[Patient representatives at the federal state level in Germany - results of a quantitative survey regarding the educational needs of patient representatives]. / Patientenvertretung auf der Ebene der Bundesländer - Ergebnisse einer quantitativen Befragung zu den Bildungsbedürfnissen von Patientenvertretern und Patientenvertreterinnen.

OBJECTIVES: During the last decades patient and public involvement has gained more and more political approval. An important milestone regarding collective patient interests was the Statutory Health Insurance Modernisation Act in 2004 (§ 140 f SGB V). No systematic research has been conducted regarding the situation of patient representatives at the federal state level as yet. The aim of the following study is to close this gap, focusing on educational needs of patient representatives. METHODS: After screening the literature we identified and discussed relevant aspects of patient participation in a focus group of 7 patient representatives. Based on these findings a standardised questionnaire was developed in cooperation with scientists and patient representatives. We sent the written questionnaire to 504 patient representatives at the federal state level. The survey was targeted at patient representatives who currently participate or have in the past participated in a committee at federal state level according to § 140 f SGB V. RESULTS: A total of 184 completed questionnaires was returned for an overall response rate of 36.5%. Most respondents felt poorly prepared for their role and regard a compulsory preparation course as necessary. Patient representatives want to be an active part in the decision-making process of the committee meetings. They report educational needs on different topics and they are willing to close these gaps. For the future, patient representatives expect increasing significance of collective participation. CONCLUSION: The results can be used to develop educational programmes for patient representatives in order to qualify them for the best possible performance of their tasks. Furthermore the results can provide a scientific basis for political discussions and for reasoning capacity building of patient representatives.

Replacement of endoprosthetic implants within a two years follow-up period: a statutory health insurance routine data analysis.

BACKGROUND: The statutory health insurance system embodies a large amount of data on the treatments of their members. Depending on joint, prosthesis type, patient activity and comorbidity, knee and hip replacements can last up to 20 years. Based on statutory health insurance data the main object of this analysis was to investigate how high the early revision rate of replacements actually is. METHODS: The number of replacements in the years 2005 and 2006 has been extracted from the TK database for hip (OPS-Code 5-820, n = 20,875), knee (OPS 5-822, n = 13,466), upper limbs (OPS 5-824, n = 901), and lower limbs (OPS 5-826) replacements. This data has then been related to each consecutive operation (i. e. change or excision of joint endoprosthesis) over a joint-specific observation period of two years. RESULTS: In 3.7% of the cases joint replacements stood for less than 2 years (hip 3.5%, knee 3.8%, upper limbs 6.5%, and lower limbs 5.5%). There is a significantly positive correlation between the treatment data of the hospitals and the outcome as to low rates of reoperations at early stages. The main reason for short lifetime (76 - 81%) is mechanical failure. CONCLUSION: The percentage of joint endoprostheses with significantly short lifetimes has been unexpectedly high. The de facto lifetimes of joint endoprostheses thus often do not match the manufacturers' information. The authors strongly support the idea of a national endoprosthesis register as such a register could give detailed information on firstly whether these deficits are due to material defects, osteolysis or dislocation and secondly which products are mainly affected.

Exploring Health System Responsiveness in Ambulatory Care and Disease Management and its Relation to Other Dimensions of Health System Performance (RAC) - Study Design and Methodology.

BACKGROUND: The responsiveness of a health system is considered to be an intrinsic goal of health systems and an essential aspect in performance assessment. Numerous studies have analysed health system responsiveness and related concepts, especially across different countries and health systems. However, fewer studies have applied the concept for the evaluation of specific healthcare delivery structures and thoroughly analysed its determinants within one country. The aims of this study are to assess the level of perceived health system responsiveness to patients with chronic diseases in ambulatory care in Germany and to analyse the determinants of health system responsiveness as well as its distribution across different population groups. METHODS AND ANALYSIS: The target population consists of chronically ill people in Germany, with a focus on patients suffering from type 2 diabetes and/or from coronary heart disease (CHD). Data comes from two different sources: (i) cross-sectional survey data from a postal survey and (ii) claims data from a German sickness fund. Data from both sources will be linked at an individual-level. The postal survey has the purpose of measuring perceived health system responsiveness, health related quality of life, experiences with disease management programmes (DMPs) and (subjective) socioeconomic background. The claims data consists of information on (co)morbidities, service utilization, enrolment within a DMP and sociodemographic characteristics, including the type of residential area. DISCUSSION: RAC is one of the first projects linking survey data on health system responsiveness at individual level with claims data. With this unique database, it will be possible to comprehensively analyse determinants of health system responsiveness and its relation to other aspects of health system performance assessment. The results of the project will allow German health system decision-makers to assess the performance of nonclinical aspects of healthcare delivery and their determinants in two important areas of health policy: in ambulatory and chronic disease care.