of life (Radbruch et al. 2020). This includes the identification of palliative needs, (advance) planning of care and interventions for holistic symptom control (Downar et al. 2019) with the aim of improving the quality of life of patients and relatives (Radbruch et al. 2020). In Germany, palliative care for palliative patients in more stable phases of the illness is provided on an outpatient basis, supported by general practitioners and specialists, general outpatient palliative care teams (AAPV) or specialized outpatient palliative care teams (SAPV). If the burden of symptoms increases, you may be admitted to a palliative care unit. Hospice services and hospices exist across sectors (Simon et al. 2016). Interest in measuring and increasing the quality of care is also constantly increasing in PC: In 2004, the National Consensus Project for Quality Palliative Care (NCP) created guidelines for eight quality-critical areas in PC (2004). These constantly updated guidelines are intended to support those involved in healthcare to use treatment principles and best practice examples in their treatment to ensure high-quality PC for all people with life-limiting illnesses and their relatives, regardless of the respective setting, diagnosis, prognosis or age to enable (Ferrell et al. 2018).
22.09.2021
Bei diesem Text handelt es sich um die Kurzfassung, des Thesenpapiers 8.0, das die Autorengruppe (siehe MVF Online First) erarbeitet hat (Datum 29.8.2021), das zu folgenden Aspekten Stellung nimmt:1. Es wird ein Konzept für das Verständnis der Epidemie entwickelt (Kap. 2 „Pandemie als Komplexes System“), mit dem das schwer zu entschlüsselnde Verhalten der Epidemie zu erklären ist, und das es erlaubt, Empfehlungen für die Steuerung (Messparameter) und die Präventionsstrategie abzuleiten;2. Es wird ein Indikatoren-Set entwickelt (Kap. 3), das die Melderate („Inzidenz“) ablösen kann und über eine erheblich bessere Aussagekraft verfügt;3. Es werden in einem umfangreichen, kritischen Ansatz das Wissen zur SARS-CoV2-Epidemie im Kindes- und Jugendalter dargestellt (Kap. 4) und weitgehende Erleichterungen für diese bisher am stärksten psychosozial belastete Bevölkerungsgruppe gefordert;4. Es wird eine Politische Theorie der Pandemie vorgestellt, die die „Massivreaktion“ der gesellschaftlichen und politischen Ebenen erklärt und für die Diskussion der Handlungsoptionen öffnet.Die Autorengruppe beschäftigt sich seit März 2020 ehrenamtlich mit der Corona-Thematik und greift kontinuierlich mit Thesenpapieren und Ad-hoc-Stellungnahmen in die politische Diskussion ein.
22.09.2021
The aging of society, the shortage of skilled workers, but also digitalization have shaped the healthcare system for many years and pose major challenges for its designers. With increasing age, the general risk of disease also increases (RKI 2020). Older patient groups are more likely to have multimorbidities and have an increased need for treatment measures that must be financed by the health system. At the same time, the system's income is falling because the financing model, at least in the GKV, is based on contributions that are based on income and the average income is falling with an increasing proportion of pensioners.1 In addition, the healthcare system is struggling with a shortage of qualified specialists is exacerbated by the increasing need for treatment (Wunsch/Buchmann 2019) and is already visible in basic medical care in structurally weak rural regions. Digitalization counteracts this by opening up location-independent ways of providing services in the healthcare system and even creating new service areas. The Digital Care Act (DVG) introduced the regular ability to prescribe and reimburse selected health apps, so-called digital health applications (DiGA), in the GKV. Nevertheless, the digital conversion and the creation of new service areas are associated with additional costs. Overall, the healthcare system is faced with a significant financing problem and it is foreseeable that the current supply and reimbursement logic is not sustainable.
22.09.2021
According to estimates, there are currently around 4 million people living in Germany who have already suffered from cancer in the course of their lives, and around 500,000 people are diagnosed with cancer every year (RKI/GEKID 2019). Thanks to numerous innovations in diagnostics and therapy, the treatment of cancer is now associated with better chances of survival, but has also become more complex. While previously the three pillars of cancer therapy were usually referred to (surgery, radiotherapy and chemotherapy), today five treatment modalities are assumed: surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy (Weber 2018). Multidisciplinary and intersectoral case discussions with representatives of various specialist disciplines (in particular surgery, pathology, radiology, oncology) in tumor conferences, tumor boards, consultations or forums with the aim of making a common treatment recommendation are a central part of the qualified care of patients with complex oncological diseases. In particular, the terms “tumor conference” and “tumor board” are often used interchangeably. The consultation and decision-making processes that take place as part of the multidisciplinary tumor conferences (MTK) have a significant influence on the diagnostic and therapeutic measures initiated (Basta et al. 2017; Hermes-Moll et al. 2016). Studies have shown that MTK can improve diagnostic reliability and clinical outcomes (Basta et al. 2017; Lamb et al. 2011). Some studies suggest that case discussion in MTK is positively associated with longer survival (Hong et al. 2010; Kesson et al. 2012; Pillay et al. 2016). But there are also isolated study results that suggest no improvement in therapy or prolongation of overall survival through a discussion in MTK (Specchia et al. 2020; Keating et al. 2013; Kee et al. 2004). A high-quality MTK recommendation can therefore have a lasting impact on the care, quality of life and survival of sick people - and ultimately also on the costs of the healthcare system.
22.09.2021
The discussion about the structure of hospital care is characterized by two theses: On the one hand, there is an argument for concentrating hospital care on a smaller number of locations. This is justified not only with reference to a higher cost-effectiveness of hospital care and a more efficient use of scarce human resources, but also with a higher quality of care, especially in more complex procedures for which a positive volume-outcome relationship can be proven. From another perspective, however, it is argued, among other things, that greater concentration worsens the accessibility of hospital care, especially in rural regions, while additional quality gains from greater concentration can either no longer be expected or can be expected in another way - for example through increased concentration use of telemedicine – could be achieved. And from a competition theory perspective, too much concentration could have a negative impact on the intensity of competition between hospitals and thus reduce incentives for quality. What is striking in this discussion is that relatively little is known about the actual concentration of hospital care and its development. The aim of this article is therefore to examine at different levels and from different perspectives how highly concentrated hospital care in Germany is currently, how the concentration has changed in recent years, and where there is still potential for increasing the quality of care through a higher level of care Concentration of hospital care exist1.
22.09.2021
In the run-up to the 20th German Congress for Health Services Research (October 6-8, 2021), “Monitor Health Services Research” spoke to the Congress President Prof. Dr. Holger Pfaff, who demands, among other things, that “healthcare research must become more theory-oriented”. He describes the next stage of development that is to be ignited: “Health Care Research 2.0”. Because, Pfaff continues, health services research has “come a long way” in the last two decades with good methodology, but now needs to “continue to improve scientifically” in order to get to the point of what is difficult to explain - or in the case of completely new events such as Covid-19. to be able to overcome the point of what cannot yet be explained. Pfaff in the cover interview of “Monitor Health Services Research”: “This point has now been reached.”
07.08.2021
Die Diagnose Multiple Sklerose betrifft überwiegend jüngere Patienten in einer sehr aktiven Lebensphase. Obschon gut behandelbar, sind die Therapieentscheidungen von einer hohen Variabilität der Symptomatik und der Progredienz der Erkrankung geprägt. Standards in der mittlerweile vielfältigen Arzneimitteltherapie haben sich etabliert, während neuere Therapieoptionen sich zunehmend durchsetzen. Gepaart mit einer Sensibilisierung für patientenindividuelle Ansprüche und regionale Besonderheiten in der Versorgung hat sich die MS-Therapie deutlich weiterentwickelt.