Valk-Draad Maria Paula, Bohnet-Joschko Sabine
Lehrstuhl für Management und Innovation im Gesundheitswesen, Fakultät für Wirtschaft und Gesellschaft, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.
Lehrstuhl für Community Health Nursing, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2023 Feb;66(2):199-211. doi: 10.1007/s00103-022-03654-4. Epub 2023 Jan 10.
Interventions to reduce potentially risky hospitalizations among nursing home residents are highly relevant for patient safety and quality improvement. A catalog of nursing home-sensitive conditions (NHSCs) grounds the policy recommendations and interventions.
In two previous research phases, an expert panel developed a catalog of 58 NHSCs using an adapted Delphi-procedure (the RAND/UCLA Appropriateness Method). This procedure was developed by the North American non-profit Research and Development Organisation (RAND) and clinicians of the University of California in Los Angeles (UCLA). We present the third phase of the project focused on the development of interventions to reduce NHSCs starting with an expert workshop. The workshop results were then evaluated by six experts from related sectors, supplemented, and systematically used to produce recommendations for action. Possible implementation obstacles were considered and the time horizon of effectiveness was estimated.
The recommendations address communication, cooperation, documentation and care competence as well as facility-related, financial, and legal aspects. Indication bundles demonstrate the relevance for the German healthcare system. To increase effectiveness, the experts advise a meaningful combination of individual recommendations.
By optimizing multidisciplinary communication and cooperation, combined with an- also digital - expansion of the infrastructure and the creation of institution-specific and legal prerequisites as well as remuneration structures, an estimated 35% of all hospitalizations, approximately 220,000 hospitalizations for Germany, could be prevented. The implementation expenditure could be refinanced by avoided hospitalization savings amounting to 768 million euros.
减少疗养院居民潜在风险住院率的干预措施对于患者安全和质量提升至关重要。疗养院敏感状况（NHSCs）目录为政策建议和干预措施提供了依据。
在之前的两个研究阶段，一个专家小组采用改编的德尔菲程序（兰德/加州大学洛杉矶分校适宜性方法）制定了一份包含58种NHSCs的目录。该程序由北美非营利性研发组织（兰德）和加州大学洛杉矶分校（UCLA）的临床医生共同开发。我们展示了该项目的第三阶段，该阶段聚焦于从专家研讨会开始制定减少NHSCs的干预措施。然后，来自相关领域的六位专家对研讨会结果进行了评估、补充，并系统地用于制定行动建议。考虑了可能的实施障碍，并估计了有效性的时间范围。
这些建议涉及沟通、合作、记录和护理能力以及设施、财务和法律方面。指征组合表明了其与德国医疗保健系统的相关性。为提高有效性，专家建议对各项建议进行有意义的组合。
通过优化多学科沟通与合作，结合基础设施的数字化扩展以及创建机构特定的法律前提条件和薪酬结构，估计可预防德国所有住院病例的35%，约22万例住院病例。实施费用可通过避免住院节省的7.68亿欧元来再融资。
