INTRODUCTION:Multidisciplinary tumor board (MTB) decisions are essential in the treatment of lung cancer. The association of adherence to MTB recommendations with survival time is limitedly reported in the literature. This study aimed to determine the adherence to MTB recommendations and its association with survival in patients with lung cancer treated at two European cancer centers. METHODS:This is a retrospective observational study including lung cancer patients from Pius hospital in Germany (diagnosed between 2014-2018) and the University Medical Center (UMCG) in the Netherlands (diagnosed between 2015-2019). Kaplan-Meier analysis was used for survival analysis. Cox proportional hazards model was used to adjust for confounders. R and RStudio was used for statistical analysis. This study is approved by the Ethical Commission of Carl von Ossietzky University of Oldenburg (2018-100). RESULTS:Adherence rate was 89.8% and the most common reason for non-adherence was patient preference (42.9%, 76 out of 177 patients in the non-adherent group). There was a statistically significant difference in survival between adherent and non-adherent groups. Adherence was an independent predictor of survival in the multivariate analysis. CONCLUSION:Adherence to MTB recommendations is associated with improved survival in patients with lung cancer. Further research should focus on the evaluation of MDT organization and its association with patient outcomes.

Im September kehrt der Deutsche Kongress für Versorgungsforschung an seinen Ursprungsort zurück und feiert an der Uniklinik Köln sein 25-jähriges Jubiläum. Die Kongresspräsidentinnen Prof. Dr. Lena Ansmann, Medizinsoziologin am IMVR der Universität zu Köln, und Prof. Dr. Nicole Ernstmann, Diplom-Psychologin und Professorin für Versorgungsforschung in Köln, zeigen im Gespräch mit „Monitor Versorgungsforschung“ auf, warum es sich lohnt, dem von ihnen gestalteten Fachkongress teilzunehmen. Das Motto „Menschen. Beziehungen. Organisationen” ist für sie viel mehr als eine Trias der Schlagworte, sondern die Beschreibung eines Wegs in eine mögliche Zukunft der patientenzentrierten Versorgung.

Introduction Worldwide, pneumococci are the most common cause of morbidity and mortality from lower respiratory tract infections. Despite recommendations of the Standing Committee on Vaccination (STIKO), the vaccination rate against pneumococci in over 60-year-olds in Germany remains low. This study therefore investigates the associations between psychological reasons for (non-) vaccination, knowledge about pneumococci, age and gender, previous vaccination decisions, and pneumococcal vaccination intention in over 60-year-olds. Methods The analysis is based on data from the study "ALtersspezifische Impfinanspruchnahme VErbessern," in which 1117 patients aged 60 and over were surveyed in 2022. In addition to the descriptive evaluation of the cross-sectional data, a Spearman correlation analysis was carried out. Predictive variables were also identified in a linear regression analysis. Results Confidence in the safety of vaccination (beta = 0.514, p < 0.001) and receiving the influenza vaccination (beta = 0.153, p < 0.001) in the last season are the strongest predictors of pneumococcal vaccination intention. In addition, the perceived risk of pneumococcal infection (beta = 0.086, p = 0.002) showed a significant positive correlation with vaccination intention. The regression analysis performed was able to explain 48.8% of the variance in vaccination intention (R2 = 0.488). Discussion Confidence and risk perception appear to be decisive factors in the decision to get vaccinated. Measures that address these aspects could increase vaccination intention. A joint administration of the influenza and pneumococcal vaccination could be useful, as receiving an influenza vaccination in the previous season showed a positive effect on the intention to get the pneumococcal vaccination.

