10 Jahre geriatrische frührehabilitative Komplexbehandlung im DRG-System

Kolb, Gerald; Breuninger, Katrin; Gronemeyer, Stefan; Heuvel, Dirk van den; Lübke, Norbert; Lüttje, Dieter; Wittrich, Anke; Wolff, Jan

doi:10.1007/s00391-013-0592-7

Cited by 34 publications

(21 citation statements)

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“…The execution of the GFK framework in practice was impeded by the lack of inter-organisational infrastructure (health system context), which contributed to unnecessary incurrence of costs (efficiency), an increased likelihood of adverse events or medical mistakes (safety), and frustration among staff (satisfaction). These findings resonate with Kolb et al’s evaluation of the GFK 10 years after its inception, from the perspectives of the German Federal Association of Geriatrics (BVG), the German Health Insurance Medical Service (MDK) and the National Association of Statutory Health Insurance Funds (GKV Spitzenverband) [32]. The authors also found evidence of a lacking inter-organisational structure, which was not in line with the overarching goals of comprehensive geriatric care, namely a transsectoral, interlinked, and therefore holistic approach to geriatric care.…”

Section: Discussionsupporting

confidence: 83%

“…In this article, we focus specifically on the geriatric hospital. Its patient population consists of patients with complex, multiple age-related conditions that are in temporary need of acute care before they can be discharged or transferred to a long-term care facility [32]. Care for geriatric patients is delivered by a geriatric team led by a geriatric physician, who have weekly team meetings and perform standardised comprehensive geriatric assessments.…”

Section: Methodsmentioning

confidence: 99%

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Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Busetto

Kiselev

Steinhagen‐Thiessen

et al. 2017

BMC Health Serv Res

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BackgroundMany health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a “context-mechanisms-outcomes”-based model provides insights into when and why beneficial outcomes can be achieved.MethodsWe conducted 15 semi-structured interviews with health professionals employed at the hospital. The data were qualitatively analysed using a “context-mechanisms-outcomes”-based model. Specifically, mechanisms were defined as the different components of the integrated care intervention and categorised according to Wagner’s Chronic Care Model (CCM). Context was understood as the setting in which the mechanisms are brought into practice and described by the barriers and facilitators encountered in the implementation process. These were categorised according to the six levels of Grol and Wensing’s Implementation Model (IM): innovation, individual professional, patient, social context, organisational context and economic and political context. Outcomes were defined as the effects triggered by mechanisms and context, and categorised according to the six dimensions of quality of care as defined by the World Health Organization, namely effectiveness, efficiency, accessibility, patient-centeredness, equity and safety.ResultsThe integrated care intervention consisted of three main components: a specific reimbursement system (“early complex geriatric rehabilitation”), multidisciplinary cooperation, and comprehensive geriatric assessments. The inflexibility of the reimbursement system regarding the obligatory number of treatment sessions contributed to over-, under- and misuse of services. Multidisciplinary cooperation was impeded by a high workload, which contributed to waste in workflows. The comprehensive geriatric assessments were complemented with information provided by family members, which contributed to decreased likelihood of adverse events.ConclusionsWe recommend an increased focus on trying to understand how intervention components interact with context factors and, combined, lead to positive and/or negative outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2105-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Busetto

Kiselev

Steinhagen‐Thiessen

et al. 2017

BMC Health Serv Res

View full text Add to dashboard Cite

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“…This study will also evaluate treatment response through repeated assessment at the beginning and the end of multidisciplinary geriatric care programs. The programs will be comparable in the majority of participants and will encompass individual allied health training of at least 20 sessions, and re-evaluation and adaptation of medication (in the frame of, e.g., the early rehabilitation in geriatric medicine concept as applied in Germany [117,118]). This approach will allow the definition of effective versus non-effective response-totreatment parameters as well as the definition of predictive parameters for defined treatment approaches.…”

Section: Discussionmentioning

confidence: 99%

Motor, cognitive and mobility deficits in 1000 geriatric patients: protocol of a quantitative observational study before and after routine clinical geriatric treatment – the ComOn-study

et al. 2020

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Background: Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany).

