Pub Date : 2024-05-01DOI: 10.1016/S1865-9217(24)00076-X
{"title":"Inhaltsverzeichnis / Table of Contents","authors":"","doi":"10.1016/S1865-9217(24)00076-X","DOIUrl":"https://doi.org/10.1016/S1865-9217(24)00076-X","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S186592172400076X/pdfft?md5=48938d6e8fec9313123d7db9ca0197b9&pid=1-s2.0-S186592172400076X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141239093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.zefq.2024.02.003
Lisa Kramer , Malte Moos , Bastian Thaa , Robert Welte , Marc Esser
Introduction
Health-Related Quality of Life (HRQoL) data is frequently requested in early benefit assessment in Germany. To test the hypothesis that the importance of HRQoL in general and the significance of disease-specific instruments in particular has increased since the introduction of AMNOG in Germany, we analysed all early benefit assessments between 2011 and 2022.
Methods
All 793 early benefit assessments completed between 01/01/2011 and 03/11/2022 were systematically analysed. The HRQoL instruments featured in the dossier submissions were extracted for all assessments and categorized into generic and specific instruments. All G-BA resolutions were likewise assessed for consideration and acceptance of generic and specific HRQoL instruments. In addition, it was examined whether there was an association between HRQoL data and the extent of additional benefit.
Results
Since 2014 HRQoL data have continuously been submitted in 70% to 80% of assessments per year with the exception of 2022 (63%). Generally, disease-specific instruments are favoured, regarding submissions by industry but especially with higher acceptance by the G-BA in the resolution. Subgroup analyses revealed oncology as a major contributor to the submission and acceptance rates of disease-specific instruments. Disease-specific instruments were submitted in 81% of all oncology assessments and accepted in 53% of assessments. Overall, assessments with accepted HRQoL data tend to reach a higher overall benefit. Procedures with accepted HRQoL were most likely to receive a considerable benefit (31%), while for procedures in which HRQoL data were not accepted, a benefit was most often (65%) not proven.
Discussion
Industry has followed the request for submission of specific HRQoL instruments early on. Higher submission rates of specific instruments over time which at the same time meet the methodological requirements indicate that industry has learned from early assessments. A potential reason for the high submission- and acceptance rates of specific HRQoL instruments in oncology might be the particularly high relevance of HRQoL in this indication. Possible effects of changes in legislature on the future development of submission and acceptance of HRQoL data need to be monitored.
Conclusion
In Germany, HRQoL has gained a relevant position in early benefit assessment over time. Overall specific instruments are favoured, regarding submissions by industry but especially through consideration by the G-BA in the resolution. Furthermore, HRQoL data can be supportive for benefit assessments, in particular to show that advantages in morbidity and/or mortality are reflected in HRQoL and not at the expense of HRQoL.
{"title":"Health-related quality of life (HRQoL) in German early benefit assessment: The importance of disease-specific instruments","authors":"Lisa Kramer , Malte Moos , Bastian Thaa , Robert Welte , Marc Esser","doi":"10.1016/j.zefq.2024.02.003","DOIUrl":"10.1016/j.zefq.2024.02.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Health-Related Quality of Life (HRQoL) data is frequently requested in early benefit assessment in Germany. To test the hypothesis that the importance of HRQoL in general and the significance of disease-specific instruments in particular has increased since the introduction of AMNOG in Germany, we analysed all early benefit assessments between 2011 and 2022.</p></div><div><h3>Methods</h3><p>All 793 early benefit assessments completed between 01/01/2011 and 03/11/2022 were systematically analysed. The HRQoL instruments featured in the dossier submissions were extracted for all assessments and categorized into generic and specific instruments<strong>.</strong> All G-BA resolutions were likewise assessed for consideration and acceptance of generic and specific HRQoL instruments. In addition, it was examined whether there was an association between HRQoL data and the extent of additional benefit.</p></div><div><h3>Results</h3><p>Since 2014 HRQoL data have continuously been submitted in 70% to 80% of assessments per year with the exception of 2022 (63%). Generally, disease-specific instruments are favoured, regarding submissions by industry but especially with higher acceptance by the G-BA in the resolution. Subgroup analyses revealed oncology as a major contributor to the submission and acceptance rates of disease-specific instruments. Disease-specific instruments were submitted in 81% of all oncology assessments and accepted in 53% of assessments. Overall, assessments with accepted HRQoL data tend to reach a higher overall benefit. Procedures with accepted HRQoL were most likely to receive a considerable benefit (31%), while for procedures in which HRQoL data were not accepted, a benefit was most often (65%) not proven.