2022
Completed work areas including a short summary of results and reference to new publications
The results of the first round of interviews were used to determine the degree of agreement between assessments of the relevance and feasibility of measures to promote value-based care. High or moderate agreement was found for 69 of the 112 statements submitted. Measures that did not have a consensus group opinion or for which the level of agreement was low (n = 43) will be carried forward to the second round of interviews and resubmitted to participants for assessment.
Current processes/preparations
Invitations to participate in the second round of online surveys will be sent to all addressees of the first round of surveys in June 2022. We are currently compiling an overview of the results of the first survey round, which will be made available to participants together with the invitation to the second survey round. The participants in the second round can use the anonymized group opinion to reconsider their assessment in the second round of questioning.
Outlook on the next steps
After the second round of questioning has been completed, a detailed evaluation of both rounds of questioning will take place.
Completed work areas including a short summary of results and reference to new publications
The value-based care approach aims to improve treatment outcomes that are important to patients. It also aims to optimize the relationship between costs and achieved treatment outcomes.
To achieve this, several core strategies for health care reform have been proposed in the literature. With our survey, we investigate the relevance and feasibility of these measures to improve health care in Germany from the perspective of health care providers, payers and regulatory institutions.
Current processes/preparations
Delphi Study
Invitations to participate in the online survey will be sent out in April 2022. Currently, we are creating a database of potential participants. If you are interested in participating in the survey, please email Delphi-CoRe-Net@uk-koeln.de to request a link to participate in the online questionnaire. If you have any questions, you can also reach us by phone at 0221 478 30924. We appreciate your interest in the survey.
Outlook on the next steps
The initial results of the online survey will be fed back to the participants after approximately 6 weeks. This will show, among other things, how much agreement there is in the assessments of all participants. Depending on the agreement of the assessments and the scope of the additional measures mentioned, a second round of questioning will follow.
2021
Completed work areas including a short summary of results and reference to new publications
Semi-structured interviews were conducted with 15 individuals between May and September 2021. These included representatives of hospital management, hospital associations, scientific institutions for quality assessment in health care, statutory health insurers, stakeholders in joint self-governance, and patients. Fourteen individuals rated VBC as basically positive. The stronger patient orientation by focusing on treatment outcomes instead of treatment volumes was rated as positive. In addition, unwanted overuse and misuse of care at the end of life in particular could be reduced. The challenges in recording standardized outcomes were mentioned as a point of criticism of the concept, especially for multimorbid patients or patients with rare or complex diseases as well as therapies that are difficult to plan. For example, feasibility, validity, reliability, independence, and clinical relevance of instruments and parameters were mentioned as requirements for outcome measurement. In addition, concerns were expressed about implementability under current regulatory frameworks.
Current processes/preparations
Based on the results of the stakeholder interviews and an additional literature review, a questionnaire for a subsequent Delphi survey is currently being developed. The Delphi survey is intended to elicit from a larger sample which elements of the value-based care approach have the greatest potential for implementation in Germany.
Outlook on the next steps
The Delphi survey will take the form of an online survey and is expected to begin in spring 2021.
Our paper on “Determinants for tailoring and implementation of question prompt sheets in the last year of life” was accepted as a poster at the 12th World Research Congress of the European Association for Palliative Care. We are looking forward to the congress in May 2022!
Completed work areas including a short summary of results and reference to new publications
The first evaluations show that a large number of currently existing remuneration regulations in Germany and internationally were discussed in the interviews. The focus was particularly on the influence of these regulations on patient-centeredness in inpatient care – however, cross-sector examples and suggestions were also taken up. In addition to the discussion of existing regulations, many suggestions for alternative regulations were made by the interviewees. These suggestions ranged from changes in the processes for determining reimbursement levels to fundamental restructuring of the health care system according to various international models. In addition, the interviews identified both positive and negative aspects of the concept of “value-based healthcare”.
Current processes/preparations
The interviews are currently still being systematically evaluated. In particular, the positively and negatively evaluated aspects of value-based healthcare are being analysed in more detail. The topics and suggestions identified in the interviews will be taken up in a subsequent online survey and presented to a larger group of people for evaluation.
