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Since 2009, informal caregivers (CGs) have been able to obtain information on support options and receive initial relief through consultation as part of informal caregiver counselling (ICC) in accordance with § 7a SGB XI. However, this offer has been used infrequently, and scientific evidence on non-users is lacking.The data were obtained from the cross-sectional study 'Progress in Home Care (ProCare)' and constituted a representative sample of CGs caring for care receivers (CRs) who were covered by statutory insurance in Bavaria (n=2,824). The analysis of use was based on Bradshaw's taxonomy of social need. The characteristics of (non-)users of ICC were identified descriptively (expressed need), and difference and regression analyses were computed (comparative need). For non-users of ICC, the reasons for non-use were evaluated (felt need), and the subjective and objective need for using ICC were compared (felt vs. normative need). Furthermore, information sources on care-related topics were analysed for CGs who were not aware that they were entitled to ICC.ICC was used by 20.97% (n=593) of CGs in the previous three months, of whom 85.91% stated that they benefited from the ICC. Multivariate binary logistic regression revealed that CGs of CRs who were older (OR=1.01) or had a higher level of care (OR=1.33) or dementia (OR=1.30) used ICC more frequently. Functional coping was also associated with more frequent use (OR=1.10). 53.99% of non-users stated that they had no need for ICC to date. However, only 36.73% of this group demonstrated no normative need. CGs who were not yet aware of ICC can be reached in the future via the Internet and social media (55.92%), doctors (53.13%), and their immediate environment (49.65%).The high level of satisfaction with ICC highlights its potential, underscoring the necessity for its utilisation to be augmented. In order to prevent high burden at an early stage, preventative, ongoing use should be achieved instead of the current late utilisation and functional coping strategies of CGs should be strengthened. Additionally, there is a large discrepancy between objective and subjective perceptions of CGs burden and associated needs, as well as a lack of knowledge about ICC. In order to raise awareness in CGs, a wider range of targeted information sources should be used.

Non-pharmacological therapies such as speech/ language and occupational therapy are considered essential components in the care of people with dementia and mild cognitive impairment. However, data on the actual utilisation of these services in routine care are lacking. This study aimed to examine the utilisation of these services using routine data.Based on routine data from the research database of the Institute for Applied Health Research Berlin (2017-2022), annual utilisation densities of speech/ language therapy and occupational therapy were calculated in relation to the annual prevalence of dementia/mild cognitive impairment and analysed by federal state. In addition, all individuals with an initial diagnosis in 2017 were followed over a five-year period as part of a longitudinal study to examine the use of therapeutic services.The six-year prevalence was 5.1%, with an annual average of n=85,496 individuals identified with dementia/mild cognitive impairment. The mean annual utilisation densities were 2.5% for speech/language therapy and 7.0% for occupational therapy. North Rhine-Westphalia had the highest, Bremen the lowest utilisation density. In the longitudinal analysis, 9.4% of affected individuals (n=13,746) received at least one therapy prescription. Utilisation decreased with disease duration, while home visits became more frequent.Despite established guideline recommendations, speech/language and occupational therapy remain underutilised in the care of people with dementia or mild cognitive impairment in Germany. To address these care gaps, targeted information strategies for stakeholders and the implementation of interdisciplinary care pathways in routine practice are needed.

The aim of this study was to develop suitable measures and strategies through a trans- and interdisciplinary discourse to improve pandemic management in (acute) inpatient care facilities (clinics, nursing homes) and thereby reduce the burden on nursing staff.Two scenario-based workshops were conducted-one focused on acute care and the other on long-term care. Following a collaborative, transdisciplinary approach, the workshops integrated perspectives from nursing practice, research, and relevant institutions. Using foresight methods such as the Futures Wheel and Ideation Canvas, participants co-developed potential solutions for optimizing pandemic preparedness and response. A total of 38 participants took part in the two-day workshops (acute care: 18; long-term care: 20).Participants developed outcomes at both structural and organizational levels, identifying short- and long-term effective strategies and interventions. Key findings addressed areas such as communication, internal organization, interface management, and the involvement of nursing practitioners. Examples include the (political) empowerment and increased participation of nurses, the development of digital and interdisciplinary structures, including skill-grade mix teams. Across both care settings, participants emphasized the need for formal nursing representation and clearly defined professional roles and responsibilities.Effective crisis management in inpatient care settings requires a systemic approach that integrates actions at the micro, meso, and macro levels. Coordinated collaboration between policy, science, and practice is essential to strengthen system resilience and sustainably improve working conditions in healthcare.

