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Background
Despite the current undersupply of cochlear implants (CIs) with simultaneously increasing indication, CI implantation numbers in Germany still are at a relatively low level.
Methods
As there are hardly any solid forecasts available in the literature, we develop a System Dynamics model that forecasts the number and costs of CI implantations in adults for 40 years from a social health insurance (SHI) perspective.
Results
CI demand will grow marginally by demographic changes causing average annual costs of about 538 million €. Medical-technical progress with following relaxed indication criteria and patients’ increasing willingness for implantation will increase implantation numbers significantly with average annual costs of 765 million €.
Conclusion
CI demand by adults will increase in the future, thus will the costs for CI supply. Continuous research and development in CI technology and supply is crucial to ensure long-term financing of the growing CI demand through cost-reducing innovations.
Background
Out-of-hospital cardiac arrest is one of the most frequent causes of death in Europe. Emergency medical services often struggle to reach the patient in time, particularly in rural areas. To improve outcome, early defibrillation is required which significantly increases neurologically intact survival. Consequently, many countries place Automated External Defibrillators (AED) in accessible public locations. However, these stationary devices are frequently not available out of hours or too far away in emergencies. An innovative approach to mustering AED is the use of unmanned aerial systems (UAS), which deliver the device to the scene.
Methods
This paper evaluates the economic implications of stationary AED versus airborne delivery using scenario-based cost analysis. As an example, we focus on the rural district of Vorpommern-Greifswald in Germany. Formulae are developed to calculate the cost of stationary and airborne AED networks. Scenarios include different catchment areas, delivery times and unit costs.
Results
UAS-based delivery of AEDs is more cost-efficient than maintaining traditional stationary networks. The results show that equipping cardiac arrest hot spots in the district of Vorpommern-Greifswald with airborne AEDs with a response time < 4 min is an effective method to decrease the time to the first defibrillation The district of Vorpommern-Greifswald would require 45 airborne AEDs resulting in annual costs of at least 1,451,160 €.
Conclusion
In rural areas, implementing an UAS-based AED system is both more effective and cost-efficient than the conventional stationary solution. When regarding urban areas and hot spots of OHCA, complementing the airborne network with stationary AEDs is advisable.
Background
Even with high standards of acute care and neurological early rehabilitation (NER) a substantial number of patients with neurological conditions still need mechanical ventilation and/or airway protection by tracheal cannulas when discharged and hence home-based specialised intensive care nursing (HSICN). It may be possible to improve the home care situation with structured specialized long-term neurorehabilitation support and following up patients with neurorehabilitation teams. Consequently, more people might recover over an extended period to a degree that they were no longer dependent on HSICN.
Methods
This healthcare project and clinical trial implements a new specialised neurorehabilitation outreach service for people being discharged from NER with the need for HSICN. The multicentre, open, parallel-group RCT compares the effects of one year post-discharge specialized outpatient follow-up to usual care in people receiving HSICN. Participants will randomly be assigned to receive the new form of healthcare (intervention) or the standard healthcare (control) on a 2:1 basis. Primary outcome is the rate of weaning from mechanical ventilation and/or decannulation (primary outcome) after one year, secondary outcomes include both clinical and economic measures. 173 participants are required to corroborate a difference of 30 vs. 10% weaning success rate statistically with 80% power at a 5% significance level allowing for 15% attrition.
Discussion
The OptiNIV-Study will implement a new specialised neurorehabilitation outreach service and will determine its weaning success rates, other clinical outcomes, and cost-effectiveness compared to usual care for people in need for mechanical ventilation and/or tracheal cannula and hence HSICN after discharge from NER.
Trial registration
The trial OptiNIV has been registered in the German Clinical Trials Register (DRKS) since 18.01.2022 with the ID DRKS00027326.
In 2009, the Democratic Republic of Congo (DRC) started its journey towards achieving Universal Health Coverage (UHC). This study examines the evolution of financial risk protection and health outcomes indicators in the context of the commitment of DRC to UHC. To measure the effects of such a commitment on financial risk protection and health outcomes indicators, we analyse whether changes have occurred over the last two decades and, if applicable, when these changes happened. Using five variables as indicators for the measurement of the financial risk protection component, there as well retained three indicators to measure health outcomes. To identify time-related effects, we applied the parametric approach of breakpoint regression to detect whether the UHC journey has brought change and when exactly the change has occurred.
Although there is a slight improvement in the financial risk protection indicators, we found that the adopted strategies have fostered access to healthcare for the wealthiest quantile of the population while neglecting the majority of the poorest. The government did not thrive persistently over the past decade to meet its commitment to allocate adequate funds to health expenditures. In addition, the support from donors appears to be unstable, unpredictable and unsustainable. We found a slight improvement in health outcomes attributable to direct investment in building health centres by the private sector and international organizations. Overall, our findings reveal that the prevention of catastrophic health expenditure is still not sufficiently prioritized by the country, and mostly for the majority of the poorest. Therefore, our work suggests that DRC’s UHC journey has slightly contributed to improve the financial risk protection and health outcomes indicators but much effort should be undertaken.
Background
Multiple Sclerosis is an autoimmune inflammatory disease of the central nervous system that often leads to premature incapacity for work. Therefore, the MSnetWork project implements a new form of care and pursues the goal of maintaining or even improving the state of health of MS patients and having a positive influence on their ability to work as well as their participation in social life. A network of neurologists, occupational health and rehabilitation physicians, psychologists, and social insurance suppliers provide patients with targeted services that have not previously been part of standard care. According to the patient’s needs treatment options will be identified and initiated.