</p></div><div><h3>Discussion</h3><p>Industry has followed the request for submission of specific HRQoL instruments early on. Higher submission rates of specific instruments over time which at the same time meet the methodological requirements indicate that industry has learned from early assessments. A potential reason for the high submission- and acceptance rates of specific HRQoL instruments in oncology might be the particularly high relevance of HRQoL in this indication. Possible effects of changes in legislature on the future development of submission and acceptance of HRQoL data need to be monitored.</p></div><div><h3>Conclusion</h3><p>In Germany, HRQoL has gained a relevant position in early benefit assessment over time. Overall specific instruments are favoured, regarding submissions by industry but especially through consideration by the G-BA in the resolution. Furthermore, HRQoL data can be supportive for benefit assessments, in particular to show that advantages in morbidity and/or mortality are reflected in HRQoL and not at the expense of HRQoL.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S1865-9217(24)00078-3
{"title":"Liste der Affiliierten Institute und Fachgesellschaften / List of Affiliations","authors":"","doi":"10.1016/S1865-9217(24)00078-3","DOIUrl":"https://doi.org/10.1016/S1865-9217(24)00078-3","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000783/pdfft?md5=dd0f306ab17997efd4c0fc1c1a96996b&pid=1-s2.0-S1865921724000783-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141239811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lean, especially Value Stream Mapping is increasingly used in hospitals to optimize processes. This method, which originated in the automotive industry, enables all staff involved in the process to make it more customer-friendly. Despite the widely reported success of Lean projects, they have failed in some cases. This study investigated the contextual factors and mechanisms that contribute to a successful implementation of Value Stream Mapping.
Methods
Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source.
Results
At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement.
Discussion
A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings.
Conclusions
These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.
{"title":"Contextual factors and mechanisms in the implementation of Value Stream Mapping in breast cancer centres – A multiple case study","authors":"Kerstin Dittmer, Marina Beckmann, Holger Pfaff, Ute Karbach","doi":"10.1016/j.zefq.2024.03.006","DOIUrl":"10.1016/j.zefq.2024.03.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Lean, especially Value Stream Mapping is increasingly used in hospitals to optimize processes. This method, which originated in the automotive industry, enables all staff involved in the process to make it more customer-friendly. Despite the widely reported success of Lean projects, they have failed in some cases. This study investigated the contextual factors and mechanisms that contribute to a successful implementation of Value Stream Mapping.</p></div><div><h3>Methods</h3><p>Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source.</p></div><div><h3>Results</h3><p>At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement.</p></div><div><h3>Discussion</h3><p>A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings.</p></div><div><h3>Conclusions</h3><p>These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000540/pdfft?md5=32bc9dd6c92a49f67eaf7dece16d0613&pid=1-s2.0-S1865921724000540-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.zefq.2024.03.002
Claudia Mehl , Teresa Müller , Thorsten Nau , Christian Bachmann , Max Geraedts
Background
In Germany, no consented quality indicator set (QI set) exists to date that can be used to assess the quality of pediatric care. Therefore, the aim of the project “Assessment of the quality of routine ambulatory health care for common disorders in children and adolescents” (QualiPäd) funded by the Innovation Committee of the Federal Joint Committee (grant no.: 01VSF19035) was to develop a QI set for the diseases asthma, atopic eczema, otitis media, tonsillitis, attention-deficit hyperactivity disorder (ADHD), depression and conduct disorder.
Methods
For the observation period 2018/2019, quality indicators (QIs) were searched in indicator databases, guidelines and literature databases and complemented in part by newly formulated QIs (e. g., derived from guideline recommendations). The QIs were then assigned to content categories and dimensions according to Donabedian and OECD and reduced by removing duplicates. Finally, a panel of experts consulted the QIs using the modified RAND-UCLA Appropriateness Method (RAM).