Qualitative evidence syntheses (QES) can answer qualitative research questions across different studies and thus offer an important part in the collection of evidence. While QES are a common set of methods internationally, they appear to be little used in health services research in the German-speaking countries to date.The aim of the study was to analyse the current use of QES in health services research in the German-speaking countries in order to draw conclusions for their establishment.An online survey was conducted by the subgroup Qualitative Evidence Syntheses in the German Network Health Services Research. The survey was aimed at health services researchers in German-speaking countries. Among other things, experiences with QES as well as barriers and support factors during implementation were surveyed. The data were analysed using descriptive statistics and content-structuring qualitative content analysis.A total of n=103 people took part in the survey, n=45 of whom had already been involved in QES. They had used QES to analyse the perspectives of target groups, to describe and evaluate health care, to (further) develop models and concepts and to implement and evaluate interventions. The participants referred to the high added value of QES, particularly due to its practical relevance, as well as to methodological difficulties in implementation and the desire for better training programmes.Qualitative evidence syntheses offer a potential that is still underutilised in health services research and can be particularly useful in the development and evaluation of interventions and the investigation of contexts and complexity.

The functioning of emergency departments (ED) is considered an indicator of the effectiveness and efficiency of the healthcare system. In Germany, there is increasing pressure to improve emergency care. EDs are relatively autonomous organizational units that interact with other levels within and outside the hospital organization. Based on a model of organization-related care research, the current state of emergency care is described and barriers to and facilitators of change are discussed.A narrative review was used that includes literature sources on organizational impacts on the functioning of EDs. Publications were considered that, in addition to the interface perspective, have a relevance to the current state as well as to the proposed changes from the legislature and other actors. These were assigned to the respective organizational levels and (potential) effects were described. The macro-meso-micro model of organization-related health services research serves as a heuristic.Insufficient consideration of interdependencies and interfaces between organizational actors and levels of emergency care facilitates friction and hinders care innovation. At the macro level of the healthcare system, structures, responsibilities and financing are regulated, which significantly impact functioning at the meso and micro levels. At the meso-level of the hospital, the role of the ED is influenced by the difficulty of controlling patient flows and the lack of Diagnoses Related Groups (DRGs) to cover the costs for outpatient emergency care. The micro-level of the ED has to prioritize treatment and is confronted with the challenges of "exit blocks" when there are indications for patient transfer. Previous reform efforts did not take this organizational complexity into account.Reform proposals must take into account the organizational complexity and interests that arises from interfaces, interactions and stakeholder interests. Organization-related health services research can examine the contextual conditions that affect emergency care in order to derive recommendations for health care innovations.

The number of patients with invasive home mechanical ventilation (IHMV) in Germany is vastly increasing. Currently, only limited data is available on the characteristics of these patients. The aim of the present study was to describe the health care situation of IHMV patients living in Bavaria using routinely collected data within the project OVER BEAS.The routine data were derived from the care assessment of the Medical Service (MD) in Bavaria (years 2017-2020). In this dataset, IHMV patients were identified using specific filter variables. Patients were analysed regarding sociodemographic characteristics, diagnosis, mobility, therapeutic measures, and need for care.The dataset comprised 536 adult IHMV patients (34.5% female, median age 68, IQR 58 75); 13.1% lived in nursing homes (NH), 22.2% in home care (HC), and 64.2% in shared living communities (SLC). From 2017 to 2020 a trend in proportionally more patients living in SLC was observed. Differences between the living situations were seen in the frequency of physical (NH 91.4%; HC 76.5%; SLC 90.4%; p<0.001) and occupational therapy (NH 47.1%, HC 58.8%, SLC 69.8%, p<0.001). 69.4% of IHMV patients were classified as having the highest need for care.The routine data from the MD Bavaria could be successfully used to describe the characteristics of patients in the highly complex setting of IHMV. In order to facilitate regular monitoring of the care situation, it would be advantageous to implement more precise recording of IHMV in routine data.

Based on anonymized inpatient service data from 2023 using the InEK-DatenBrowser (according to § 21 KHEntgG), the correlation between restrictions in the activities of daily living - measured with the Barthel Index - and the assigned level of care was examined. The aim was to demonstrate that the Barthel Index can be used as a practical tool for assessing the need for care in everyday medical practice. The results show that a lower Barthel Index is significantly associated with a higher level of care. Using ordinal logistic regression analyses (OR for level of care>1 are between 1.40 and 14.52) and the Kendall correlation test (τ=0.32; p<0.001; Cohen's d=1.10) we were able to demonstrate a statistically significant correlation. Thus, the Barthel Index can be used as an indicator for care needs - especially in cases where no formal level of care has yet been assigned. These findings can support medical decision-making and contribute to more needs-based care. Additionally, they could potentially ease physicians' daily routines by enabling the early identification of a need for long-term care.

