1
|
Appel KS, Lee CH, Nunes de Miranda SM, Maier D, Reese JP, Anton G, Bahmer T, Ballhausen S, Balzuweit B, Bellinghausen C, Blumentritt A, Brechtel M, Chaplinskaya-Sobol I, Erber J, Fiedler K, Geisler R, Heyder R, Illig T, Kohls M, Kollek J, Krist L, Lorbeer R, Miljukov O, Mitrov L, Nürnberger C, Pape C, Pley C, Schäfer C, Schaller J, Schattschneider M, Scherer M, Schulze N, Stahl D, Stubbe HC, Tamminga T, Tebbe JJ, Vehreschild MJGT, Wiedmann S, Vehreschild JJ. A precise performance-based reimbursement model for the multi-centre NAPKON cohorts - development and evaluation. Sci Rep 2024; 14:13607. [PMID: 38871878 DOI: 10.1038/s41598-024-63945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
Fair allocation of funding in multi-centre clinical studies is challenging. Models commonly used in Germany - the case fees ("fixed-rate model", FRM) and up-front staffing and consumables ("up-front allocation model", UFAM) lack transparency and fail to suitably accommodate variations in centre performance. We developed a performance-based reimbursement model (PBRM) with automated calculation of conducted activities and applied it to the cohorts of the National Pandemic Cohort Network (NAPKON) within the Network of University Medicine (NUM). The study protocol activities, which were derived from data management systems, underwent validation through standardized quality checks by multiple stakeholders. The PBRM output (first funding period) was compared among centres and cohorts, and the cost-efficiency of the models was evaluated. Cases per centre varied from one to 164. The mean case reimbursement differed among the cohorts (1173.21€ [95% CI 645.68-1700.73] to 3863.43€ [95% CI 1468.89-6257.96]) and centres and mostly fell short of the expected amount. Model comparisons revealed higher cost-efficiency of the PBRM compared to FRM and UFAM, especially for low recruitment outliers. In conclusion, we have developed a reimbursement model that is transparent, accurate, and flexible. In multi-centre collaborations where heterogeneity between centres is expected, a PBRM could be used as a model to address performance discrepancies.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04768998 ; https://clinicaltrials.gov/ct2/show/NCT04747366 ; https://clinicaltrials.gov/ct2/show/NCT04679584 .
Collapse
Affiliation(s)
- Katharina S Appel
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany.
| | - Chin Huang Lee
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Susana M Nunes de Miranda
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Daniel Maier
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens-Peter Reese
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for medical Data Science, Würzburg, Würzburg, Germany
| | - Gabriele Anton
- Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, Pneumology Section, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany
| | - Sabrina Ballhausen
- Internal Medicine Department I, Pneumology Section, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Beate Balzuweit
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
| | - Carla Bellinghausen
- Department I of Internal Medicine, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
| | - Arne Blumentritt
- Independent Trusted Third Party of the University Medicine Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Markus Brechtel
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Irina Chaplinskaya-Sobol
- Department of Medical Informatics at the University Medical Center Göttingen, Göttingen, Germany
| | - Johanna Erber
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, Technical University of Munich, University Medical Center, Munich, Germany
| | - Karin Fiedler
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Ramsia Geisler
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Ralf Heyder
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Illig
- Hannover Medical School, Hannover Unified Biobank, Hannover, Germany
| | - Mirjam Kohls
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
| | - Jenny Kollek
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Clinical Trial Unit Berlin, Berlin, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roberto Lorbeer
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Olga Miljukov
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for medical Data Science, Würzburg, Würzburg, Germany
| | - Lazar Mitrov
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Carolin Nürnberger
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for medical Data Science, Würzburg, Würzburg, Germany
| | - Christian Pape
- Department of Medical Informatics at the University Medical Center Göttingen, Göttingen, Germany
| | - Christina Pley
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Clinical Trial Office, Berlin, Germany
| | - Christian Schäfer
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jens Schaller
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Mario Schattschneider
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Margarete Scherer
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
| | - Nick Schulze
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Dana Stahl
- Independent Trusted Third Party of the University Medicine Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Hans Christian Stubbe
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner-Site Munich, Munich, Germany
| | - Thalea Tamminga
- Internal Medicine Department I, Pneumology Section, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Johannes Josef Tebbe
- Hospital Lippe, Department of Gastroenterology and Infectious Diseases, Lippe, Germany
- Bielefeld University, Medical School OWL, Bielefeld, Germany
| | - Maria J G T Vehreschild
- Goethe University Frankfurt, University Hospital Frankfurt, Department II of Infectious Diseases, Frankfurt, Germany
| | - Silke Wiedmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Charitéplatz 1, 10117, Berlin, Germany
| | - Jörg Janne Vehreschild
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany.
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany.
| |
Collapse
|
6
|
Ankolekar A, Dahl Steffensen K, Olling K, Dekker A, Wee L, Roumen C, Hasannejadasl H, Fijten R. Practitioners' views on shared decision-making implementation: A qualitative study. PLoS One 2021; 16:e0259844. [PMID: 34762683 PMCID: PMC8584754 DOI: 10.1371/journal.pone.0259844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Shared decision-making (SDM) refers to the collaboration between patients and their healthcare providers to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored practitioner experiences of SDM in a context where SDM has been successfully implemented. Specifically, we focused on practitioners' perceptions of SDM as a paradigm, factors influencing implementation success, and outcomes. METHODS We used a qualitative approach to examine the experiences and perceptions of 10 Danish practitioners at a cancer hospital experienced in SDM implementation. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data was analyzed through thematic analysis. RESULTS Prior to SDM implementation, participants had a range of attitudes from skeptical to receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM. We identified four main factors that influenced SDM implementation success: raising awareness of SDM behaviors among clinicians through concrete measurements, supporting the formation of new habits through reinforcement mechanisms, increasing the flexibility of PDA delivery, and strong leadership. According to our participants, these factors were instrumental in overcoming initial skepticism and solidifying new SDM behaviors. Improvements to the clinical process were reported. Sustaining and transferring the knowledge gained to other contexts will require adapting measurement tools. CONCLUSIONS Applying SDM in clinical practice represents a major shift in mindset for clinicians. Designing SDM initiatives with an understanding of the underlying behavioral mechanisms may increase the probability of successful and sustained implementation.
Collapse
Affiliation(s)
- Anshu Ankolekar
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hajar Hasannejadasl
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|