Using a newly developed maturity model, the progress of digitization in German hospitals and the effect of funding from the Hospital Future Fund are to be evaluated. The model enables a standardized and comprehensive assessment based on extensive data collection and the self-assessment of the participating hospitals. It calculates an individual DigitalRadar score and, for international comparability, an EMRAM indicator for each hospital.

For hospitals that have applied for funding under the Hospital Future Act (KHZG), participation in the accompanying evaluation is mandatory. Hospitals that have not applied for funding can also participate in the self-assessment on a voluntary basis. The digital tool is available online and offers the opportunity for a new German public reporting in the health care sector.

The inav was involved in the development of the maturity model and is responsible for the accompanying quantitative and qualitative evaluation.

More information can be found on the DigitalRadar website.

The new form of health care “SmartAssistEntz” is designed to help patients who have completed an inpatient alcohol withdrawal program to identify, access, and use the appropriate follow-up measures sustainably.

Alcohol dependence is one of the most common mental disorders worldwide and is often characterized by a chronic course. The German healthcare system offers a wide range of treatment options for those affected. However, only a small proportion of patients make use of further care services after completing inpatient withdrawal. Consequently, patients do not receive adequate support in a phase characterized by a high risk of relapse.

The smartphone-based concept provides the following eCoach-accompanied components:

1. Enhancement of abstinence motivation through app-based training of abstinence skills.
2. App-based telediagnostics for the identification of individually tailored follow-up actions
3. Transfer to selected follow-up programs on the basis of an individual sustainability plan, which is jointly developed in six weekly telephone calls between the patient and the eCoach.

Methods

The evaluation will compare SmartAssistEntz with the standard of care. The primary outcome parameter is the risk of relapse within six months after completion of withdrawal. Secondary parameters include the use of evidence-based follow-up treatments after inpatient withdrawal, severity of alcohol dependence, health-related quality of life, and (total) costs. Tertiary outcome parameters are usability and satisfaction with “SmartAssistEntz”. For this purpose, patients and treatment providers will be surveyed and routine data from the participating health insurance funds and the German pension insurance will be used.

Funding

For the three-year project period, there is funding of a total of approx. 2.4 million euros. If successful, the “SmartAssistEntz” care concept could be transferred to other regions or to standard care.

Chronic obstructive pulmonary disease (COPD) is a disease that progresses over several years and results in permanent damage of the lungs. As a result, those affected suffer from severe shortness of breath. With a prevalence of almost six percent, COPD is one of the most common diseases in Germany.

Sudden worsening of the patient’s condition (exacerbations) occur frequently and often lead to hospitalization. The TelementorCOPD project aims to detect these exacerbations at an early stage, initiate appropriate interventions and thus avoid hospitalizations. This is also associated with an increase in the quality of life of COPD patients.

With the help of a special COPD app, participating patients receive a physical and pulmonary training program with a focus on prevention. In addition, vital signs and the results of COPD assessment tests are automatically recorded and transmitted via telemeters. On this basis, the exacerbation risk can be analyzed, which is visualized using a traffic light system. Specially trained COPD nurses who monitor the parameters can then initiate early risk-adapted interventions and contact the patients via video chat or refer them to the treating pulmonologists.

The inav GmbH was assigned with the evaluation of the project. An unblinded randomized controlled trial will determine if the COPD app and the monitoring of vital signs can significantly reduce acute exacerbations in the intervention group compared to the control group.

The project is funded by the Innovation Fund for three years with a ca. 3.76 million euros. If successful, the optimization of outpatient COPD care will lead to an improvement in patients’ health status and increase their quality of life. The care concept can also be transferred to other regions and indications.

Further information: www.telementor-copd.de

Photo: freepik | DCStudio

The project “Back innovative pain therapy with e-health for our patients” (Rise-uP) systematically analyzes how the treatment of back pain, which to date has often been of little effectiveness, can be improved.

For many people in Germany, back pain is part of their everyday life; one in five people with Statutory Health Insurance (SHI) visits a doctor at least once a year because of it. Despite the high prevalence, there is still no target-oriented treatment path. Misuse and overuse of treatment are often the case.

The central idea of this intervention concept is to eliminate the currently existing fragmented structures for the treatment of back pain patients and to develop treatment pathways. The Rise-uP treatment concept is based on early use of an assessment tool to measure the risk of chronification (STartBack questionnaire), a telemedicine networking software (Therapienavigator) and a medical app (Kaia). The focus of this intervention program lies on patients with acute and subacute back pain.

Methods

Rise-uP is a prospective cohort study with an intervention group and a control group in terms of an observational study (health services research study), with an observation period of 18 months. The evaluation includes the analysis of quantitative primary data from several validated questionnaires, as well as secondary data from i) routine data from a statutory health insurance, ii) data from a health app, and iii) data from telemedicine software.

The primary endpoint relevant to the number of cases is the patients’ pain level, which is measured using a pain index (Visual Analogue Scale, VAS). In addition, functionality and general quality of life are assessed. Within the framework of a health economic evaluation, it will be examined whether a significant change in the total cost of care exists. Furthermore, an incremental cost-effectiveness analysis is performed. In the incremental cost-effectiveness analysis, the costs per reduced pain index are calculated.

