We conclude from our findings that maternal inheritance of a gene in the chromosome 16p12 region increases the risk for enhanced IgE responsiveness. The most prominent candidate in this region is represented by the IL4 receptor gene.

IntroductionPatients often experience interface problems when treated by different specialists and in different healthcare sectors. Integrated care concepts aim to reduce these problems. While most integrated healthcare models focus on individual diseases, the integrated care model ‘Gesundes Kinzigtal’ applies a population-based approach and addresses the full spectrum of morbidities for a population defined by area of residence—the Kinzigtal. A special feature of the model is the joint savings contract between the regional management company and the statutory health insurers. The INTEGRAL study aims at assessing the effectiveness of ‘Gesundes Kinzigtal’ under routine conditions in comparison to conventional care over a period of 10 years in order to understand the benefits but also the potential for (unintended) harms.Methods and analysis Database Claims data from statutory health insurance funds 2005–2015. The evaluation consists of a quasi-experimental study, with Kinzigtal as intervention region, at least 10 further regions with a similar population and healthcare infrastructure as primary controls and an additional random sample of insurees from the federal state of Baden-Württemberg as secondary controls. Model-specific and ‘non-specific’ indicators adopted from the literature and enriched by focus group interviews will be used to evaluate the model’s effectiveness and potential unintended consequences by analysing healthcare utilisation in general. Temporal trends per indicator in the intervention region will be compared with those in each control region. The overall variation in trends for the indicators across all regions provides information about the potential to modify an indicator due to local differences in the healthcare system.Ethics and disseminationEthic Commission of the Faculty of Medicine, Philipps-University Marburg (ek_mr_geraedts_131117). Results will be discussed in workshops, submitted for publication in peer-review journals and presented at conferences.Trial registration numberDRKS00012804.

ealth care in Germany is provided-historically grown-in sectors that are largely distinct from one another, at the interfaces of which recurrent losses of information and "breaks in care" occur, leading to negative effects on the quality and cost of care (1, 2). One approach to improving the effectiveness and efficiency of health care is seen in "integrated care" with horizontal and vertical networks of actors. A concept of this kind was developed for a rural area by Optimedis AG and the "Kinzigtal Medical Quality Network Medical Initiative" (MQNK), which undertook a joint venture to form "Gesundes Kinzigtal GmbH." The selective contract "Gesundes [healthy] Kinzigtal Integrated Care" (Integrierte Versorgung Gesundes Kinzigtal, IVGK) was entered into with two health insurance companies (Box).The population-based IVGK is considered to be a best-practice example of integrated care in Germany as well as internationally (3-6). The early years saw extensive accompanying research and process evaluation, for example, by means of surveys among members (e1), as well as surveys among service partners regarding satisfaction, cooperation, and their commitment to integrated care (e2), health promotion among the elderly (e3), patient satisfaction, and preference of insured persons in terms of their participation in decision-making (e4). Based on routine data, a survey on underuse, overuse, and misuse of care was conducted, involving four authors of the study reported here. The survey investigated the quality of care only for the period 2005-2011 compared to care in Baden-Württemberg (random sample)-using 18 indicators for selected diseases that formed the focus of the IVGK (7).No external outcome evaluation based on routine statutory health insurance data for the period after 2011 has been carried out as yet. This represents a serious gap in evidence-especially if one assumes that undesirable trends such as underuse, for example, as a result of managed care elements like the shared savings contract (e5, 8), would only become demonstrably evident after a number of years. It also appears conceivable that unintended side effects as a result of focusing integrated care management on specific programs only emerge after years. Although evaluation studies, albeit with inconsistent results, from other countries are available (4, 9-17), the differences in health care as well as in the understanding of SummaryBackground: The population-based integrated health care system called "Gesundes Kinzigtal" (Integrierte Versorgung Gesundes Kinzigtal, IVGK) was initiated more than 10 years ago in the Kinzig River Valley region, which is located in the Black Forest in the German state of Baden-Württemberg. IVGK is intended to optimize health care while maximizing cost-effectiveness. It consists of programs for promoting health and for enabling cooperation among service providers, as well as of a shared-savings contract that has enabled resources to be saved every year. The goal of the present study was to investigate trends in the quality of care p...

Zusammenfassung Ziel der Studie Die starre Trennung von ambulanter und stationärer Versorgung im deutschen Gesundheitssystem verhindert eine Behandlungskontinuität, obwohl sie sich für psychiatrische Patienten als sehr wichtig erwiesen hat. Die vorliegende Studie analysiert die Behandlungskontinuität einer Modellklinik mit einem Gesamtbudget nach § 64b SGB V und konstantem Behandlungspersonal über alle Settings hinweg im Vergleich zu einer Kontrollklinik mit Regelfinanzierung ohne ein solches Team. Methodik In einer prospektiven Kohortenstudie mit einem Beobachtungszeitraum von 20 Monaten wurden Daten zur Behandlungskontinuität von 220 Patienten der Modellklinik und 215 Patienten der Kontrollklinik erhoben. Ergebnisse Die Modellklinik erreichte eine signifikant höhere Behandlungskontinuität als die Kontrollklinik, sowohl während der stationären Behandlung zum Zeitpunkt der Rekrutierung als auch in allen Settings während des Beobachtungszeitraums. Schlussfolgerung Ein Gesamtbudget kann die notwendigen Voraussetzungen für eine flexiblere psychiatrische Versorgung und eine bessere Umsetzung der Behandlungskontinuität schaffen.

IntroductionThe quality of healthcare in childhood and adolescence is of key importance, in order to foster a healthy development and to avoid chronic health problems. Yet, data for Germany regarding the quality of healthcare for this patient group are lacking. The QualiPäd research project aims to estimate the quality of outpatient healthcare for children and adolescents in Germany, focusing on common psychiatric and physical disorders.Methods and analysisQuality indicators for seven common physical and mental childhood and adolescent clinical conditions (attention deficit/hyperactivity disorder, asthma, atopic dermatitis, depression, otitis media, conduct disorder/oppositional defiant disorder, tonsillitis) will be developed and ratified by experts, using the RAND/UCLA Appropriateness Method.Initially, 1400 medical records of children and adolescents with one of the aforementioned clinical conditions will then be randomly drawn from 40 outpatient practices in the German federal state of Hessen. The records will then be assessed regarding their adherence to the respective quality indicators. Based on this, the percentage of appropriate and inappropriate (eg, wasteful) healthcare of all clinical conditions (primary endpoint) will be estimated. Additionally, possible factors influencing the quality of care (eg, patient characteristics, type of condition, type of practice) will be identified using generalised estimation equation models.Ethics and disseminationThis study will show for which of the studied clinical conditions and/or patients improvement of quality of care is necessary within the German health system. Also, the quality indicators designed for the study can afterwards be implemented in regular care and thus enable regular reporting of the outpatient care of this target group. The authors plan to disseminate their findings through international, peer-reviewed scientific publications, and through presentations at national and international paediatric and child psychiatric conferences.Trial registration numberDRKS00022408.