[Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research]. / Empfehlungen für ein Kerncurriculum für Masterstudiengänge der Versorgungsforschung.

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.

Emotional safety of people living with dementia: a systematic review.

BACKGROUND: Emotional safety is particularly important for people living with dementia. Although there have been efforts to define this concept, no systematic review has been performed. AIM: We aimed to identify and analyze the knowledge available over a 10-year period regarding the emotional safety of people living with dementia to concretize this phenomenon. METHODS: Seven databases were searched. Qualitative, quantitative and mixed-methods studies published between November 2007 and October 2017 were included. Study selection and critical appraisal were performed by two reviewers. A content analysis of the qualitative data and a descriptive analysis of the quantitative data were performed. RESULTS: In total, 27 publications (n = 26 studies) were included. The following five main categories were identified: (1) "emotional safety as a primary psychological need"; (2) "emotional safety in the context of disease-related, biographical, demographic and socioeconomic factors"; (3) "inner conditions and strategies"; (4) "outer conditions and strategies"; and (5) "emotional safety as a condition". CONCLUSION: People living with dementia appear to be particularly vulnerable to decreased emotional safety. Research should focus on achieving a comprehensive understanding of their emotional safety needs.

[Educational Programmes in Health Services Research in Germany: Current State and Future Perspectives]. / Studiengänge zur Versorgungsforschung in Deutschland: aktueller Stand und zukünftige Perspektiven.

OBJECTIVE: The aim of this study was to analyse accredited study programmes of health services research in Germany at Master's degree level regarding their structural data and content. METHODS: Using a descriptive qualitative design, all included plans of study courses, module handbooks and descriptions of the Master's degree programmes were analysed. RESULTS: The Master's degree programmes were similar in their structural elements as well as in their content of education. They aim at enhancing competences related to the areas of health services research to identify health care needs and to develop, initiate, evaluate and critically assess innovative care strategies across disciplines. DISCUSSION: Although the content is similar, the study programmes focus on specific aspects that allow students to choose a certain programme depending on their preferences. A next step can be the development of a core curriculum that takes into consideration further findings and the discourse of different stakeholders.

Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review.

BACKGROUND: Studies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings. Treatment could be surgical or conservative. We also analysed study designs, methods and variables, as well as which assessments were applied to measure pain management and mental status. METHOD/DESIGN: The development of this systematic review protocol was guided by the PRISMA-P requirements, which were taken into consideration during the review procedures. MEDLINE, EMBASE, CINAHL, Web of Knowledge and ScienceDirect were searched. Studies published up to January 2016 were included. The data extraction, content and quantitative descriptive analysis were carried out systematically, followed by a critical appraisal. RESULTS: Eight of the 13 included studies focusing on patient data showed that people with dementia received less drug-based pain management than people without cognitive impairment. Four studies based on surveys of healthcare professionals stated that cognitive impairment is a major barrier for effective pain management. There was heterogeneity regarding the assessment of the mental status and the pain assessment of the patients. The assessment of the drugs administered in all of the studies working with patient data was achieved through chart reviews. CONCLUSION: People with dementia do not seem to receive the same amount of opioid analgesics after hip fracture as people without cognitive impairment. There is need to enhance pain assessment and management for these patients. Future research should pay more attention to the use of the appropriate items for assessing cognitive impairment and pain in people with dementia. TRIAL REGISTRATION: This systematic review was registered at Prospero ( CRD42016037309 ); on 11 April 2016, and the systematic review protocol was published (Syst Rev. 5(1):1, 2016).

[Memorandum III, Part 3: Quality of Care and Patient Safety Research Methods]. / DNVF-Memorandum III "Methoden für die Versorgungsforschung", Teil 3: Methoden der Qualitäts- und Patientensicherheitsforschung.

The German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e.V. (DNVF)] fosters the methodological quality of health services research studies by memoranda and other initiatives. Quality of care and patient safety research (QCPSR) form core areas of health services research. The present memorandum explicates principal QCPSR questions and methods. Based on the issues' particular relevance for health policy, the memorandum exemplifies methods for developing and testing indicators, risk adjustment techniques, methods for collecting patient safety data, tools to analyse patient safety incidents and methods for evaluating often complex and multicomponent QCPS interventions. Furthermore, we point out urgent research topics.

Reporting systems in long term care: heading for implementation / Berichts- und Lernsysteme in der stationären Langzeitpflege auf dem Weg zur Implementierung.