Results
The search resulted in a preliminary QI set of 2324 QIs. After the reduction steps and the evaluation of the experts, 282 QIs were included in the QI set (asthma: 72 QIs, atopic eczema: 25 QIs, otitis media: 31 QIs, tonsillitis: 12 QIs, ADHD: 53 QIs, depression: 43 QIs, conduct disorder: 46 QIs). The QIs are distributed among the following different categories: Therapy (138 QIs), Diagnostics (95 QIs), Patient-reported outcome measures/Patient-reported experience measures (PROM/PREM) (45 QIs), Practice management (31 QIs), and Health reporting (4 QIs). In the Donabedian model, 89 % of the QIs capture process quality, 9 % outcome quality, and 2 % structural quality; according to the OECD classification, 61 % measure effectiveness, 23 % patient-centeredness, and 16 % safety of care.
Conclusion
The consented QI set is currently being tested and can subsequently be used (possibly modified) to measure the quality of routine outpatient care for children and adolescents in Germany, in order to indicate the status quo and potential areas for improvement in outpatient care.
{"title":"Entwicklung eines Indikatorensets zur Evaluation der Versorgungsqualität in der ambulanten Routineversorgung häufiger Erkrankungen des Kindes- und Jugendalters","authors":"Claudia Mehl , Teresa Müller , Thorsten Nau , Christian Bachmann , Max Geraedts","doi":"10.1016/j.zefq.2024.03.002","DOIUrl":"10.1016/j.zefq.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>In Germany, no consented quality indicator set (QI set) exists to date that can be used to assess the quality of pediatric care. Therefore, the aim of the project “Assessment of the quality of routine ambulatory health care for common disorders in children and adolescents” (QualiPäd) funded by the Innovation Committee of the Federal Joint Committee (grant no.: 01VSF19035) was to develop a QI set for the diseases asthma, atopic eczema, otitis media, tonsillitis, attention-deficit hyperactivity disorder (ADHD), depression and conduct disorder.</p></div><div><h3>Methods</h3><p>For the observation period 2018/2019, quality indicators (QIs) were searched in indicator databases, guidelines and literature databases and complemented in part by newly formulated QIs (e.<!--> <!-->g., derived from guideline recommendations). The QIs were then assigned to content categories and dimensions according to Donabedian and OECD and reduced by removing duplicates. Finally, a panel of experts consulted the QIs using the modified RAND-UCLA Appropriateness Method (RAM).</p></div><div><h3>Results</h3><p>The search resulted in a preliminary QI set of 2324 QIs. After the reduction steps and the evaluation of the experts, 282 QIs were included in the QI set (asthma: 72 QIs, atopic eczema: 25 QIs, otitis media: 31 QIs, tonsillitis: 12 QIs, ADHD: 53 QIs, depression: 43 QIs, conduct disorder: 46 QIs). The QIs are distributed among the following different categories: Therapy (138 QIs), Diagnostics (95 QIs), Patient-reported outcome measures/Patient-reported experience measures (PROM/PREM) (45 QIs), Practice management (31 QIs), and Health reporting (4 QIs). In the Donabedian model, 89<!--> <!-->% of the QIs capture process quality, 9<!--> <!-->% outcome quality, and 2<!--> <!-->% structural quality; according to the OECD classification, 61<!--> <!-->% measure effectiveness, 23<!--> <!-->% patient-centeredness, and 16<!--> <!-->% safety of care.</p></div><div><h3>Conclusion</h3><p>The consented QI set is currently being tested and can subsequently be used (possibly modified) to measure the quality of routine outpatient care for children and adolescents in Germany, in order to indicate the status quo and potential areas for improvement in outpatient care.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000497/pdfft?md5=312f88d4b19ff0af49ec9fdc7ed9fb6b&pid=1-s2.0-S1865921724000497-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.zefq.2024.03.001
Julia Karch, Kristina Kast
Introduction and Objectives
Internet and mobile-based interventions (IMIs) can reduce the unmet need for treatment of people with depression. The service providers as key actors in the healthcare market play an essential role in implementation. Therefore, the barriers, drivers and expectations from the perspective of psychotherapists were examined.
Methods
In the Nuremberg area, n = 15 psychotherapists were interviewed using a semi-structured guideline. The data were then evaluated according to the principles of Grounded Theory.
Results
Primarily, optimizing patient benefits and bridging waiting times and aftercare were seen as advantages. Challenges exist in relation to insufficient information and communication channels between those involved in the healthcare market and the resulting lack of therapists' experiences with IMIs.