Outlook on the next steps
The online survey should start in fall 2021.
Completed work areas including a short summary of results and reference to new publications
In cooperation with the subproject LYOL-C II, interviews with providers (n=6) and patient representatives (n=3) have been conducted in order to gain detailed insights into the care situation of patients in the last year of life and to be able to better assess possible improvements in the care of these patients.
A positive vote of the ethics committee for the subproject MenDis-CHD II in cooperation with OrgValue II is now available. In parallel, a draft for the Question Prompt Sheets has been developed, which will be finalized by the information from the interviews.
Detailed information on this can be found in the sections LYOL-C II and MenDis-CHD II.
Current processes/preparations
Delphi Study
The ethics application for the Delphi study was approved. In the first part of the study, interviews will be conducted to discuss the impact of regulatory and reimbursement policies on the ability to provide patient-centered care. The recruitment of interview partners has started.
Cooperation with the subprojects LYOL-C II and MenDis-CHD II
In cooperation with the subproject LYOL-C II the conducted interviews help to assess the feasibility and implementation possibilities of the planned intervention. In further steps, the interviews will now be qualitatively evaluated and the implementation concept will be concretized. Detailed information can be found in the newsletter section on LYOL-C II.
In cooperation with the MenDis-CHD II subproject, initial interviews have already been conducted with general practitioners and patient representatives, and experiences and requirements for the identification and needs-based care of patients with coronary heart disease (CHD) and mental/cognitive disorders have been collected. The results will be incorporated into the design of the intervention and the concept development of the implementation.
The study documents and the ethics application are currently being prepared in preparation for the pilot intervention study in general practices. One aim of OrgValue II is the analysis of organizational characteristics of the general practices and their influence on the outcomes of the intervention. For this purpose, a questionnaire is currently being developed to capture relevant organizational characteristics. In parallel, the technical implementation of the data export is being clarified in cooperation with MenDis-CHD II and a joint data protection concept is being developed. Detailed information can be found in the newsletter section on MenDis-CHD II.
Outlook on the next steps
As a subproject which is strongly integrated into the two intervention projects LYOL-C II and MenDis-CHD II, OrgValue II supports these two projects in the following weeks, among other things, in the design of the intervention, the creation of implementation concepts of the planned interventions, and further in the recruitment of patients and general practitioners.
2020
Completed work areas including a short summary of results and reference to new publications
For the intervention projects LYOL-C II and MenDis-CHD II, which are being carried out in cooperation with OrgValue II, interview guidelines and first drafts of the study materials have been prepared in recent weeks. The recruitment of interview partners will take place soon. Detailed information on this can be found in the sections LYOL-C II and MenDis-CHD II.
An article on the validation of the PACIC-S9 proxy questionnaire in cooperation with LYLOL-C was published at BMC Palliative Care.
An article comparing the assessment of patient-centredness by patients and relatives in cooperation with MenDis-CHD was published in the Journal of Primary Care and Community Health.
Delphi study
The planning for the Delphi study has been completed and the ethics application is under review. The first interviews with experts are planned for February 2021. In the interviews, the influence of regulatory requirements and remuneration rules on the possibility of providing patient-centred care will be discussed. In particular, the various stakeholders’ alternative proposals to the existing rules are of interest.
Cooperation with the subprojects LYOL-C II and MenDis-CHD II
The sub-project OrgValue II is closely integrated into the other two sub-projects LYOL-C II and MenDis-CHD II within the framework of CoRe-Net II. In cooperation with the sub-projects LYOL-C II and MenDis-CHD II, providers and patient representatives will soon be invited for interviews. For this purpose, the study documents have been prepared in the last few weeks. The aim is to learn from their experiences and assessments and to discuss with them the further procedure and the design of the planned intervention. Detailed information on this can be found in the LYOL-C II and MenDis-CHD II newsletter section.
Outlook
In January and February, interviews with providers and patient representatives will take place in cooperation with the two projects LYOL-C II and MenDis-CHD II. Interested parties are welcome to contact the study team. We look forward to your support.
