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Coors M, Flemming R, Schüttig W, Hubert GJ, Hubert ND, Sundmacher L. Health economic evaluation of the 'Flying Intervention Team' as a novel stroke care concept for rural areas: study protocol of the TEMPiS-GÖA study. BMJ Open 2022; 12:e060533. [PMID: 36127094 PMCID: PMC9490577 DOI: 10.1136/bmjopen-2021-060533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Providing comprehensive stroke care poses major organisational and financial challenges to the German healthcare system. The quasi-randomised TEMPiS-Flying Intervention Team (TEMPiS-FIT) study aims to close the gap in the treatment of patients who had ischaemic stroke in rural areas of Southeast Bavaria by flying a team of interventionalists via helicopter directly to patients in the regional TEMPiS hospitals instead of transporting the patients to the next comprehensive stroke centre. The objective of the present paper is to describe the methods for the economic evaluation (TEMPiS-Gesundheitsökonomische Analyse (TEMPiS-GÖA)) alongside the TEMPiS-FIT study to determine whether the new form of care is cost-effective compared with standard care. METHODS AND ANALYSIS The within-trial cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) will be performed from a statutory health insurance perspective as well as from a societal perspective over the time horizon of 12 months after the patients' hospital discharge. Direct costs from outpatient and inpatient care are collected from routine data of the participating health insurance funds, while medical and non-medical costs from a patient's perspective are retrieved from primary data collected during the TEMPiS-FIT study and follow-up questionnaires. Results will be presented as incremental cost-effectiveness ratio and incremental cost-utility ratio quantifying the incremental costs and health benefits compared with standard care practice. The outcome of the CEA will be measured in costs per minute reduction in mean process time to thrombectomy. The outcome of the CUA will be presented as costs per quality-adjusted life year gained. ETHICS AND DISSEMINATION Ethical approval for the TEMPiS-FIT study was granted by the Bavarian State Medical Association Ethics Committee (# 17056). Results will be disseminated via reports, presentations of the results in publications and at conferences and on the TEMPiS website. TRIAL REGISTRATION NUMBER German Clinical Trials Register DRKS00023885. Registered on 2 July 2021 - retrospectively registered.
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Affiliation(s)
- Marie Coors
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Ronja Flemming
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Wiebke Schüttig
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Gordian Jan Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Centre, München Klinik Harlaching, Munich, Germany
| | - Nikolai Dominik Hubert
- Department of Neurology, TEMPiS Telemedical Stroke Centre, München Klinik Harlaching, Munich, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, Munich, Germany
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Schwarzbach CJ, Michalski D, Wagner M, Winkler T, Kaendler S, Elstner M, Dreßing A, Claßen J, Meisel A, Grau A. [Position paper on stroke aftercare of the German Stroke Society-Part 3: structural concepts for future forms of care of stroke aftercare]. DER NERVENARZT 2022; 93:385-391. [PMID: 34932127 PMCID: PMC9010383 DOI: 10.1007/s00115-021-01230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND Irrespective of the great impact stroke exerts on the society as a whole and far-reaching advances in acute treatment and rehabilitation of stroke, so far outpatient services for post-stroke care have not been established on a national level in Germany. OBJECTIVE AND METHODS Against the background of this contemporary lack of care, in May 2020 the German Stroke Society (DSG) established the stroke aftercare commission. This position paper discusses structural models of future services addressing outpatient post-stroke care. RESULTS AND DISCUSSION The specialized care by a neurologist should be central to a multidisciplinary, interprofessional and transsectoral treatment. Structural concepts of post-stroke care must take regional differences but also effective strategies for quality control into account. Certification processes and appropriate financing of follow-up registries at state and federal levels may pave the way for improvement over the medium term. Structured outpatient post-stroke care services should be open to all subgroups of stroke patients. Additionally, innovative technologies can make an important contribution to post-stroke care; however, the implementation of specialized services demands adequate funding as well as separate financial incentives for the providers. The solution must carefully balance the advantages and disadvantages of the specific care and financing models. Currently the discussion of new models of post-stroke care is gaining new momentum, which opens up perspectives for the advancement of the otherwise still insufficient contemporary care structures.