Discussion
In addition to the drivers and barriers, different fields of action must be taken into account in order to increase the implementation of IMIs in the care of people with depression; these include the way that IMIs are integrated into the treatment process, the conception of IMIs and the relationships on the healthcare market. The decisive factor here is to increase cooperation between all those involved in the healthcare market.
Conclusion
The barriers identified are mainly due to insufficient information and communication channels within the healthcare market. They provide helpful guidance for understanding how the increased implementation of IMIs into the care process in the treatment of depression can succeed.
{"title":"Wie können Potenziale von internet- und mobilbasierten Interventionen in der Versorgung von Depressionen genutzt werden? Erkenntnisse aus einer qualitativen Befragung deutscher Psychotherapeut*innen","authors":"Julia Karch, Kristina Kast","doi":"10.1016/j.zefq.2024.03.001","DOIUrl":"10.1016/j.zefq.2024.03.001","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><p>Internet and mobile-based interventions (IMIs) can reduce the unmet need for treatment of people with depression. The service providers as key actors in the healthcare market play an essential role in implementation. Therefore, the barriers, drivers and expectations from the perspective of psychotherapists were examined.</p></div><div><h3>Methods</h3><p>In the Nuremberg area, n<!--> <!-->=<!--> <!-->15 psychotherapists were interviewed using a semi-structured guideline. The data were then evaluated according to the principles of Grounded Theory.</p></div><div><h3>Results</h3><p>Primarily, optimizing patient benefits and bridging waiting times and aftercare were seen as advantages. Challenges exist in relation to insufficient information and communication channels between those involved in the healthcare market and the resulting lack of therapists' experiences with IMIs.</p></div><div><h3>Discussion</h3><p>In addition to the drivers and barriers, different fields of action must be taken into account in order to increase the implementation of IMIs in the care of people with depression; these include the way that IMIs are integrated into the treatment process, the conception of IMIs and the relationships on the healthcare market. The decisive factor here is to increase cooperation between all those involved in the healthcare market.</p></div><div><h3>Conclusion</h3><p>The barriers identified are mainly due to insufficient information and communication channels within the healthcare market. They provide helpful guidance for understanding how the increased implementation of IMIs into the care process in the treatment of depression can succeed.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000515/pdfft?md5=ccc1d32962194f54e51d8f99d7c4c1a5&pid=1-s2.0-S1865921724000515-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.zefq.2023.12.007
Anna Kowalski , Tatjana Blazejewski , Lion Lehmann , Dania Schütze , Svea Holtz , Johanna Römer , Ferdinand M. Gerlach , Beate S. Müller
Background
The topic of patient safety has been a subject of much discussion since the end of the last millennium. Ensuring patient safety is a central challenge in health care. An important tool to raise awareness for and learn from adverse events and thus promote patient safety are error-reporting and learning systems (Critical Incident Reporting System = CIRS).
Methods
More than 17 years after its establishment, the CIRS “jeder-fehler-zaehlt.de” (JFZ) for German primary care has undergone a revision in terms of content and technology. The revised web-based system can be used for reporting as well as for classifying and analyzing incident reports. During this process, a descriptive analysis of the current report inventory was carried out, with a focus on serious medication errors. This included all 781 valid incident reports received between September 2004 and December 2021.
Results
In 576 of the 781 reports (73.8%), the GP practice was directly involved in the critical incident. Among error types, process errors predominated (79.8% of the classifications, 99.1% of the reports) compared with knowledge and skills errors (20.2% of the classifications, 39.7% of the reports). Communication errors (63.0%) were the most common contributing factor to critical incidents, followed by flaws in tasks and measures (39.7%). Serious and permanent patient harm was rarely reported (8.3% of the reports), whereas temporary patient harm was more common (40.3% of the reports). Incident reports about medication errors with at least serious patient harm included, in particular, substances that affected blood clotting, corticosteroids, and opiates.
Discussion
Our results complement the rates that are reported internationally for error types, patient harm, and contributing factors. Serious but preventable adverse events, so-called never events, are frequently associated with the medication process in both JFZ reports and the literature.
Conclusion
Critical incident reporting systems cannot provide accurate information about the frequency of errors in health care, but they can offer important insights into, for example, serious medication errors. Therefore, they offer both employees and healthcare institutions an opportunity for individual and institutional learning.
