Parkinson’s disease is the most common neurogenerative movement disorder in Germany. About 300,000 people are affected, and the disease’s prevalence is expected to increase in the future due to demographic change. Typical symptoms include tremors in the arms and legs as well as impaired gait, speech, and swallowing. In advanced stages, cognitive impairment may occur, sometimes progressing to dementia. Although Parkinson’s disease cannot be cured, its progression can be delayed with the help of medication and an activating therapy consisting of physiotherapy, occupational therapy, and speech therapy. Currently, however, only one third of all Parkinson’s patients receive specific activating therapy.

The Parkinson AKTIV project is committed to enabling more people with Parkinson’s disease to receive an activating therapy. The first priority is to improve the communication between the service providers involved in order to adjust the range of therapies to the individual needs of the patients. Numerous specialists are already part of the multidisciplinary Parkinson’s Network Münsterland. A web-based communication platform and so-called quickcards will be used to further improve the exchange of information within the scope of the project. The quickcards contain patient-relevant information and guideline-based therapy recommendations. They will be made accessible to those providing treatment, so that everyone involved in the care process will have access to the information they need to design and coordinate activating therapy on a patient-specific basis.

The accompanying scientific study will include an evaluation design with an intervention and control group. It will be determined whether the quality of life of people with Parkinson’s disease can be improved by the intervention.

The project will receive ca. 2.6 million euros in funding from the Innovation Fund over a period of three and a half years.

If the project is successful, the networking of all service providers involved can also be implemented in other regions with the help of the web-based communication platform. The quickcards could be established as an important element of the new healthcare concept, regardless of a specific infrastructure.

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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.

According to current research, about five to ten percent of all tumor diseases are hereditary. Due to genetic changes, there is a significantly increased risk of cancer in individual families, which often already manifests itself as a tumor disease in young people. The so-called tumor risk syndrome (TRS) can be identified by examining a family’s medical history, risk calculations and a genetic test. Based on this, preventive measures can be taken.

However, there is currently still a lack of clinical pathways that offer advice and support to the attending medical specialists in determining the indication and interpreting of the findings. Especially in structurally weaker regions with little exchange between specialists, the hereditary causes of cancer are often not identified.

The aim of the OnkoRisk NET project is to create a cooperative network in which practicing oncologists and specialists in human genetics can exchange information. The project also includes the development of clinical pathways and the establishment of telemedical genetic counseling. This way, the human genetics oncology standard care in structurally weak regions is to be improved.

The inav GmbH was appointed to evaluate the project. Some of the parameters that will be recorded and analyzed as part of the study include patient satisfaction, psychological stress, and the use of genetic counseling by other family members.

The project will be funded for 45 months with a total of approximately 2.5 million euros from the Innovation Fund. If successful, the project will ensure access to genetic counseling, diagnostics and risk-adapted prevention for genetic tumor risk syndromes in structurally weaker regions.

Foto: freepik | kjpargeter

The aim of DELIVER-CARE is to develop a model for the delegation of medical activities to medical assistants (MFA) in chronic inflammatory diseases.

Chronic inflammatory diseases are complex clinical conditions requiring a high level of care. In the current health care setting, the vast amount of time required for optimal treatment cannot be provided. The lack of access to specialist care, or the severe delay in accessing it, often leads to a deterioration in prognosis and quality of life. This problem could be counteracted by delegating medical activities to medical assistants (MFA).

In this process, MFAs are expected to perform their own structured consultation. They identify current symptoms and the drug tolerability and serve as the primary point of contact in the event of special incidents, e.g., drug side effects. Subsequently, the results are discussed with the patient and the specialist. This provides patients with a more effective drug therapy, individualized information and faster access to specialists.

Methods

A randomized controlled trial will be conducted to evaluate DELIVER-CARE. Within the scope of the study, the effectiveness of the MFA consultation compared to the standard of care will be tested over a period of twelve months. For three disease categories (gastroenterology, rheumatology, dermatology), the study will determine the influence of the MFA consultation on disease activity and the extent to which patient-related factors such as disease management, quality of life or patient satisfaction improve. In addition, cost-effectiveness will be evaluated.

Funding

The project will be funded for four years with a total of ca. 2.2 million euros. If successful, the concept can be transferred to other regions as well as to other diseases (e.g. ophthalmology) with department-specific adaptation.