In connection with a hospital stay, patients have to make important health-related decisions. Adequately responding to the needs of patients requires good communication skills of healthcare professionals within healthcare organizations. The PIKoG project (As made for us – Improving professional health literacy in hospitals) aimed at improving professional health literacy by implementing participatory health literacy training and supporting measures in a hospital setting. This study aimed to analyze processes supporting and hindering the implementation of the complex intervention. A mixed-methods study was conducted, including focus group interviews and a paper-pencil survey with healthcare professionals. Data was combined and analyzed using categories derived from the Medical Research Council’s guidance on process evaluation: (1) Implementation, (2) Mechanisms of impact, and (3) Context. Interview data were analyzed using structured qualitative content analysis according to Kuckartz. Survey data were analyzed descriptively. One of three on-site, full-day health literacy training sessions was offered weekly. Supporting measures were implemented step by step over the course of a year. Both the training and the supporting measures were rated positively overall, but they could not be effectively integrated into daily routines. The COVID-19 pandemic as well as resource constraints adversely affected implementation by altering workflows, increasing stress levels and shifting priorities. The participatory approach and individual change agents fostered the implementation of the complex intervention. Nurses were reached the most, while physicians engaged least in the interventions. Adaptations during the implementation increased the use of the implemented measures and gave rise to ideas for future improvements. The study highlights the challenges involved in implementing a complex intervention supporting professional health literacy in an organization and stresses the importance of considering available resources, recruiting opinion leaders, and being responsive to the needs of different groups. While the participatory co-design development approach was found to be valuable, it does not guarantee successful organizational change in times when hospitals face multiple challenges. Subsequent studies should therefore focus on investigating the capacities of healthcare organizations for organization-wide improvement processes and identify how healthcare organizations can be innovative and patient-centered even in the presence of extremely difficult contextual conditions. DRKS00019830, since 16th of April 2020.

BackgroundRising demand for physicians has led to increased competition among German hospitals, driving them to offer various measures to attract physicians. However, a comprehensive examination of these attraction measures (e.g. training opportunities) from an organizational perspective is lacking. By using organization theory, we explore how hospital attraction measures are associated with organizational and environmental hospital characteristics.MethodsWe examined hospital attraction measures by analyzing physician job advertisements (ads) sourced from online job boards. A total of n = 1,971 job ads from n = 639 German hospitals were selected. Job ads were analyzed via thematic content analysis. The resulting data set was then linked to secondary data from German hospitals, followed by a multilevel logistic regression analysis.ResultsAttraction measures varied between hospitals depending on several factors including hospital size, ownership, and location. Surprisingly, the chance of offering a wider range of attraction measures in job ads increased for urban hospitals compared to their rural counterparts. Hospitals also offered more attraction measures to residents, making their job ads stand out from those for other positions (e.g. consultants).ConclusionOrganizational and environmental hospital characteristics matter when explaining differences in attraction measures. This is why hospitals should consider adapting their attraction measures to their context.

Weltweit stellen Pneumokokken die häufigste Ursache für Morbidität und Mortalität bei Infektionen der unteren Atemwege dar. Trotz Empfehlungen der Ständigen Impfkommission (STIKO) bleibt die Impfquote gegen Pneumokokken bei über 60-Jährigen in Deutschland niedrig. Daher wurden für diese Gruppe die Zusammenhänge zwischen psychologischen Gründen des (Nicht‑)Impfens, Wissen über Pneumokokken, Alter und Geschlecht, früheren Impfentscheidungen und der Pneumokokken-Impfintention untersucht. Die Analyse basiert auf Daten der Studie „ALtersspezifische Impfinanspruchnahme VErbessern“, bei der 2022 1117 Patient:innen ab 60 Jahren befragt wurden. Neben der deskriptiven Auswertung der Querschnittsdaten wurde eine Spearman-Korrelationsanalyse durchgeführt. Zudem wurden in einer linearen Regressionsanalyse prädiktive Variablen identifiziert. Vertrauen in die Sicherheit von Impfungen (β = 0,514, p < 0,001) und eine Influenza-Impfung (β = 0,153, p < 0,001) in der letzten Saison sind die stärksten Prädiktoren für die Pneumokokken-Impfintention. Zudem zeigt die Einschätzung des von einer Pneumokokken-Infektion ausgehenden Risikos (β = 0,086, p = 0,002) einen signifikanten positiven Zusammenhang zur Impfintention. Die durchgeführte Regressionsanalyse konnte 48,8