Background: There is a need for discussing influencing factors of the implementation of critical incident reporting systems in long term care. Objective of this publication is to describe the value of Reporting and Learning Systems and to discuss concrete recommendations for implementation based on the Consolidated Framework for Implementation Research. Influencing factors of successful implementation: A successful implementation is related to a systematic approach and several success factors. The following factors of implementation after analysis with Consolidated Framework for Implementation Research are relevant: (i) a standardised and straightforward design, (ii) the consideration of external stimuli, (iii) the development of a positive organisational and safety culture that facilitates implementation by providing resources, (iv) the consideration of needs, knowledge and individual processes of change, and (v) repeated evaluation of the implementation process. Outlook: A particular focus should be applied to visible interventions. Safety culture will be reinforced by enabling personalized reports. However, today it is needed to face current barriers. It is recommended to develop and to test instruments that measure implementation and to investigate the success of sustainable implementation.

Are administrative data valid when measuring patient safety in hospitals? A comparison of data collection methods using a chart review and administrative data.

OBJECTIVE: To evaluate the validity and reliability of German Diagnosis Related Group administrative data to measure indicators of patient safety in comparison to clinical records. DESIGN: A cross-sectional study was conducted using chart review (CR) as gold standard and screening of associated administrative data based on DRG coding. SETTING: Three German somatic acute care hospitals for adults. PARTICIPANTS: A total of 3000 cases treated between May and December, 2010. MAIN OUTCOME MEASURES: Eight indicators were used to analyse the incidence of associated adverse events (AEs): pressure ulcers, catheter-related infections, respiratory failure, deep vein thromboses, hospital-acquired pneumonia, acute renal failure, acute myocardial infarction and wound infections. We calculated sensitivity, specificity, positive predictive value (PPV) and Cohen's Kappa with 95% confidence intervals. RESULTS: Screening of administrative data identified 171 AEs and 456 were identified by CR. A number of 135 identical events were identified by both methods. Sensitivities for the detection of AEs using administrative data ranged from 6 to 100%. Specificities ranged from 99 to 100%. PPV were 33 to 100% and reliabilities were 12 to 85%. CONCLUSIONS: Indicators based on German administrative data deviate widely from indicators based on clinical data. Therefore, hospitals should be cautious to use indicators based on administrative data for quality assurance. However, some might be useful for case findings and quality improvement. The precision of the evaluated indicators needs further development to detect AEs by the valid use of administrative data.

[Admission and discharge of people with dementia- Communication from the perspective of respite care experts]. / Aufnahme und Entlassung von Menschen mit Demenz - Kommunikation aus Sicht von Experten der Kurzzeitpflege.

BACKGROUND: There is a lack of information regarding the structures and processes of communication between home and respite care at admission and discharge of people with dementia (PwD}. Considering the background,it was aimed to reconstruct information exchange between home and respite care of PwD and to identify factors which affect the quality of communication structure and processes. METHODS: Semi-structured guided telephone interviews with 16 experts out of 15 respite care facilities were conducted. A structured content analysis and a process-mapping were performed. RESULTS: Core procedures of admission and discharge of PwD were identified. There were differences and overlaps between the institutions. The differences were related to the point of time and the frequency of intake inter-"views, the checks of information completeness and the provision of information.The institutions had in common that no further coordinative steps were planned after discharge. Aneed for action was identified regarding the coordination of care and the performance of handover evaluations. CONCLUSION: A timely provision of information for respite care is crucial fo rPwD. The coordination of all stakeholders,the assignment of responsibilities in communication, and easing the burden of informal caregivers is a requirement for care continuation. Across sectorial case-management, a standard of care transition, and the evaluation of hand overs is recommended.

[Implementing systematically: To what extent can implementation science make an educational contribution to health care practice?] / Systematisch implementieren. Inwiefern kann die Implementierungswissenschaft einen Bildungsbeitrag für die Akteure im Gesundheitswesen leisten?

BACKGROUND: Implementation science is currently struggling with the challenge to translate its findings into implementation practice in health care. Therefore, it is of interest to explore to what extent advanced trainings are relevant for health care practice to support knowledge circulation, and what needs to be considered in their design. DESIGN OF EDUCATIONAL INITIATIVES AND TRAINING: Internationally, numerous initiatives have emerged in recent years to make implementation science more accessible to health care implementers. They focus, in particular, on the development of curricula for actors in health care practice and the widespread implementation of these qualification programs. In German-speaking countries, the interest in health services research is particularly evident at the level of Master's degree programs to make implementation science accessible to health care. However, these efforts need to be complemented by a participatory, needs-oriented and theory-based approach to advanced training for implementers in health care practice. This will enable the required competencies to be addressed on different levels of training and the further development of training formats. DISCUSSION: Recent literature shows that implementers in German-speaking countries can benefit from a training program tailored to their needs. International experience in the field of advanced training in implementation science for health care practice allows us to derive essential components for the development of advanced training for the German-speaking region.