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

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The aim of RubiN is to implement a care and case management system that supports geriatric patients to enable them to remain in their own homes for as long as possible.

The demographic change is accompanied by a growing number of chronically and multimorbidly ill patients. Especially among geriatric patients, acute and chronic (multiple) illnesses occur simultaneously. The term geriatrics therefore does not refer to the entirety of elderly people, but describes a condition associated with advanced age. This is compounded by age-related physiological changes, as a result of which the residual capacities of various bodily functions are increasingly limited and everyday activities can no longer be managed sufficiently. In addition, the fragmented structures and scarcely networked sectors of the German healthcare system are not designed for the care of elderly, chronically or multimorbidly ill patients.

Therefore, the project “RubiN – Regional uninterrupted care in a Network” aims to improve the identification, care setting and health status of geriatric patients; in particular, the independence of elderly patients is to be preserved. For this purpose, within accredited practice networks, a multiprofessional, cross-sectoral and assessment-based training curriculum for health professionals is to be used for the case management of geriatric patients. At the same time, the workload of primary care physicians in geriatric patient care should be reduced. To achieve this, legally secure delegation in care networks must be ensured by developing and introducing a set of general structural and process requirements.

Methods

The evaluation of the project is based on three levels: First, a quantitative evaluation with primary data is conducted. The data is collected using standardized measurement instruments. The primary patient-related endpoint is the ability to cope with everyday activities after twelve months, based on the Barthel Index. Furthermore, a formative process evaluation is carried out, in which the aspects of acceptance, feasibility and implementation of the intervention are examined. This will involve the use of both qualitative and quantitative survey methods. A health economic evaluation will also be conducted. The design of the evaluation is prospectively controlled.

The aim of the project is to test telemedical care for the treatment of patients with skin diseases in rural areas.

Both primary care and specialist care are steadily disappearing in rural areas. In Mecklenburg-Western Pomerania, for example, dermatologist practices are concentrated primarily in urban centers and mid-sized cities, while rural areas are increasingly threatened by insufficient care. The consequences for patients living in the state include long waiting times for an appointment and poor accessibility to dermatological specialist practices.

The project focuses on the implementation of a telemedical consultation between primary care physicians or physicians in emergency rooms and dermatologists (private practices or dermatology clinics) with the help of an app. Dermatology is particularly well suited for a telemedical consultation, as symptomatic skin changes can be easily communicated via images. The attending physician photographs the patient’s affected skin area and sends the image – along with information about the patient’s medical history and symptoms – to the dermatology specialist. The specialist then recommends the next course of action.

Methods

The evaluation of the dermatological teleconsultation is performed by analyzing routine data, patient and physician surveys, and focus group interviews as well as expert discussions.

Funding

The project is funded with ca. 1.8 million euros. If successful, the new form of care will be transferred to other structurally weak, rural regions. The app and the underlying telemedical concept could also be adapted for other medical disciplines in the future.

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.

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.

Every year, more than 465,000 people suffer from heart failure. Due to the aging society, the rate is expected to increase. Growing cost pressure is a rising challenge for the German healthcare system. The majority of costs associated with heart failure occur in the hospital. The number of hospitalizations can be reduced by adequate management of office-based physicians and better coordination between the different sectors. Currently, many hospitalized cases could also be treated as outpatients. At the same time, some severe outpatient cases would benefit from a referral to the hospital. Thus, there is a lack of need-based guidance of patients to the appropriate outpatient or inpatient treatment. In addition, the different reimbursements in the outpatient and inpatient sectors set false incentives. While flat rates per patients are applied in the outpatient sector, flat rates per case are used in the inpatient sector. When in doubt, this difference in reimbursement systems reinforces the tendency to treat patients as inpatients.

The goal of sekTOR-HF is the need-based and resource-optimized cross-sectoral care of patients with heart failure. For this purpose, coordination and communication structures are established as a bridge between the sectors. These include an eHealth platform for communication between all parties involved, a electronic patient file, and a regional network office that supports the monitoring of patients and thus coordinates the available resources in the outpatient and inpatient sectors. The network office continuously monitors patients by evaluating digitally transmitted vital data. In the event of any deterioration, the network office can activate service providers at the appropriate level of care at an early stage.