Publication

Priebe, J.A., Haas, K.K., Moreno Sanchez, L.F., Schoefmann, K., Utpadel-Fischler, D.A., Stockert, P., Thoma, R., Schiessl, C., Kerkemeyer, L., Amelung, V.E., Jedamzik, S., Reichmann, J., Marschall, U., Toelle, T.R. (2020). Digital Treatment of Back Pain versus Standard of Care: The Cluster-Randomized Controlled Trial, Rise-uP. Journal of Pain Research 13: 1823–1838.

Diabetes mellitus affects around nine percent of the population in Germany, and forecasts predict that this percentage will increase in the future. Many patients receive intensified insulin therapy, which is time-consuming, organizationally complex and requires intensive doctor-patient contact. This study was initiated on the assumption that consistent monitoring combined with individual medical care supported by telemedicine can significantly contribute to improving or stabilizing the metabolism of people with diabetes mellitus. The telemedical approach was based on consistent glucose measuring, which was transmitted electronically to the physician.

The evaluation was to investigate whether the care of patients with diabetes mellitus and intensified insulin therapy using telemedicine leads to an improvement in the glycemic metabolic status. The primary endpoint was the HbA1c level. The secondary endpoints were the additional costs of the intervention, further indicators of the glycemic metabolic status, the feasibility of the approach in the daily practice and in the daily life of the patients, and the patients’ satisfaction with the therapy. Data collection and project implementation were conducted from 01.10.2018 through 31.07.2019. The target groups of the project were patients with diabetes mellitus type-1 and type-2 as well as the treating physicians.

To provide answers to the research questions, a quasi-experimental study with a pre-post design was conducted. Within the study period of six months, there were two (patients) and three (physicians) survey time points. For the interviews, both self-developed and standardized questionnaires were used. Depending on the research question and endpoint, descriptive and/or inferential statistical analyses were used. Statistical data analysis was performed using SPSS Subscription Version 2019.

The aim of the project is to increase the individual adherence of patients with cystic fibrosis (CF, cystic fibrosis) on the basis of continuous telemonitoring and coaching in order to achieve a reduction in exacerbations and hospitalizations as well as an improvement in the quality of life. In addition, the strain on patients and their relatives caused by the time required for therapy shall be reduced.

In Germany, approximately 8,000 patients are affected by CF, an incurable genetic disorder. This rare disease affects the function of various organs, such as the liver, lungs and pancreas, and often causes irreversible damage in progress of the disease. The treatment of CF, which consists of daily inhalation and medication, is associated with an immense time investment on the part of those affected. As a result, only 30 to 50 percent of CF patients consistently comply with the therapy.

Patients with CF receive individual coaching to increase adherence, depending on their telemedically monitored therapy compliance. At the same time, telemedicine-enabled home spirometry is used to monitor the patient’s state of health (lung function). The attending physicians receive not only regular reports in preparation for an upcoming visit, but also indications of any deterioration via an alarm feature. This enables the physician to intervene at short notice with the aim of preventing a deterioration by adjusting the therapy. An integrated video consultation is available for this purpose, which can also be held at the patient’s request. In addition to the low-threshold intervention option, the video consultation also serves as a form of relief for patients and their relatives.

Methods

A randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the project in terms of treatment adherence, quality of life, and health status. Due to the nature of the intervention (coaching, video consultation), blinding is not feasible for either patients or physicians. Qualitative interviews with physicians, patients and their relatives as well as a health economic evaluation will be conducted in order to quantify and demonstrate the potentials of the improvement.

Funding

The project is funded by the Innovation Fund over a period of 3.5 years with an amount of ca. 3.8 million euros.

To increase the effectiveness and efficiency of care – that is the purpose of an electronic patient record (ePA). However, the introduction of ePA into the German healthcare system is proving to be extremely complex. Why is Germany having such a hard time with this change, and to what extent do ePA showcase countries like Denmark or Israel differ from Germany? The study conducted by inav consisted of a literature review, case studies and the development of a scorecard.

The focus of the literature review centered on the international evidence base on ePA, specifically the effects of ePA on health care delivery and existing evidence on implementation. The literature review was conducted using database queries on PubMed and Google Scholar. Systematic reviews published between January 1, 2010 and July 14, 2016 were considered.

In addition, the study included case studies to examine the situation and progress of ePA implementation and use in selected countries. The case studies were conducted for Denmark, Israel, the United States, and Austria. The selection was complemented by case studies on the corporate solutions of Apple and Google. The case studies were based on in-depth interviews with experts on a national and international level.

The third part of the study, the “European Scorecard”, was designed to classify the implementation status of the German ePA on a European scale and to compare it with selected countries. For the development of the scorecard, relevant indicators were identified that reflect the complexity of ePA implementation and are available and comparable for a wider range of countries. Once the scorecard was developed, a selection of 20 countries were rated in terms of ePA implementation and use using a traffic light system. In 2018, an update of the scorecard was conducted, also by the inav.

Based on the synopsis of the results of the three elements, recommended courses of action were determined in various subject areas.

Further Information (German language)

https://www.medhochzwei-verlag.de/Shop/ProduktDetail/die-elektronische-patientenakte-978-3-86216-331-1

https://www.stiftung-muench.org/wp-content/uploads/2018/09/Scorecard-final.pdf