Feeling safe in the context of digitalization in healthcare: a scoping review.

BACKGROUND: Digitalization in healthcare and society can be challenging, particularly for people who have limited digital experiences. New digital technologies can influence individuals' perceived safety and well-being. In this study, we aimed to identify and analyze the literature on needs and influencing factors in the context of emotional and psychological safety and digitalization in healthcare. METHODS: A scoping review was conducted based on the PRISMA-ScR standard. The literature was searched based on the databases Medline via PubMed, PsycINFO via Ovid, and CINAHL via EBSCO. Literature was included after a review of the titles, abstracts, and full texts published in English or German in the last 5 years (October 2017-September 2022). Eligible literature included definitions and descriptions of emotional and/or psychological safety and was related to digitalization in healthcare and was analyzed qualitatively via inductive content analysis. The findings were analyzed from ethical, psychosocial, legal, economic, and political perspectives. RESULTS: A total of 32 publications were finally included thereof qualitative (n = 20), quantitative (n = 3), and mixed methods (n = 2) studies. Other included publications were systematic integrative reviews, scoping reviews, narrative reviews, white papers, and ethical statements. Of these publications, four qualitative studies focused on emotional or psychological safety in the context of digital technology use in healthcare as a primary research aim. Most literature has shown that perceived safety is influenced by perceived changes in healthcare, digital (health) literacy, the design of digital technology, and need orientation. The needs identified in this context overlap strongly with the influencing factors. A low or high perceived safety has an impact on users' thoughts and actions. CONCLUSION: The importance of emotional safety in the context of digital technologies in healthcare is growing, while psychological safety seems to be underrepresented. The interaction between the influencing factors and the need to feel safe leads to considerations that can affect user behavior and have far-reaching outcomes for the implementation of digital technology in healthcare. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework Registries on 16 December 2022 https://doi.org/10.17605/OSF.IO/HVYPT .

Competence-based catalog of learning objectives for the subject area of quality management in medical studies - position paper of the working group Quality Management in Education, Training and Continuing Education of the Society for Quality Management in Health Care (GQMG).

Background: Traditionally, direct medical competences are taught in medical studies, whereas leadership and quality management competences are hardly taught, although graduates are already confronted with management tasks at the beginning of their clinical work. With the upcoming amendment of the Medical Licensing Regulations, this topic area will probably be addressed and must be adequately taught by the faculties. The learning objectives in the area of quality management listed in the current working version of the German National Catalogue of Learning Objectives in Medicine (NKLM) 2.0 have so far been formulated in rather general terms and need to be concretized. Aim: To develop a competence-based learning objectives catalog for the topic area of quality management in medical studies as a structured framework recommendation for the design of faculty teaching-learning programs and as a suggestion for further development of the NKLM. Methods: The competence-based learning objectives catalog was developed by an eight-member working group "Quality Management in Education, Training and Continuing Education" of the Gesellschaft für Qualitätsmanagement in der Gesundheitsversorgung e.V. (GQMG) within the framework of a critical synthesis of central publications. The members of the project group have many years of project experience in quality management in health care as well as in university didactics. Results: Six basic competence goals as well as 10 specific competence goals could be formulated and consented upon. These are each flanked by a list of essential basic concepts and examples. These focus on quality improvements, including patient safety and treatment success against the background of a physician leadership role in an interprofessional context. Discussion: A competency-based set of learning objectives has been compiled that encompasses the necessary concepts and basic knowledge of quality management required for those entering the profession to understand and actively participate in quality management after completing medical school. To the authors' knowledge, no comparable learning objectives catalog is currently available for medical studies, even internationally.

Indicators for implementation outcome monitoring of reporting and learning systems in hospitals: an underestimated need for patient safety.