The second objective of the project is to develop a new cross-sector reimbursement model that provides incentives for cost-efficient care. For this purpose, the inav is conducting a theoretical and empirical analysis of various international cross-sector payment models, such as bundled payments. This is being done in exchange with international experts who contribute their experience on already existing models.

The second objective of the project is to develop a new cross-sector reimbursement model that provides incentives for cost-efficient care. For this purpose, the inav is conducting a theoretical and empirical analysis of various international cross-sector payment models, such as bundled payments. This is being done in exchange with international experts who contribute their experience on already existing models. The data of the participating heart failure patients collected in the project are the basis for examining different models with regard to incentives, resource consumption and transferability to the German context.

The project will receive ca. 3.8 million euros in funding from the Innovation Fund over a period of three and a half years.

“IGiB-StimMT” adapts inpatient and outpatient care capacities  in accordance with the changing population structure in the central area of Templin. The project introduces relevant interdisciplinary and intersectoral structures.

Demographic change in Germany is characterized by rising mortality rates, declining birth rates and an aging society. Rural areas in particular are reporting less and less young people and ever more elderly people – a development that is also reflected medically in an increase in chronic illnesses and/or multiple illnesses. Since a significant shift in the population structure is also predicted for the central area of Templin, it is necessary to develop and implement new and needs-based care structures.

Methods

Considering the multi-layered nature of the project, the evaluation will be carried out on several levels. Based on a mixed-methods approach, the evaluation is conducted on two levels. On the one hand, a structure and process analysis is performed, on the other hand, a health economic evaluation of the project is carried out. Furthermore, accompanying research based on qualitative scientific methods will be conducted. This is to find out whether the complex intervention can adapt the care structures and processes in the central area of Templin to existing challenges in a needs-oriented approach.

Funding

The project was funded by the Innovation Fund for a total of four years with ca. 14.5 million euros.

The Dimini prevention project aims to increase the health literacy of patients with an increased risk of developing DMT2. This way, long-term behavioral preventive changes are to be achieved.

Diabetes mellitus type 2 (DMT2) is one of the most prevalent common illnesses in Germany, with currently more than six million people affected. In addition, an estimated further three to five million people are affected by undetected DMT2 or elevated blood glucose levels. In the long term, DMT2 can lead to serious secondary diseases and result in high costs. It is therefore particularly important to identify relevant risk parameters in a timely manner and to address them early on with adequate preventive measures.

To identify individuals at high risk of DMT2 at an early stage, the project uses the so-called FINDRISK test, which determines the individual risk profile on the basis of eight easy-to-answer questions on, among others, height, weight and dietary habits. Based on this, those affected receive the needs-based Dimini lifestyle intervention over a period of three months. This contains a set of health-related information and a request to keep an analog diet and exercise diary. Optionally, affected individuals can also use an app to access and document all elements of the lifestyle change. General practitioners provide support and accompany the project through interim coaching sessions.

Methods

The effectiveness of the lifestyle intervention will be investigated by a randomized controlled trial. This will involve quantitative evaluations through validated questionnaires and qualitative evaluations through focus group and individual interviews. The primary endpoint is body weight. Additionally, abdominal circumference, HbA1c level, dietary and physical activity behavior as well as quality of life of the study participants will be investigated.

Publications

Püschner, F. , Urbanski-Rini, D., Dubois, C., Schliffke, M., Göhl, M., Petersen, C. (2022) Dimini (Diabetes mellitus? – Ich nicht!): Aktivierung der Gesundheitskompetenz von Versicherten mit erhöhtem Risiko für Diabetes mellitus Typ 2 mittels Coaching in der Vertragsarztpraxis. Diabetologie und Stoffwechsel. https://doi.org/10.1055/a-1733-6666

Bertram, N., Püschner, F., Binder, S., Schliffke, M., Göhl, M., Petersen, C. (2020). Dimini – Diabetes Mellitus? Ich nicht! In: Hahn, U. & Kurscheid, C. (Hrsg.), Intersektorale Versorgung. Best Practices – erfolgreiche Versorgungslösungen mit Zukunftspotenzial (S. 213-231). Berlin: Springer Gabler.

Further information

www.dimini.org