The functioning of emergency departments (ED) is considered an indicator of the effectiveness and efficiency of the healthcare system. In Germany, there is increasing pressure to improve emergency care. EDs are relatively autonomous organizational units that interact with other levels within and outside the hospital organization. Based on a model of organization-related care research, the current state of emergency care is described and barriers to and facilitators of change are discussed.A narrative review was used that includes literature sources on organizational impacts on the functioning of EDs. Publications were considered that, in addition to the interface perspective, have a relevance to the current state as well as to the proposed changes from the legislature and other actors. These were assigned to the respective organizational levels and (potential) effects were described. The macro-meso-micro model of organization-related health services research serves as a heuristic.Insufficient consideration of interdependencies and interfaces between organizational actors and levels of emergency care facilitates friction and hinders care innovation. At the macro level of the healthcare system, structures, responsibilities and financing are regulated, which significantly impact functioning at the meso and micro levels. At the meso-level of the hospital, the role of the ED is influenced by the difficulty of controlling patient flows and the lack of Diagnoses Related Groups (DRGs) to cover the costs for outpatient emergency care. The micro-level of the ED has to prioritize treatment and is confronted with the challenges of "exit blocks" when there are indications for patient transfer. Previous reform efforts did not take this organizational complexity into account.Reform proposals must take into account the organizational complexity and interests that arises from interfaces, interactions and stakeholder interests. Organization-related health services research can examine the contextual conditions that affect emergency care in order to derive recommendations for health care innovations.

Physical activity has been shown to be beneficial for people diagnosed with cancer. MOVE-ONKO aims at implementing a new multiprofessional care pathway in 3 large regions in Germany at the interface of oncological treatment and exercise therapy for cancer patients. The related study aims to evaluate the implementation processes and patient outcomes. The project comprises 3 phases: 1) preparation, 2) implementation in Comprehensive Cancer Centres (CCCs), 3) implementation in remote cancer centres. In phase 1, individual prerequisites for the implementation are assessed in the participating CCCs. The care pathway which is supported by digital/app-based exercise oncology health record is developed and adapted to the CCCs. Phases 2 and 3 focus on the implementation and evaluation of the care pathway. To study the effectiveness, primarily changes in patients' health-related quality of life are examined in a prospective design. Secondary outcomes include physical activity behaviour, motivation for physical activity and patient activation. A sample of 2240 cancer patients ≥ 18 years (n = 280 patients at seven CCCs in phase 2 and n = 1.960 patients at the seven CCCs and 49 remote oncological centres in phase 3) are recruited for assessment at inclusion and at 4, 12 and 24 weeks. The newly implemented care structures and processes will be assessed from the perspective of key informants, healthcare providers and patients. The perspectives of key informants on the implementation from the CCCs will be recorded in a prospective design based on a questionnaire and supplemented by in-depth semi-structured interviews across the three phases. The implementation processes are documented by assessing existing structures in CCCs. In phase 2 (n = 105) and phase 3 (n = 350), healthcare providers will be surveyed with questionnaires. Based on purposeful sampling (n = 18) will be interviewed. Additionally, qualitative patient interviews will be conducted about their experiences in the care pathway. A successful implementation of the care pathway as part of the study will contribute to the growing evidence on the implementation of a nationwide structured approach to exercise therapy for patients with cancer. ClinicalTrials.gov (ClinicalTrials Identifier NCT06185777) at December 29, 2023.

Abstract:The scope and definition of health care research is a matter of discussion in our scientific community. The Board of the German Network for Health Care Research has drafted a position paper that was extensively reviewed and commented upon by all working groups and specialist groups of the network. The present version represents consented common grounds to a large degree but is neither complete nor final. We consider this position paper a living document that will evolve and further converge in an ongoing discussion in the network.

