Juliane Andrea Duevel, MSc, completed her master's degree in public health (Bielefeld University) and since 2018 has been a research associate at the Chair of Health Economics and Health Management at the Faculty of Health Sciences.
Alina Baumgartner, MSc, has a master's degree in public health and is doing her PhD phase at the Interdisciplinary Centre for Health Technology Assessment and Public Health, Erlangen.
Prof Case Manag. 2024;29(4):158-170. doi: 10.1097/NCM.0000000000000701. Epub 2023 Nov 23.
In terms of continuous and coordinated health care, cross-sectoral care structures are crucial. However, the German health care system is characterized by fragmentation of medical services and responsibilities. This fragmentation leads to multiple interfaces frequently causing loss of information, effectiveness, and quality. The concept of case management has the potential to improve cooperation between sectors and health care providers. Hence, a case management intervention for patients with stroke was evaluated with an acceptance analysis on the physicians' willingness to cooperate with stroke managers and their assessment of the potential of case management for the health care of patients with stroke.
Primary practice settings included physicians working in the hospital, rehabilitation, and outpatient sectors who had actual or potential contact with a stroke case manager within the project region of East Westphalia-Lippe.
The analysis was conducted using a mixed-methods approach. Expert interviews were conducted in 2020. Afterward a questionnaire was developed, which was then distributed to physicians in 2021. Both the interviews and the questionnaire included questions on conceptual knowledge and concrete expectations prior of the project, on experiences during the project and on recommendations and physicians' assessment of future organization in health care to classify and describe the acceptance.
Nine interviews were conducted and 23 questionnaires were completed. Only slightly more than 50% of the physicians had prior knowledge of the case management approach. Overall, ambiguous results concerning the acceptance of case managers were revealed. Additional personal assistance for patients with stroke was seen as beneficial at the same time critical perspectives regarding further fragmentation of health care and overlapping of competences with existing professional groups or forms of health care were collected. General practitioners in particular were critical of the case management approach.
From the physicians' point of view, at least two changes are necessary for the project approach to be integrated into standard care. First, the target group should be adapted according to the case management approach. Second, the delegation of tasks and responsibilities to case managers should be revised. The sectoral difference in the acceptance of case managers by physicians indicates that active cooperation and communication in everyday work has direct impact on the acceptance of a new occupational profession. Physician acceptance has a significant impact on the implementation of new treatment modalities and thus influences the overall quality of health care.
在连续和协调的医疗保健方面，跨部门的护理结构至关重要。然而，德国的医疗保健系统以医疗服务和责任的碎片化为特征。这种碎片化导致了多个接口，经常导致信息、效果和质量的丢失。病例管理的概念有可能改善部门之间和医疗保健提供者之间的合作。因此，评估了一种针对中风患者的病例管理干预措施，该干预措施通过对医生与中风管理师合作的意愿进行接受度分析，并评估了病例管理对中风患者医疗保健的潜在影响。
初级实践环境包括在医院、康复和门诊部门工作的医生，他们在东威斯特法伦-利珀项目地区与中风管理师有实际或潜在的接触。
分析采用混合方法进行。2020 年进行了专家访谈。之后制定了一份问卷，并于 2021 年分发给医生。访谈和问卷都包含了项目前的概念知识和具体期望、项目期间的经验以及关于未来医疗保健组织的建议和医生评估的问题，以对接受度进行分类和描述。
进行了 9 次访谈，完成了 23 份问卷。只有略多于 50%的医生对病例管理方法有事先了解。总的来说，对病例管理师的接受程度呈现出模棱两可的结果。同时，人们认为为中风患者提供额外的个人帮助是有益的，但也有人对医疗保健进一步碎片化以及与现有专业群体或医疗保健形式重叠的职权范围提出了批评。全科医生尤其对病例管理方法持批评态度。
从医生的角度来看，要将项目方法纳入标准护理，至少需要进行两项改变。首先，应根据病例管理方法调整目标人群。其次，应修改向病例管理师分配任务和责任的规定。医生对病例管理师接受程度的部门差异表明，在日常工作中积极合作和沟通直接影响对新职业的接受程度。医生的接受度对新治疗方法的实施有重大影响，因此影响整体医疗保健质量。