OBJECTIVE: We aimed to investigate the perception of the implementation success of reporting and learning systems in German hospitals, the perceived relevance of the implementation outcomes and whether and how these implementation outcomes are monitored. An reporting and learning system is a tool used worldwide for patient safety that identifies and analyses critical events, errors, risks and near misses in healthcare. METHODS: A pretested exploratory cross-sectional online survey was conducted with reporting and learning system experts from 51 acute care hospitals. For communicative validation, the results were discussed in person in an expert panel discussion (N=23). RESULTS: Fifty-three per cent (n=27) of the participants (N=51) of the online survey perceived that their reporting and learning system was being comprehensively and successfully implemented. However, no service or patient outcomes were reported to ultimately capture the concept of implementation success. Most of the participants reported a (high) relevance of the implementation outcomes' acceptability and sustainability. In total, 44 measures were provided to monitor implementation outcomes. However, most of the quantitative measures were based on the (relative) number of entered reports. Qualitative measures were reported in relation to the 'quality of the report'. In general, the measures were poorly specified. CONCLUSION: There is an underestimated need to develop validated 'implementation patient safety indicator(s) (sets)' to monitor implementation outcomes of reporting and learning systems. We also identified a potential need to facilitate awareness of the concept of implementation success and its relevance for patient safety. Drafts of indicators that could be used as a starting point for the further development of 'implementation patient safety indicators' were provided.

Emotional Safety in the Context of Dementia: A Multiperspective Qualitative Study.

BACKGROUND: Current research acknowledges the relevance of the emotional safety of people living with dementia. However, available evidence regarding this topic is limited. A comprehensive view of this topic that equally considers the perspectives of people living in an early stage of dementia, relatives, and public stakeholders is lacking. OBJECTIVE: This study aimed to obtain a multiperspective view of emotional safety in the context of dementia in the living environment. METHODS: A descriptive qualitative study was conducted based on data collected through semi-structured guided interviews (n = 14), focus groups (n = 3), guided feedback, and participatory approaches. People living in an early stage of dementia (N = 6), relatives of people living with dementia (N = 11), and public stakeholders (N = 15) were included. RESULTS: Considering "social togetherness", "personal condition", "health", "physical environment", and "society" in the light of "living and learning in relations" are preconditions for understanding emotional safety in the context of dementia. "Living and learning in relations" refers to the interaction of people in the context of dementia and relations to the topic of dementia. The focus lies on the (collective) learning. The individuality of each person and his or her situation is central, related to dementia-related, psychosocial, biographical, physical, and economic factors. CONCLUSION: Our study highlights the relevance of research on emotional safety in the context of dementia. Approaches to improving the emotional safety of people living in an early stage of dementia should consider the complex situations of each target group in relation to each other at the micro, meso, and macro levels.

Assessment of patient-reported outcomes after polytrauma - instruments and methods: a systematic review.

OBJECTIVES: We (1) collected instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL) and social participation during follow-up after polytrauma, (2) described their use and (3) investigated other relevant patient-reported outcomes (PROs) assessed in the studies. DESIGN: Systematic Review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. DATA SOURCES: MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, as well as the trials registers ClinicalTrials.gov and WHO ICTRP were searched from January 2005 to April 2018. ELIGIBILITY CRITERIA: All original empirical research published in English or German including PROs of patients aged 18-75 years with an Injury Severity Score≥16 and/or an Abbreviated Injury Scale≥3. Studies with defined injuries or diseases (e.g. low-energy injuries) and some text types (e.g. grey literature and books) were excluded. Systematic reviews and meta-analyses were excluded, but references screened for appropriate studies. DATA EXTRACTION AND SYNTHESIS: Data extraction, narrative content analysis and a critical appraisal (e.g. UK National Institute for Health and Care Excellence) were performed by two reviewers independently. RESULTS: The search yielded 3496 hits; 54 publications were included. Predominantly, HRQoL was assessed, with Short Form-36 Health Survey applied most frequently. ADL and (social) participation were rarely assessed. The methods most used were postal surveys and single assessments of PROs, with a follow-up period of one to one and a half years. Other relevant PRO areas reported were function, mental disorders and pain. CONCLUSIONS: There is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but require further harmonisation between central players. Additional knowledge on rarely reported PRO areas (e.g. (social) participation, social networks) may lead to their consideration in health services provision. PROSPERO REGISTRATION NUMBER: CRD42017060825.

Implementation Outcomes and Indicators as a New Challenge in Health Services Research: A Systematic Scoping Review.

