[Development and implementation of integrated health care in pain medicine : the nationwide German headache treatment network]. / Entwicklung und Umsetzung der integrierten Versorgung in der Schmerztherapie : Das bundesweite Kopfschmerzbehandlungsnetz.

Integrated care builds interdisciplinary networks across the different healthcare sectors. A conjoint effort toward clearly defined treatment goals is crucial for medically effective and economically efficient care. Allowing creativity in the implementation of integrated care triggers competition for more effective ideas and better solutions. Based on a summary of the development of integrated care and the example of the nationwide German headache treatment network, the successful organization and implementation of this cross-sectoral care within pain medicine is illustrated. An interdisciplinary nationwide network of pain therapists working hand in hand across the sectors, both in the outpatient and inpatient setting, and employing modern treatment regimens results in optimal pain relief. The treatment quality is assessed by continuous accompanying research and sustainable cost efficiency in all sectors of healthcare is confirmed through analysis of both direct and indirect costs. The project was started in May 2007. In the meantime, almost all large statutory health insurance providers in Germany have joined this healthcare project. The large treatment network confirms the significant clinical and economic efficiency of pain medicine. It demonstrates that coordinated modern therapy effectively relieves pain, lowers costs sustainably, and reduces sick leave. Patient satisfaction is very high. The healthcare providers may directly participate in treatment success through risk-sharing.

[Diagnosis-oriented diagnosis, therapy and fee schedules in oncology. A model trial]. / Diagnose-orientierte Diagnostik, Therapie und Kostenerstattung in der operativen Onkologie. Ein Modellversuch.

In 1996 the project "operative oncology" was initiated by the Department of Surgery University of Kiel in order to guarantee a solid and longterm financing of surgical oncological interventions with a high quality standard. First step was to determine the detailed costs of the diagnostic and different surgical procedures in order to calculate flat rates per case. Covered by these comprehensive prices per case are also the psychooncological support, prospective evaluation of quality of life and molecular-oncological diagnostics (determination of micrometastasis). The development of project was primarily financed by the AOK health insurance company of Schleswig-Holstein. It was calculated by the GSbG and is supported since April, 1st, 1998 by all health insurance companies of the region.

[Identification of acute geriatric patients in the city of Hamburg ("direct data collection")]. / Identifikation akut-geriatrischer Patientlnnen in der Freien und Hansestadt Hamburg ("Direkterhebung").

In the past the calculation for an in-patient special offer (quantity of beds needed) was mainly carried out by diagnosis-based statistics of hospital cases. The decision for an in-patient care within a geriatric unit is however influenced by factors as "status of self-help abilities", "social situation" and "co-morbidity". Those factors are investigated either directly by the help of the patient himself or by questioning the nurses and/or the medical staff. A new way of measuring will be introduced for this questioning. The crucial element is the Barthel-Index (BI). Supporting measures are done by the inclusion of main data concerning the social situation as well as recording the modified screening according Lachs. From the 6th of September until 14th of December 1997 the three-part measuring technique was used at seven hospitals in Hamburg (amongst them one University hospital and one hospital with a geriatric unit) within the framework of a representative sample survey. These collected data register 18 admission days of all patients of sixty or over who at the time of questioning stayed for five days in one of those acute hospitals. In some hospitals some additional data were collected at the third or 6th day after admission. Altogether a whole "virtual day-admission" of the 60 years old or older patients was collected for the City of Hamburg at the 5th day after admission. Out of 425 patients 137 were moved or exmitted before questioning, 4 had already died. Out of the rest of 284 patients two of them refused the questioning, whilst the data of 6 patients were not feasible for evaluating. Finally 276 patients were questioned. Out of them 231 patients are "not potential candidates for a geriatric hospital or a geriatric day-care unit", 8 are "candidates for a geriatric day-care unit directly after discharge of primary care" and 37 are "candidates for an in-patient geriatric hospital". The presented three-part question-sheet shows a sensitivity of 89.2% and a specification of 92.2%. This measuring technique in the hands of a trained examiner appears to be a valid and manageable tool in the framework of geriatric consultation as well as for the investigation of own directly ascertained statistic datas for "potential candidates for an in-patient geriatric hospital".