Die Nutzungsstruktur von Notaufnahmen gilt als Indikator für die Funktionsfähigkeit des Gesundheitssystems. In Deutschland besteht Handlungsdruck zur Verbesserung der Notfallversorgung. Notaufnahmen sind relativ eigenständige organisationale Einheiten, die mit anderen Ebenen innerhalb und außerhalb der Organisation Krankenhaus interagieren. Anhand eines Schemas der organisationsbezogenen Versorgungsforschung soll der Ist-Stand der Notfallversorgung beschrieben und Barrieren und Förderfaktoren gegenüber Veränderungen diskutiert werden. Es handelt sich um einen narrativen Review, der Literaturquellen zu organisationalen Einflüssen auf die Arbeitsweise in der Notaufnahme einbezieht. Dabei wurden Publikationen berücksichtigt, die neben der Schnittstellenperspektive einen aktuellen Bezug zum Ist-Zustand sowie zu den Änderungsvorschlägen des Gesetzgebers und weiterer an der Planung und Umsetzung beteiligter Akteur:innen haben. Diese wurden den jeweiligen organisationalen Ebenen zugeordnet und (potenzielle) Auswirkungen beschrieben. Als Heuristik dient das Makro-Meso-Mikro-Modell der organisationsbezogenen Versorgungsforschung. Unzureichende Berücksichtigung von Interdependenzen und Schnittstellen zwischen organisationalen Ebenen der Notfallversorgung begünstigen Friktionen und erschweren Versorgungsinnovation. Auf der Makroebene des Gesundheitswesens werden Strukturen, Zuständigkeiten sowie Finanzierungen geregelt, die die Arbeitsweise der Meso- und Mikroebene maßgeblich beeinflussen. Auf der Mesoebene Krankenhaus wird die Rolle der Notaufnahme durch kaum steuerbare Patient:innenströme und fehlende abrechnungsrelevante Diagnoses Related Groups (DRGs) für die ambulante Notaufnahmeversorgung beeinflusst. Die Mikroebene Notaufnahme muss Behandlungspriorisierungen vornehmen und ist mit Herausforderungen von „exit blocks“ bei Verlegungsindikationen konfrontiert. Bisherige Reformvorschläge erfassen diese organisationale Komplexität nicht. Reformvorschläge müssen die organisationale Komplexität berücksichtigen, die durch Schnittstellen, Wechselwirkungen und Akteursinteressen entstehen. Die organisationsbezogene Versorgungsforschung kann die Kontextbedingungen untersuchen, die auf die Notfallversorgung einwirken, um Empfehlungen für Versorgungsinnovationen abzuleiten.

PURPOSE:Multidisciplinary tumor boards (MTBs) intend to increase the quality of cancer care. Research on the association of adherence to MTB recommendations with survival is limited. This study aims to determine the impact of adherence to MTB recommendations on survival in colorectal cancer patients. METHODS:This is a retrospective, observational study including patients diagnosed between 01.01.2014 and 31.12.2018. Electronic health records were reviewed to determine the adherence. Study endpoints were adherence rate, disease-free survival (DFS), and overall survival (OS). Follow-up was performed until 12.12.2023. RESULTS:There was a significant difference in DFS (median DFS: 79 months [95% CI, 73-89] vs 22 months [95% CI, 17-87]) and OS (median OS: 78 months [95% CI, 75-86] vs 65 months [95% CI, 28-NR]) between the adherent group (n=406) versus the non-adherent group (n=52) (log-rank test, p<0.05). Performance status, stage and non-adherence were independent predictors of survival in the multivariate analysis (p<0.05 for all). The most common reason for non-adherence was patient preference (n=23). CONCLUSION:While MTBs have become an indispensable part of clinical practice, adherence to MTB recommendations was crucial to achieve survival benefit in this study. Patient preference should be prospectively analyzed from a patient and caregiver perspective in future studies.