Against the background of increasing problems in the provision of medival care in rural regions, the further development of outpatient medical concepts focussing on the imperative of economic efficiency and economy is essential. The delegation of medical tasks to medical assistants (MFA) offers a promising approach to relieve the burden on GPs and to support the provision of sustainable care. The 'VERSORGT am ORT' (VaO) project develops this principle and aims to reduce working hours away from patients by partially shifting delegated home visits to specialised care rooms without compromising the quality of care.Parameters for evaluating the VaO concept were quality of life (LQ) and satisfaction (PZ) of patients through standardized questionnaires, time spent away from patients and distance travelled. An initial data analysis from May 2024 to May 2025 compared the standard in the form of home visits (home visit /HB scenario) with partial transfer to VaO rooms according to the VaO model (VaO scenario) using paired t-tests over two survey time points.The n=134 data sets analysed showed significant differences in favour of the VaO model in the scenario comparison. The mean differences for travel time were MW=1.89 [min], travel time MW=2.79 [min], set-up time MW=0.63 [min], total time MW=5.32 [min] and kilometres travelled MW=1.89 [km] with p-values<0.001. Overall, a 20.9% reduction in working time away from the patient from 25.32 to 20.01 min and a 7.8% reduction in kilometres travelled from 13.34 to 12.30 km were achieved. The psychological component of the patients' LQ improved significantly from MW=52.94 to MW=57.27. The physical sum scale increased slightly from MW=41.01 to MW=43.94. Satisfaction remained almost unchanged.These results indicate that the VaO system can significantly increase the efficiency of GP care in rural areas. Despite a small absolute difference in the figures, the relative comparison already shows the potential and the increased efficiency of this innovative form of care. In addition, the interim evaluation shows that the concept does not lead to negative effects on QoL and patient satisfaction. An expansion to other regions and an in-depth analysis of the outcome parameters in further studies are recommended.

Specialist care in Germany is provided by hospitals as well as by independent physicians with their own practices authorized to provide care within the framework of the Statutory Health Insurance (SHI). This duplicate capacities for specialized care, and in particular the SHI-specialist track has come under criticis. Based on publicly accessible secondary data sources (Federal Statistical Office, National Association of SHI Physicians and German Medical Association), this study analyzes and quantifies the relevance of the two tracks along the parameters density of the regional (number of facilities) and specialist (number of specialized departments and specialist practices) care network, distribution of specialists and case numbers. Differences by specialty and changes between 2012 and 2022 are determined according to the distribution of specialists to tracks. In 2022 the SHI-specialist track dominated in terms of the number of medical facilities (96% of all were attributed to them) and specialized departments und specialist practices (89%), with 86% of all outpatient / inpatient cases and 90% of all outpatient cases being handled by them. Slightly less than 50% were accounted for by outpatient specialists (by headcount) or full-time equivalents of SHI-specialists. The distribution of physicians varied greatly according to specialties, while the relative proportions by tracks compared to 2012 remained largely constant. As the data sources are not harmonized, conversions and compromises were partly necessary for processing and interpretation the parameter-specific data. However, in the interests of transparency, extrapolation and weighting (also with regard to differences in workload treating outpatients or inpatients) were avoided. Distortions resulting from availability and handling of the date are named by type and direction. However, they are subordinate compared to the data unambiguously interpretable. The dimensions of the reported results can be regarded as robust. Considering the clear dominance of the SHI-specialist track, centralization of specialist care at hospitals would be accompanied by considerable challenges. Prior to demanding reform, criticism of the duplicate capacities for specialized care should be substantiated by data, while its potential advantages is acknowledged in the scientific discussion.

Periods of heat lead to increased mortality and morbidity. The aim of the present study was to investigate whether a trend of rescue deployments on heat days (Tmax≥32°C) from 2014 to 2024 is recognizable, whether morbidity already increases at lower temperatures (Tmax≥30°C or≥28°C) and whether an exposure-response curve is recognizable - for all patients and separately for different age groups.All 250,507 deployments from June to August 2014-2024 in Frankfurt am Main and weather data from the German meteorological Service at the Frankfurt weather station were used for the study. For each year, the deployments on heat days were compared with those on non-heat days (difference and ratio). Using the pairs of values (year, additional number of rescue missions on heat days with Tmax≥32°C), a linear regression model was adapted for the years 2014 to 2024 and the trend in the additional number of missions per year was estimated. Additional analyses were carried out for Tmax≥30°C and≥28°C. For the calculation of the exposure-response curve, the exposures over all years were calculated according to daily Tmax in 2°C steps, with Tmax<18°C as reference. These analyses were carried out for all patients and for age groups up to 59 years, 60-79 years and 80 years and older.Between 2014 and 2024, the additional deployments on heat days with Tmax≥32°C decreased significantly from+25 in 2014 to - 6.6 in 2024 (- 2.9; 95% CI - 3.5 - - 2.4). Overall, 6.2% (ratio=1.062 (95% CI: 1.050-1.075)) more deployments were required on heat days with Tmax≥32°C than on days without this definition, comparable to days with Tmax≥30°C (+6.3%; ratio=1.063 (95% CI: 1.053-1.073)), or≥28°C (+6.1%; ratio=1.061 (95% CI: 1.052-1.069)). The largest increase was seen in patients under 60 years of age, The dose-response curve showed a linear increase of 27% in those under 60 and 16% in those over 80, with the latter reaching a plateau at Tmax 28°C and above.The decreasing additional need for deployments at Tmax≥32°C could indicate an adaptation of the population, but requires further investigation. Morbidity already increases on days with lower Tmax. As people≤60 y are particularly affected, prevention measures should be strengthened and extended to younger, working people.