{"title":"17 Jahre hausärztliches Fehlerberichts- und Lernsystem „jeder-fehler-zaehlt.de” – Analyse des Berichtsbestandes","authors":"Anna Kowalski , Tatjana Blazejewski , Lion Lehmann , Dania Schütze , Svea Holtz , Johanna Römer , Ferdinand M. Gerlach , Beate S. Müller","doi":"10.1016/j.zefq.2023.12.007","DOIUrl":"10.1016/j.zefq.2023.12.007","url":null,"abstract":"<div><h3>Background</h3><p>The topic of patient safety has been a subject of much discussion since the end of the last millennium. Ensuring patient safety is a central challenge in health care. An important tool to raise awareness for and learn from adverse events and thus promote patient safety are error-reporting and learning systems (Critical Incident Reporting System = CIRS).</p></div><div><h3>Methods</h3><p>More than 17 years after its establishment, the CIRS “jeder-fehler-zaehlt.de” (JFZ) for German primary care has undergone a revision in terms of content and technology. The revised web-based system can be used for reporting as well as for classifying and analyzing incident reports. During this process, a descriptive analysis of the current report inventory was carried out, with a focus on serious medication errors. This included all 781 valid incident reports received between September 2004 and December 2021.</p></div><div><h3>Results</h3><p>In 576 of the 781 reports (73.8%), the GP practice was directly involved in the critical incident. Among error types, process errors predominated (79.8% of the classifications, 99.1% of the reports) compared with knowledge and skills errors (20.2% of the classifications, 39.7% of the reports). Communication errors (63.0%) were the most common contributing factor to critical incidents, followed by flaws in tasks and measures (39.7%). Serious and permanent patient harm was rarely reported (8.3% of the reports), whereas temporary patient harm was more common (40.3% of the reports). Incident reports about medication errors with at least serious patient harm included, in particular, substances that affected blood clotting, corticosteroids, and opiates.</p></div><div><h3>Discussion</h3><p>Our results complement the rates that are reported internationally for error types, patient harm, and contributing factors. Serious but preventable adverse events, so-called never events, are frequently associated with the medication process in both JFZ reports and the literature.</p></div><div><h3>Conclusion</h3><p>Critical incident reporting systems cannot provide accurate information about the frequency of errors in health care, but they can offer important insights into, for example, serious medication errors. Therefore, they offer both employees and healthcare institutions an opportunity for individual and institutional learning.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000059/pdfft?md5=ae269d2743daa146bbb507f6787031b5&pid=1-s2.0-S1865921724000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.zefq.2024.01.002
Stephanie Stiel , Alexandra Ernst , Hanna A.A. Röwer , Lea de Jong , Birte Burger , Nils Schneider , Kathrin Damm , Jona T. Stahmeyer , Beate Apolinarski , Franziska A. Herbst
Introduction
A needs-based and patient-oriented hospice and palliative care also includes day hospices as a specialised semi-inpatient care offer. The establishment and development of these facilities in Germany has been rather unsystematic. In order to ensure quality and adequacy of these structures, research is needed.
Methods
A Delphi consensus study was conducted online from November 2022 to February 2023 aiming at generating recommendations for the development and expansion of day hospices in Germany. For each recommendation, the participants indicated on a four-point verbal rating scale how much they agreed upon a) the relevance and b) the feasibility of the recommendation. Items were considered consented when 80 % of the participants (strongly) agreed with the recommendation regarding both criteria. If no consensus was reached, the recommendations were revised according to the participants’ free text comments and presented in the next Delphi round. Descriptive analyses were applied.
Results
A total of 64 experts participated in the first Delphi round and 44 in the second. In round 1, 34 recommendations and in round 2 six recommendations were consented. The final set contains a total of 40 recommendations: 18 on the tasks of day hospices, 13 on cooperation, 7 on funding, and 2 on public relations.
Discussion
Recommendations for the development and expansion of day hospices in Germany were developed. Due to their highly rated feasibility, the recommendations should be directly transferable into care practice. It remains to be seen to what extent they will be taken into account in the renegotiation of the framework agreement for day hospices.
Conclusion
The Delphi-consented recommendations provide a basis to guide action in the currently very dynamic development of hospice work and palliative care in Germany.