Despite robust evidence on the effectiveness of exercise therapy care as a supportive strategy in cancer care, access for cancer patients remains limited across Germany. This is due to a lack of renumeration opportunities, insufficient knowledge, and the absence of integrated provider networks. Existing care services have mainly arisen from individual initiatives and the unwavering commitment of sports science pioneers, who devoted their time, energy, and expertise to developing better methods of care. This study analyses the informal provider networks in the emerging field of exercise therapy care and research, focusing on recurring patterns of interaction between exercise therapy providers and medical professionals that enable patient access to exercise therapy care. This study employed a combination of qualitative network analysis and contextual analysis. A total of n = 31 qualitative interviews were carried out with representatives from the provider networks of exercise therapy care within seven comprehensive cancer centres (CCCs) to explore current patterns of care. The interview data were analysed using qualitative content analysis following Kuckartz, supported by MAXQDA software. Contextual analysis was supported by a survey of key informants (KIs) from exercise therapy care units in CCCs (n = 7) to collect data on patient flow and CCC characteristics. We identified seven recurring relational patterns of operation that facilitate patient access to exercise therapy care within care networks. These patterns include mutual recognition from previous projects and shared facilities, improved accessibility to exercise therapy care options, the development of reciprocity between supportive services, raising patient awareness and sensibilisation through existing patient navigators, planning for patient needs via structured screenings for supportive services, collaboration with medical care, and the sharing of knowledge through informational events for healthcare providers. Integrated provider networks of exercise therapy care have developed informally, resulting in structural fragility and limited robustness. As long as the effectiveness of exercise therapy care remains research-driven rather than embedded in standard care pathways, these networks remain vulnerable. Establishing formal policies and stable reimbursement mechanisms is essential to institutionalising network ties; strengthening social capital; and ensuring resilient, sustainable access to exercise therapy for all cancer patients. ClinicalTrials.gov (Clinical Trials Identifier NCT06185777), December 29, 2023.

BACKGROUND:In Germany, clear care pathways for people without natural speech who require augmentative and alternative communication (AAC) are currently lacking. Therefore, AAC is often not sustainably implemented in everyday life. For this reason, a complex intervention was developed that supplements existing AAC consultation with additional AAC training, AAC therapy, and case management. This article presents the results of the process evaluation of the complex intervention. It examines (1) how caregivers and AAC consultants rate the intervention (2), which contextual factors influence its implementation, and (3) the acceptance, use competence, and use of the new AAC system. METHODS:The process evaluation used a mixed methods design. Quantitative data were collected with a longitudinal survey of caregivers of AAC users in the intervention and comparison groups at three time points (T0: after AAC consultation; T1: 4 weeks after AAC system receipt; T2: 4 months after AAC system receipt). Semi-structured focus group interviews were conducted with caregivers of AAC users and with AAC consultants. The quantitative data were analysed descriptively and with nonparametric mean value comparisons. The qualitative results were analysed using structured qualitative content analysis. RESULTS:The evaluation and presentation of results were based on the Medical Research Council process evaluation guidance by Moore et al. The intervention elements were rated positively. AAC training and therapy enabled the participants to use the AAC system effectively in different contexts. Case management provided support, particularly in the event of problems in the care process. However, the results also show the heterogeneity of the intervention, as it depended on various contextual factors. Overall, acceptance, use competence, and use of the AAC system were rated higher in the intervention group than in the comparison group. CONCLUSIONS:The process evaluation illustrates various contextual factors that can influence the implementation of the AAC intervention. The results highlight the potential of the intervention to improve AAC care and establish a sustainable use of AAC systems in everyday life. In addition, the process evaluation provides indications of how AAC interventions can be adapted for successful implementation. TRIAL REGISTRATION:Grant number 01NVF17019.

OBJECTIVE:To identify a) interruptions (secondary activities disrupting the workflow of the main task) occurring during case discussions in multidisciplinary tumor conferences (MTCs) with patient participation, and b) observable reactions among patients and healthcare professionals (HCPs). METHODS:Within the non-interventional mixed-methods study PINTU, we video-recorded five case discussions during MTCs with patient participation at one breast and gynecological cancer center. A qualitative sequential video interaction analysis was used to identify interruptions and related interactions. RESULTS:Occurring interruptions resulted in reactions of patients and/or HCPs. Work organization and seating arrangement led to interruptions, e.g., turning around to face individuals. Some interruptions caused reactions only among patients and not among HCPs. CONCLUSION:Interruptions occur regularly in case discussions during MTCs with patient participation. Certain interruptions, which did not cause observable reactions among HCPs and seem to be commonplace, attracted the patient's attention. As interruptions can be associated with patients' unmet need for information, HCPs' awareness of interruptions should be raised. PRACTICE IMPLICATIONS:When patients participate in MTCs, interruptions should be reduced to improve HCP-patient interactions. Our findings can lead to recommendations for improving organization of MTCs with patient participation aiming to cause fewer interruptions and thus better quality of patient care.