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“…In Germany, the Diagnosis Related Groups (DRG) allow to classify procedures for geriatric hospital patients in the hospital reimbursement system. A standard procedure is the so called “early rehabilitation in geriatric medicine” (“Geriatrische Frührehabilitative Komplexbehandlung”, GFK) [26]. A GFK procedure is applied for older acute hospital patients and includes, at a minimum standard, the following aspects: (1) Care is delivered by a multidisciplinary team, including medical doctors, nurses, physiotherapists, occupational therapists, speech and language therapists and other allied health professionals.…”

Section: Introductionmentioning

confidence: 99%

“…There are three main procedure codes (OPS) that apply for the GFK according to the length of care: OPS 8–550.0 for 7–13 days with at least 10 treatment sessions; OPS 8–550.1 for 14–20 days with at least 10 treatment sessions; OPS 8–550.2 for ≥21 days with at least 10 treatment sessions [26]. The mean duration of sessions needs to be at least 30 min and no more than 10% of treatments may be group-based sessions.…”

Section: Introductionmentioning

confidence: 99%

An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients – a randomized, controlled pilot and feasibility trial

et al. 2019

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Background There is inconclusive evidence for the effectiveness of additional exercise in older hospital patients. The aims of this study were (1) to assess the feasibility of an augmented prescribed exercise program (APEP) in older acute medical patients and (2) to measure the potential effects of APEP on mobility capacity in order to assess the feasibility of a large full-scale study. Methods We conducted a single-center, prospective, parallel-group, single-blinded, randomized (1:1) controlled pilot and feasibility trial. Participants were recruited from acute geriatric wards of a general hospital. Key inclusion criteria were: age ≥ 65 years and walking ability. Key exclusion criteria were severe cognitive impairment and medical restriction for physical exercise interventions. Both groups received usual care, including physiotherapy. Intervention group participants were scheduled for additional exercise sessions (20–30 min, 4-5x/week). Feasibility of the trial design was assessed along pre-defined criteria for process, resources and management. Feasibility of the APEP intervention was analyzed by means of adherence, compliance and safety. Outcomes were measured at baseline and prior to hospital discharge. The primary outcome was mobility capacity (de Morton Mobility Index; DEMMI). Secondary outcomes were walking ability, physical endurance, fear of falling, frailty and length of stay. Results Thirty-five participants were recruited (recruitment rate 20.3%). We lost 7 participants to follow-up (retention rate: 80%). Intervention group participants (n = 17) each participated in 5.3 ± 2.2 additional exercise sessions (mean duration: 23.2 ± 4.0 min; mean adherence rate 78% ± 26%). No severe adverse events occurred during study assessments or APEP sessions. There were no statistically significant differences in mean change scores in any outcome measure. A sample of 124 participants would be required to detect a difference of 4 DEMMI points (ES = 0.45) with a power of 80%. Conclusions This small feasibility RCT indicates that an APEP intervention may be safe and feasible in older acute medical patients. APEP may possibly induce small to moderate effects on mobility, but the clinical relevance of these effects may be limited. These results inform the planning of a larger-scale phase III study. Trial registration German Clinical Trials Register ( DRKS00011262 ). Registered 27 October 2016. Electronic supplementary material The online version of this article (10.1186/s12877-019-1246-4) contains supplementary material, which is available to authorized users.

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10 Jahre geriatrische frührehabilitative Komplexbehandlung im DRG-System

Cited by 34 publications

References 0 publications

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

Motor, cognitive and mobility deficits in 1000 geriatric patients: protocol of a quantitative observational study before and after routine clinical geriatric treatment – the ComOn-study

An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients – a randomized, controlled pilot and feasibility trial

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