Methods
The MSnetWork study is designed as a multicenter randomized controlled trial, with two parallel groups (randomization at the patient level with 1:1 allocation ratio, planned N = 950, duration of study participation 24 months). After 12 months, the patients in the control group will also receive the interventions. The primary outcome is the number of sick leave days. Secondary outcomes are health-related quality of life, physical, affective and cognitive status, fatigue, costs of incapacity to work, treatment costs, out-of-pocket costs, self-efficacy, and patient satisfaction with therapy.
Intervention effects are analyzed by a parallel-group comparison between the intervention and the control group. Furthermore, the long-term effects within the intervention group will be observed and a pre-post comparison of the control group, before and after receiving the intervention in MSnetWork, will be performed.
Discussion
Due to the multiple approaches to patient-centered, multidisciplinary MS care, MSnetWork can be considered a complex intervention. The study design and linkage of comprehensive, patient-specific primary and secondary data in an outpatient setting enable the evaluation of this complex intervention, both on a qualitative and quantitative level. The basic assumption is a positive effect on the prevention or reduction of incapacity for work as well as on the patients’ quality of life. If the project proves to be a success, MSnetWork could be adapted for the treatment of other chronic diseases with an impact on the ability to work and quality of life.
Trial registration
The trial MSnetWork has been retrospectively registered in the German Clinical Trials Register (DRKS) since 08.07.2022 with the ID DRKS00025451.
Aim
A shortage in primary care physicians has been a well-known challenge in many Western countries for several years. In addition, we currently see a trend in primary care, where an increasing number of physicians work as employees instead of being self-employed, even among general practitioners. To address this shortage, knowledge of the future specialists’ attitudes toward working self-employed is needed. This qualitative systematic review aims to explore the attitudes of future specialists towards self-employment in private practice, and what factors influence these attitudes.
Subject and methods
We conducted a systematic search using PubMed, Embase, and Web of Science. We developed a search strategy that collected terms for future specialists, career choices, and self-employment and linked these with the Boolean operator “AND”. We analysed the results using a qualitative content analysis, as both qualitative and quantitative studies were included in the research.
Results
Self-employment is less attractive to future specialists. In particular, women prefer to be employed and receive a fixed salary. The main factors that influence the decision as to whether to become self-employed or not are financial conditions, bureaucracy and non-medical tasks, organisation, job satisfaction during residency, personal responsibility, career opportunities, specialty-dependent factors, personal environment, and education.
Conclusion
Among future specialists, being self-employed is less attractive than being an employee. Students should be better informed about future career opportunities to make an informed decision. However, it should be examined whether other forms of organisation are more in line with the wishes of future specialists.
Background and objective
Political, economic, communicative and cultural borders still limit the accessibility of acute healthcare services for patients so that they frequently have to accept longer distances to travel to the next provider within their own country. In this paper, we analyze the impact of borders and opening of borders on acute medical care in hospitals and on patients in border regions.
Methods
We develop a conceptual framework model of cross-border healthcare and apply it to the Polish–German border area. The model combines the distance decay effect, a catchment area analysis, economies of scale and the learning curve.
Results
Borders have a major impact on acute medical care in hospitals and on patients. Setting of new borders will reduce the accessibility of health facilities for patients or require the establishment of new hospitals. Reopening borders might induce a vicious circle leading to the insolvency of a hospital which might result in poorer health for some patients.
Conclusion
Strong effort should be invested to overcome political and cultural borders to improve the health of the population in border regions. Similarly, increased cross-border acute healthcare must be seen in the context of rural health and the special situation of small rural hospitals in rural peripheral areas.
Background
Medical research is increasingly interdisciplinary. However, not all projects are successful and cooperation is not always sustained beyond the end of funding. This study empirically assesses the effect of control and trust on the sustainability of interdisciplinary medical research in terms of its performance and satisfaction.
Methods
The sample consists of 100 German publicly funded medical research collaborations with scientists from medicine, natural and social sciences (N = 364). We develop a system model to analyze the influence of trust and control on performance and satisfaction of the cooperation.
Findings
Both control and trust are important prerequisites for sustainability, control mainly for the performance of the collaboration, and trust primarily for its satisfaction. While the level of interdisciplinarity is a positive moderator for performance, expectation of continuity is a negative intervening variable for the effect of trust and control on satisfaction. Moreover, trust principally adds to the positive impact of control on sustainability.
Conclusions
Interdisciplinary medical research requires a participative but systematic management of the respective consortium.
Strategic Management in Healthcare: A Call for Long-Term and Systems-Thinking in an Uncertain System
(2022)
Strategic management is becoming increasingly important for sustainable management in healthcare. The reasons for this can be seen in the increasing complexity, dynamics and uncertainty of the system’s regimes and the resulting need for strategic thinking in a long-term period. The scientific discussion of this issue is the aim of the present analytical framework. The starting point is the definition of the term strategic management itself, followed by a reflection on the requirements resulting from the changes in the political, social and economic value systems of our post-industrial society. In this context, Dynaxity Zone III is used to explain the long-term perspective, the high levels of complexity and uncertainty and the responsibility of strategic management as important parameters. For a practical illustration, we demonstrate two selected applications (German hospital financing systems and development process of implants) and how the implementation of strategic management in the health care system shows success.