BackgroundDigital patient portals (PPs) are platforms that enhance patient engagement and promote active involvement in health care by providing remote access to personal health data. Although many hospitals are legally required to offer these portals, adoption varies widely among patients, often influenced by sociodemographic and socioeconomic determinants. Evidence suggests that higher income, education, employment status, and specific age groups correlate with increased portal usage, highlighting a digital divide. This study aims to analyze sociodemographic and socioeconomic determinants affecting digital PP usage, addressing inconsistencies in existing research and contributing to strategies for reducing digital health disparities. ObjectiveThis study aimed to conduct a meta-analysis of the sociodemographic and socioeconomic factors contributing to the digital divide in the usage of digital PPs. MethodsA systematic review with meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in PubMed, Web of Science Core Collection, and EBSCOhost. Screening involved 3 reviewers with consensus meetings to resolve discrepancies. Data on sociodemographic and socioeconomic factors and statistical outcomes were extracted, and study quality was assessed using the Mixed Methods Appraisal tool. Results were visualized using forest and funnel plots to assess heterogeneity and publication bias. ResultsA total of 2225 studies were identified through a systematic review, and after title and abstract screening, 17 studies were included in the quantitative and qualitative analysis. The qualitative analysis revealed that younger patients (younger than 65 y) were significantly more likely to use the digital PP, while the meta-analysis revealed that women had a 16% higher likelihood of using the digital PP than men. The relationship between income and digital PP usage was inconsistent, due to different scaling in different studies. A higher level of education was significantly associated with a 37% greater likelihood of using the digital PP in the meta-analysis. In addition, employed patients were 23% more likely to use the digital PP, while married patients had a 13% higher likelihood of using it than unmarried patients. Marital status and employment can be considered as measurable factors of social relationships. ConclusionsThe review confirms that sociodemographic and socioeconomic factors significantly influence the usage of digital PP in hospital care. Marital status shows that social support plays a vital role, with married patients 13% more likely to engage with digital PPs. It is worth noting that social support through connections to society via work or work colleagues can also play an important role as like as a partner at home, with employed individuals being 22% more likely to use digital PPs. Overall, sociodemographic factors, like marital status, primarily affect usage patterns, while socioeconomic factors, like employment, enable access, emphasizing the need for comprehensive support systems to bridge the digital divide in health care. Trial RegistrationGerman register of clinical trials DRKS00033125; https://drks.de/search/de/trial/DRKS00033125 and PROSPERO CRD42024567203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567203

BACKGROUND:Multidisciplinary care is essential for the management of breast cancer. Multidisciplinary tumor boards (MTBs) can improve the health outcomes in breast cancer; however, the association of adherence to MTB recommendations with survival time has not been studied. METHODS:This is a retrospective observational study of patients with breast cancer diagnosed between 2014 and 2018 and discussed in the MTB meetings at 2 breast cancer centers certified by the German Cancer Society. Primary endpoints were adherence rate to MTB recommendations and disease-free survival (DFS). The secondary endpoint was overall survival (OS). Kaplan-Meier survival analysis and Cox proportional hazard modelling were used. Ethics approval was obtained from the Ethical Commission of Carl von Ossietzky University of Oldenburg (2018-100). RESULTS:In total, 1563 patients with breast cancer were included in the study. The adherence rate to MTB recommendations was 89.6%. The most common reason for nonadherence was patient preference (122 out of 162 nonadherent patients, 75.3%). There was a statistically significant difference in DFS and OS between adherent and nonadherent patients (log-rank test, P < .05). In the multivariate analysis, adherence was a significant predictor of DFS but not OS. CONCLUSION:Adherence to MTB recommendations demonstrated an improved DFS and OS in patients with breast cancer in the univariate analysis. In the multivariate analysis, adherence was a significant predictor of DFS but not OS. This suggests further research is needed to determine the factors underlying behind the survival time of patients with breast cancer.