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Affiliation(s)
- Christopher J Schwarzbach
- Neurologische Klinik, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
| | - Dominik Michalski
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Markus Wagner
- Stiftung Deutsche Schlaganfall-Hilfe, Gütersloh, Deutschland
| | - Tobias Winkler
- Klinik für Neurologie, kbo-Inn-Salzach-Klinikum, Wasserburg am Inn, Deutschland
| | | | | | - Andrea Dreßing
- Klinik für Neurologie und Neurophysiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Joseph Claßen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Andreas Meisel
- Centrum für Schlaganfallforschung Berlin und Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Deutschland
| | - Armin Grau
- Neurologische Klinik, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
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Hotter B, Ikenberg B, Kaendler S, Knispel P, Ritter M, Sander D, Schwarzbach C, von Büdingen HJ, Wagner M, Meisel A. [Position paper on stroke aftercare of the German Stroke Society-Part 2: concept for a comprehensive stroke aftercare]. DER NERVENARZT 2021; 93:377-384. [PMID: 34932125 PMCID: PMC9010332 DOI: 10.1007/s00115-021-01232-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
Die Schlaganfallnachsorge ist im Gegensatz zur akuten und rehabilitativen Versorgung des Schlaganfalls wenig standardisiert. Der fragmentierte ambulante Sektor erlaubt hierbei ein hohes Maß an Flexibilität, leidet aber folglich an variabler Qualität der Nachsorge. Die Kommission Nachsorge der Deutschen Schlaganfall-Gesellschaft formuliert in diesem Positionspapier ein inhaltliches Konzept, um eine strukturierte Nachsorge mit multiprofessionellem Ansatz zu entwickeln. Diese soll im Sinne einer „Comprehensive-care“-Versorgung und patientenzentriert erfolgen. Dazu schlagen wir ein diagnostisches Stufenkonzept mit Screening und ggf. weitergehender Untersuchung vor, das in Absprache mit den Betroffenen zu einem standardisierten Therapieplan führt, der im Langzeitverlauf entsprechend angepasst werden muss. Inhaltlich sind sowohl internistische Domänen (Management von Risikofaktoren) als auch genuin neurologische Domänen (Spastik, kognitive Defizite etc.) zu berücksichtigen. Besondere Herausforderungen an dieses Konzept sind die sektorenübergreifende (inter- und intrasektorale) Kommunikation zwischen den Akteuren im Gesundheitswesen untereinander sowie mit den Patienten und Angehörigen, die Notwendigkeit zur Schaffung eines Vergütungsmodells für eine solche Nachsorge und letztlich die Etablierung eines entsprechenden Qualitätsmanagements. Digitale Lösungen erachten wir als hilfreiche Werkzeuge für Aspekte der Diagnose, Therapie und Kommunikation in der Schlaganfallnachsorge.
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Affiliation(s)
- Benjamin Hotter
- Centrum für Schlaganfallforschung Berlin und Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Benno Ikenberg
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | | | - Petra Knispel
- Servicepunkt Schlaganfall, Berliner Schlaganfall-Allianz e. V., Berlin, Deutschland
| | - Martin Ritter
- Klinik für Schlaganfall- und Beatmungsmedizin, Clemenshospital, Münster, Deutschland
- Praxis Böckenholt & Ritter, Münster, Deutschland
| | - Dirk Sander
- Neurozentrum Tutzing-Feldafing, Benedictus-Krankenhaus, Tutzing, Deutschland
| | | | | | - Markus Wagner
- Stiftung Deutsche Schlaganfall-Hilfe, Gütersloh, Deutschland
| | - Andreas Meisel
- Centrum für Schlaganfallforschung Berlin und Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Deutschland
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Nursiswati N, Halfens RJG, Lohrmann C. Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian hospitals. Int J Nurs Sci 2020; 7:330-336. [PMID: 32817856 PMCID: PMC7424155 DOI: 10.1016/j.ijnss.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/16/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale (CDS) among stroke survivors. Methods The study was undertaken in four hospitals. We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics, who were rated by nurses to determine the CDS reliability coefficients. The Cronbach's α and Cohen's kappa coefficients were applied. Concurrent validity was conducted for the data on care dependency, which werecollected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index. A Spearman's rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results. Results An analysis of the results of the CDS tested on the inpatient ward and in the outpatient clinic revealed a high level of internal consistency. The reliability analysis yielded the same Cronbach's α coefficient of 0.98 for both the inpatient and outpatient data. A significant, moderate correlation was observed between the CDS and Barthel Index results. Conclusion The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.
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Affiliation(s)
- Nursiswati Nursiswati
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010, Graz, Austria
| | - Ruud J G Halfens
- Maastricht University Maastricht University, Department of Health Services Research, Caphri, Duboisdomein 30, 6229, GT Maastricht, the Netherlands
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010, Graz, Austria
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Schnitzer S, von dem Knesebeck O, Kohler M, Peschke D, Kuhlmey A, Schenk L. How does age affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund. BMC Geriatr 2015; 15:135. [PMID: 26499064 PMCID: PMC4619540 DOI: 10.1186/s12877-015-0130-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease? METHODS The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis. RESULTS 21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0-65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82-16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88-6.71) in patients aged 76-85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %). CONCLUSIONS Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.
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Affiliation(s)
- Susanne Schnitzer
- Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany.
| | - Martin Kohler
- Central Research Institute of Ambulatory Health Care in Germany, Herbert-Lewin-Platz 3, D-10623, Berlin, Germany.
| | - Dirk Peschke
- Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin, Steinplatz 2, D-10623, Berlin, Germany.
| | - Adelheid Kuhlmey
- Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
| | - Liane Schenk
- Department of Medical Sociology and Rehabilitation Science, Charité-Universitätmedizin Berlin, Luisenstr. 57, D-10117, Berlin, Germany.
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Berger K. Local versus specialized treatment: the difficulty in interpreting regional variations in treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:583-584. [PMID: 21966315 PMCID: PMC3183300 DOI: 10.3238/arztebl.2011.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Klaus Berger
- Institut für Epidemiologie und Sozialmedizin Universität Münster
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