Closed workspaces
Transfer of results of the feasibility study
The results of the feasibility study, in the course of which interviews were conducted with decision-makers* in various care organizations of the City of Cologne, were compiled in a fact sheet for the CoRe-Net website.The aim of these interviews was to gain insight into the recording of costs, revenues, the service portfolio and quality on the basis of key company figures.
You can download this fact sheet here. The aim of these interviews was to gain insight into the recording of costs, revenues, the service portfolio and quality on the basis of key company figures.
19th German Congress for Healthcare Research (DKVF)
At the DKVF, an abstract on the survey of Cologne health care organizations was accepted. The question is discussed how relevant health care institutions consider individual aspects of patient centricity and to what extent these aspects are already implemented in the individual organizations.
Recent publications
- An article comparing patient and family member evaluations of care was submitted to BMC Family Practice and is currently under review.
An article on resource orientation in care organizations was submitted to BMC Health Services Research. - An article on patient orientation and its relation to the organizational communication climate in different health care organizations and is currently being finalized for submission to Journal Patient Education Counseling.
- An article on the validation of the PACIC-S9 Proxy Questionnaire in cooperation with LYLOL-C is currently under review at BMC Palliative Care.
Current process flows
Cooperation with the subprojects LYOL-C and MenDis-CHD
The subproject OrgValue is strongly integrated into the other two subprojects LYOL-C and MenDis-CHD within the framework of CoRe-Net II. Currently, the corresponding ethics applications and study protocols are being prepared in cooperation with both of these subprojects.
For example, the planned interventions will be developed on the basis of joint surveys in order to make them comprehensively usable, taking into account organizational peculiarities. In addition, organizational characteristics that could influence the implementation of the interventions of the two subprojects LYOL-C and MenDis-CHD will be analyzed. A formative socio-economic impact assessment will then support the future implementation of the interventions included in the clinical subprojects. In a further work package, the extent to which different providers and actors in the health care system assess different reimbursement models for the implementation of patient-centered care will be investigated. Currently, first virtual meetings are taking place to discuss and actively implement first steps.
Finished work areas including a short summary of results and reference to new publications:
At the 19th German Congress for Health Care Research (DKVF), an abstract was submitted for a survey of health care organizations in Cologne. The question is discussed how relevant health care institutions consider individual aspects of patient-centeredness and to what extent these aspects are already implemented in the individual organizations.
Transfer of results of the feasibility study
The interviews with decision-makers from various health care organisations in Cologne were summarised. Initial findings were presented to the project members in an overview. In addition, the contents were prepared for the students of the courses of study Health Economics (B.Sc.) and Health Care Science (M.Sc.) in such a way that they could give the students a good overview of the particularities of the different health care organizations in the context of the lecture “Management in Health Care”.
The aim of these interviews was to gain some insights into the recording of costs, proceeds, the service portfolio and quality on the basis of key company figures. Currently, the students are also analysing which key figures are suitable for inquiring the above-mentioned dimensions in an organization-type-specific basis.
The results of the patient interviews in OrgValue were published in a scientific article in the journal BMJ Open. (https://bmjopen.bmj.com/content/bmjopen/10/5/e033449.full.pdf)
An article on the validation of the PACIC-S9 proxy questionnaire prepared in cooperation with LYLOL-C is currently under review at BMC Palliative Care.
Current processes/preparations and Outlook on following steps:
The subproject OrgValue will be closely integrated into the other two subprojects LYOL-C and MenDis-CHD within the framework of CoRe-Net II. For example, the planned interventions will be developed on the basis of cummon surveys in order to make them comprehensively usable, taking into account organisational peculiarities. In addition, organisational characteristics that could influence the implementation of the interventions of the two subprojects LYOL-C and MenDis-CHD will be analysed. A formative socio-economic impact assessment will then support the future implementation of the interventions included in the clinical subprojects. In a further work package, the extent to which different providers and actors in the health care system assess different reimbursement models for the implementation of patient-centered care will be investigated. Currently, first virtual meetings are taking place to discuss and implement first steps.