The aim of this systematic scoping review was to identify and analyze indicators that address implementation quality or success in health care services and to deduce recommendations for further indicator development. This review was conducted according to the Joanna Briggs Manual and the PRISMA Statement. CINAHL, EMBASE, MEDLINE, and PsycINFO were searched. Studies or reviews published between August 2008 and 2018 that reported monitoring of the quality or the implementation success in health care services by using indicators based on continuous variables and proportion-based, ratio-based, standardized ratio-based, or rate-based variables or indices were included. The records were screened by title and abstract, and the full-text articles were also independently double-screened by 3 reviewers for eligibility. In total, 4376 records were identified that resulted in 10 eligible studies, including 67 implementation indicators. There was heterogeneity regarding the theoretical backgrounds, designs, objectives, settings, and implementation indicators among the publications. None of the indicators addressed the implementation outcomes of appropriateness or sustainability. Service implementation efficiency was identified as an additional outcome. Achieving consensus in framing implementation outcomes and indicators will be a new challenge in health services research. Considering the new debates regarding health care complexity, the further development of indicators based on complementary qualitative and quantitative approaches is needed.

Interprofessional nutrition management - implementation and evaluation of a course for medical and nursing students using research-based learning method.

Objective: The aim of the teaching project "Interprofessional Nutrition Management in Inpatient and Home Care" of the Medical Faculty of the Heinrich Heine University (HHU) and the Fliedner University of Applied Sciences Düsseldorf (FFH) was to test an interprofessional training session on the topic of malnutrition using the method of research-based learning to evaluate feasibility. Method: In the teaching project for medical and nursing students, research-based learning was applied in a case-based cross-sector setting. The teaching project was assessed quantitatively by the participating students through questionnaires and four newly-developed scales. The modeling and reliability of the scales (from 1 to 5) was confirmed by an exploratory factor analysis and Cronbach's alpha. The scales were evaluated descriptively and through inferential statistics. Results: The medical (n=21) and nursing students (n=25) rated the teaching project positively. Across all professional groups, the social context between the students (M=4.6) and the relevance of the topic (M=4.47) were rated very highly. The use of research-based learning (M=3.9) and the final assessment of the training session (M=3.9) were rated as satisfactory. Conclusions: The method of research-based learning proved to be very suitable for interprofessional education, as it enabled situations which encouraged the health professionals to learn from one another, about one another and with one another. Through the interdisciplinary discussion of malnutrition, cooperation skills and initial competences in nutritional management can be cultivated in future doctors and nursing staff even during training.

Correction to: Information needs in people with diabetes mellitus: a systematic review.

Following publication of the original article [1], the authors opted to revise Table 1. Below is the updated version of the table.

[Systematic translation and cross-validation of defined implementation outcomes in health care services]. / Systematische Übersetzung und Cross-Validierung definierter Implementierungsoutcomes der Gesundheitsversorgung.

OBJECTIVE: To validate a German translation of construct-validated implementation outcomes of Proctor et al. (2011). METHODS: A systematic translation process and a cross-validation based on Beaton et al. (2000) were performed. RESULTS: Semantic challenges arose regarding the definitions of "adoption" and "fidelity". Consistent formulation was established. CONCLUSION: The validated definitions are a starting point for developing a comprehensive concept to measure implementation effectiveness and efficacy of interventions in health services research.

What information needs do people with recently diagnosed diabetes mellitus have and what are the associated factors? A cross-sectional study in Germany.

OBJECTIVES: This study aimed to identify: (1) information needs of people with recently diagnosed type 1 or type 2 diabetes mellitus (DM); (2) information needs within different subgroups; and (3) factors associated with information needs concerning DM such as current level of information, health-related quality of life or participation preferences. DESIGN: A mixed-method approach combining quantitative and qualitative methods was used. Information needs for different topics and estimated associated factors were described using logistic regression models. Additionally, a qualitative content analysis was performed. SETTING: Monocentre study. PARTICIPANTS: Information needs were assessed and analysed in 138 consecutive participants with DM who took part in the German Diabetes Study (54% type 2 diabetes, 64% male, mean age 46.3±12.3 years, known diabetes duration <1 year). RESULTS: Most participants displayed a need for information in all topics provided, especially in diabetes research (86%) and treatment/therapy (80%). Regarding those topics, participants wished for information regarding new treatments that simplify their everyday life. In general, participants preferred topics that focus on the management or handling of DM over topics related to clinical factors of DM, such as causes and complications. A low current level of information and treatment with antihyperglycaemic medication were significantly associated with higher information needs, and diabetes-related comorbidity and higher mental component summary score in the 36-Item Short-Form Health Survey (SF-36) with lower information needs. CONCLUSION: People with recently diagnosed DM display high information needs, which differ according to the current level of information, mode of diabetes treatment, diabetes-related comorbidity and mental component summary score in the SF-36. There appears to be a preference for information, which can help to simplify life with diabetes and for information that corresponds to their level of knowledge. This should be considered in patient information activities. TRIAL REGISTRATION NUMBER: NCT01055093.