Siegel Achim, Niebling Wilhelm
Universitätsklinikum Tübingen, Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Tübingen, Deutschland.
Universitätsklinikum Freiburg, Lehrbereich Allgemeinmedizin, Freiburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2018 Feb;130:35-41. doi: 10.1016/j.zefq.2017.12.003. Epub 2017 Dec 28.
The integrated health care pilot model "Gesundes Kinzigtal" (GK) is recognized as a reference model for integrated healthcare in Germany. The aim of GK is to improve the health of the insured persons and, at the same time, to decrease their healthcare costs compared to usual care. The evaluation of GK has so far shown that GK might reach this aim. However, there are still no evaluation studies on GK focusing on patient-reported outcomes. This gap needs to be closed by a trend study, which is the main topic of this paper: We present interim results of this study, focusing on patient satisfaction with GK, insured persons' self-reported change of health behavior, their knowledge on health maintenance, and health-related quality of life.
The baseline survey of the trend study was conducted in 2013: 3,034 members of GK were invited to complete a standardized questionnaire (by mail). In the first follow-up survey in 2015, 3,471 members were invited. Health-related quality of life was measured by EQ-5D and EQ-VAS; the other above-mentioned indicators were developed by our work group. Conducting variance analysis and logistic regression analysis using SPSS, it was analyzed to what extent the above-mentioned indicators changed between the first and the second survey.
The response rate was 23.4 % and 24.9 %, respectively. Overall patient satisfaction with GK and the mean EQ-5D value remained stable; the remaining indicators improved more or less over the course of time. Among these, the proportion of participants who indicated that they "now lead an overall healthier life" than before their enrolment into GK significantly increased from 25.6 % to 30.7 % (p=0.020).
The significant increase in the proportion of respondents who "now lead an overall healthier life" might be attributed to the fact that patient activation and empowerment was (and is) a top priority of the GK management strategy. Caution is advised, though, with this interpretation because of the limitations inherent to trend studies without an appropriate control group.
综合医疗试点模式“健康金齐希塔尔”（GK）被公认为德国综合医疗的参考模式。GK的目标是改善参保人员的健康状况，同时与常规医疗相比降低他们的医疗成本。到目前为止，对GK的评估表明GK可能实现这一目标。然而，目前仍没有针对GK的以患者报告结局为重点的评估研究。这一差距需要通过一项趋势研究来填补，这也是本文的主要主题：我们展示这项研究的中期结果，重点关注患者对GK的满意度、参保人员自我报告的健康行为变化、他们对健康维护的知识以及与健康相关的生活质量。
趋势研究的基线调查于2013年进行：邀请3034名GK成员填写一份标准化问卷（通过邮件）。在2015年的首次随访调查中，邀请了3471名成员。使用EQ-5D和EQ-VAS测量与健康相关的生活质量；上述其他指标由我们的工作组制定。使用SPSS进行方差分析和逻辑回归分析，分析上述指标在第一次和第二次调查之间的变化程度。
回复率分别为23.4%和24.9%。患者对GK的总体满意度和EQ-5D平均值保持稳定；其余指标在一段时间内或多或少有所改善。其中，表示“现在总体生活比加入GK之前更健康”的参与者比例从25.6%显著增加到30.7%（p=0.020）。
“现在总体生活比加入GK之前更健康”的受访者比例显著增加，这可能归因于患者激活和赋权是（并且一直是）GK管理策略的首要任务。不过，由于没有合适对照组的趋势研究存在固有局限性，因此对这一解释需谨慎。