{"title":"Empirisch abgeleitete Empfehlungen für den Auf- und Ausbau von Tageshospizen in Deutschland – Ergebnisse einer Delphi-Befragung mit Expert:innen","authors":"Stephanie Stiel , Alexandra Ernst , Hanna A.A. Röwer , Lea de Jong , Birte Burger , Nils Schneider , Kathrin Damm , Jona T. Stahmeyer , Beate Apolinarski , Franziska A. Herbst","doi":"10.1016/j.zefq.2024.01.002","DOIUrl":"10.1016/j.zefq.2024.01.002","url":null,"abstract":"<div><h3>Introduction</h3><p>A needs-based and patient-oriented hospice and palliative care also includes day hospices as a specialised semi-inpatient care offer. The establishment and development of these facilities in Germany has been rather unsystematic. In order to ensure quality and adequacy of these structures, research is needed.</p></div><div><h3>Methods</h3><p>A Delphi consensus study was conducted online from November 2022 to February 2023 aiming at generating recommendations for the development and expansion of day hospices in Germany. For each recommendation, the participants indicated on a four-point verbal rating scale how much they agreed upon a) the relevance and b) the feasibility of the recommendation. Items were considered consented when 80<!--> <!-->% of the participants (strongly) agreed with the recommendation regarding both criteria. If no consensus was reached, the recommendations were revised according to the participants’ free text comments and presented in the next Delphi round. Descriptive analyses were applied.</p></div><div><h3>Results</h3><p>A total of 64 experts participated in the first Delphi round and 44 in the second. In round 1, 34 recommendations and in round 2 six recommendations were consented. The final set contains a total of 40 recommendations: 18 on the tasks of day hospices, 13 on cooperation, 7 on funding, and 2 on public relations.</p></div><div><h3>Discussion</h3><p>Recommendations for the development and expansion of day hospices in Germany were developed. Due to their highly rated feasibility, the recommendations should be directly transferable into care practice. It remains to be seen to what extent they will be taken into account in the renegotiation of the framework agreement for day hospices.</p></div><div><h3>Conclusion</h3><p>The Delphi-consented recommendations provide a basis to guide action in the currently very dynamic development of hospice work and palliative care in Germany.</p></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000084/pdfft?md5=d6eea13518f4390fb675717f49df3a4b&pid=1-s2.0-S1865921724000084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.zefq.2023.12.004
Helene Hense , Sophia Ernst , Anja Zscheppang , Jochen Schmitt , Veit Roessner , Max Weniger , Katja Beesdo-Baum , Susanne Knappe
Aim of the study
Evaluation of the implementation of a standardized screening using the Strengths and Difficulties Questionnaire (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and / or to further counselling and treatment services.
Methods
1.) Semi-structured interviews were performed with participating pediatricians (n = 4), practice staff (n = 4) and custodians of screened children (n = 17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n = 34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services.
Results
In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e. g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families’ use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n = 11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians “completely” or “rather” agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care.
Discussion
The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services.
{"title":"Implementierung einer neuen Versorgungsform zur Früherkennung und Prävention emotionaler und Verhaltensauffälligkeiten bei Kindern im kinderärztlichen Setting: Qualitative Interviews mit Kinderärzt*innen, Praxispersonal und Sorgeberechtigten","authors":"Helene Hense , Sophia Ernst , Anja Zscheppang , Jochen Schmitt , Veit Roessner , Max Weniger , Katja Beesdo-Baum , Susanne Knappe","doi":"10.1016/j.zefq.2023.12.004","DOIUrl":"10.1016/j.zefq.2023.12.004","url":null,"abstract":"<div><h3>Aim of the study</h3><p>Evaluation of the implementation of a standardized screening using the <em>Strengths and Difficulties Questionnaire</em> (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and<!--> <!-->/<!--> <!-->or to further counselling and treatment services.</p></div><div><h3>Methods</h3><p>1.) Semi-structured interviews were performed with participating pediatricians (n<!--> <!-->=<!--> <!-->4), practice staff (n<!--> <!-->=<!--> <!-->4) and custodians of screened children (n<!--> <!-->=<!--> <!-->17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n<!--> <!-->=<!--> <!-->34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services.</p></div><div><h3>Results</h3><p>In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e.<!--> <!-->g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families’ use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n<!--> <!-->=<!--> <!-->11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians “completely” or “rather” agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care.</p></div><div><h3>Discussion</h3><p>The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services.</p></div><div><h3","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1865921724000023/pdfft?md5=dfb908e2297f41217e34397d8f5777cd&pid=1-s2.0-S1865921724000023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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