scholarly journals The Self-Regulatory German Healthcare System Between Growing Competition and State Hierarchy

2010 ◽  
pp. 119-179 ◽  
Author(s):  
Heinz Rothgang ◽  
Achim Schmid ◽  
Claus Wendt
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabel Geiger ◽  
◽  
Christian Kammerlander ◽  
Christine Höfer ◽  
Ruth Volland ◽  
...  

Abstract Background The economic and public health burden of fragility fractures of the hip in Germany is high. The likelihood of requiring long-term care and the risk of suffering from a secondary fracture increases substantially after sustaining an initial fracture. Neither appropriate confirmatory diagnostics of the suspected underlying osteoporosis nor therapy, which are well-recognised approaches to reduce the burden of fragility fractures, are routinely initiated in the German healthcare system. Therefore, the aim of the study FLS-CARE is to evaluate whether a coordinated care programme can close the prevention gap for patients suffering from a fragility hip fracture through the implementation of systematic diagnostics, a falls prevention programme and guideline-adherent interventions based on the Fracture Liaison Services model. Methods The study is set up as a non-blinded, cluster-randomised, controlled trial with unequal cluster sizes. Allocation to intervention group (FLS-CARE) and control group (usual care) follows an allocation ratio of 1:1 using trauma centres as the unit of allocation. Sample size calculations resulted in a total of 1216 patients (608 patients per group distributed over 9 clusters) needed for the analysis. After informed consent, all participants are assessed directly at discharge, after 3 months, 12 months and 24 months. The primary outcome measure of the study is the secondary fracture rate 24 months after initial hip fracture. Secondary outcomes include differences in the number of falls, mortality, quality-adjusted life years, activities of daily living and mobility. Discussion This study is the first to assess the effectiveness and cost-effectiveness/utility of FLS implementation in Germany. Findings of the process evaluation will also shed light on potential barriers to the implementation of FLS in the context of the German healthcare system. Challenges for the study include the successful integration of the outpatient sector as well as the future course of the coronavirus pandemic in 2020 and its influence on the intervention. Trial registration German Clinical Trial Register (DRKS) 00022237, prospectively registered 2020-07-09


2010 ◽  
Vol 1 (4) ◽  
pp. 535-547 ◽  
Author(s):  
Andrea Döring ◽  
Friedemann Paul

2017 ◽  
Vol 20 (9) ◽  
pp. A690 ◽  
Author(s):  
K Krinke ◽  
K Borchert ◽  
S Braun ◽  
T Mittendorf

Author(s):  
Dominik Pförringer ◽  
Patrick Pflüger ◽  
Lilia Waehlert ◽  
Andreas Beivers ◽  
Fritz Seidl ◽  
...  

2020 ◽  
Vol 9 (7) ◽  
pp. 2272
Author(s):  
Linda Kerkemeyer ◽  
Katharina Achtert ◽  
Inga Claus ◽  
Svenja Happe ◽  
Jeannette Overbeck ◽  
...  

Interdisciplinary care has been shown to be effective at optimizing the treatment of patients with Parkinson’s disease. An optimized collaboration between the various healthcare providers involved in the treatment process facilitates successful care. One of the main shortcomings in the German healthcare system is the limited and unstandardized communication between practitioners. The Parkinson’s network Münsterland+ (PNM+) is an interdisciplinary network of medical and non-medical experts involved in the treatment of Parkinson’s patients: neurologists, physiotherapists, occupational therapists, speech therapists, psychologists, Parkinson’s nurses, pharmacists, patients, and relatives. The PNM+ elaborates guideline-based therapy recommendations, provided as so-called “Quickcards”. Thereby, the communication of the treating neurologist and therapists is based on a coordinated feedback system and suggestions to adequately select and, if necessary, adjust the therapy. In the German healthcare system, with its fragmented structures, the PNM+ and its activities have been shown to enhance integration of the healthcare providers and thereby optimize the care of Parkinson’s disease patients. Future research should evaluate the effects and cost-effectiveness.


Health Policy ◽  
2021 ◽  
Vol 125 (1) ◽  
pp. 104-114
Author(s):  
Clarissa Lemmen ◽  
Christiane Woopen ◽  
Stephanie Stock

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