Patient safety indicators are core measures for improving healthcare. We aimed to conceptualize the prioritization of such indicators and the requirements for developing a core set of nationwide, valid, low-bureaucracy patient safety indicators. We also aimed to develop a decision aid for adapting the core set to strengthen the resilience of healthcare provision with respect to crisis situations and to identify factors related to successful implementation. A hybrid focus group design of 4 guided online focus group interviews was used by combining a semi-structured discussion and supporting materials, including questionnaires. The data were analyzed using content and descriptive analysis. A framework for prioritizing patient safety indicators for core set development and adaptation was developed. Indicator prioritization is guided by the aim of the core set, considering stakeholders' needs, potential for improvement, context of use, scientific quality, and implementability criteria. Together with the requirement criteria, such as patient safety dimensions, the breadth and depth of the indicator set can be defined. The developed decision aid for crisis events was deemed suitable for maintaining patient safety. A modular system is recommended for the adaptation of the core set to address several different indicator measurement scenarios. The developed framework and decision aid allow context-(in)dependent prioritization on the basis of the criteria for prioritizing patient safety indicators for a core indicator set and for indicator decision-making in adapting the core set for crisis events. Further real-world validation of the framework and decision aid and the associated criteria is recommended.

Background:Individuals with cardiological and pneumological diseases, as well as pregnant women, are particularly vulnerable to the health impacts of climate change. Studies indicate that these groups utilize healthcare services more frequently during periods of heat and increased air pollution. Within the LOEWE-Schwerpunkt "HABITAT", this study aimed to assess the current healthcare situation in Hesse in the fields of cardiology, pneumology and obstetrics with a focus on the availability of outpatient and inpatient healthcare services accessible within reasonable travel time. Methods:This study is a regional, descriptive, tertiary data analysis with spatial accessibility analysis. Publicly available data were used to link disease prevalences with demographic variables (notably age and social deprivation) and healthcare facility accessibility. Results:Marked regional disparities were observed in the prevalences of COPD, bronchial asthma, heart failure and coronary heart disease across districts. The incidence of hypertensive disorders in pregnancy also varied regionally. The results showed that pneumological and cardiological diseases were particularly prevalent in districts such as the Vogelsbergkreis or Hersfeld-Rotenburg, which are characterized by higher average age and higher social deprivation. These regions also exhibited a lower density of healthcare facilities. Except for a few rural communities in Vogelsbergkreis, all outpatient healthcare facilities could be reached by car within 30 minutes. Conclusion:Overall, the number of healthcare facilities and their accessibility by car in Hesse is adequate. Demographic and socioeconomic disparities further highlight that car accessibility alone is insufficient, particularly for population groups reliant on public transport.

BackgroundMinimum caseload requirements (MCRs) ensure medical treatment quality but may negatively affect spatial accessibility to health care. Previous studies optimised the caseload distribution via spatial models, with a focus on balancing spatial concentration and accessibility with centralised case redistribution models. This study seeks to capture hospitals as active participants in MCR policy decisions by incorporating their intentions and motivations regarding MCRs within their spatial context, considering current caseloads and neighbouring hospital distances.MethodsThe study modelled four MCR procedures separately in an individual model in accordance with the German policy context: complex oesophageal interventions, complex pancreatic interventions, stem cell transplantation, and total knee replacement. The spatial model for Germany involved three steps: (1) delimiting cooperating hospitals, (2) iterative grouping, and (3) categorising hospital groups.ResultsThe grouping process described above resulted in 55 (oesophagus), 126 (pancreas), 39 (stem cell), and 672 (knee) groups across Germany. A total of 50.9%, 49.2%, 51.3%, and 81.5% respectively of these groups contained only one hospital (no cooperation needed). 7, 28, 2, and 22 groups require joint MCR compliance, whereas 19, 21, 8, and 8 hospitals are recommended special permission with a reduced caseload threshold to ensure spatial accessibility for certain regions. The results inform regional policy makers based on the hospital decision space.ConclusionsThis study models potential hospital cooperation based on proximity and caseload, introducing joint MCR compliance. The modelling process supports the formation, categorisation, and analysis of hospital groups, with parameter thresholds enabling flexible policy testing. This approach considers hospitals' intentions and motivations regarding MCRs, and reserves their decision space. This spatial model provides a theoretical basis for granting exceptional MCR permissions to improve spatial accessibility.

Linking project data and data from routine clinical practice with healthcare-related data is essential for German healthcare research in order to answer complex questions validly and efficiently. Currently, fragmented data sources, heterogeneous legal requirements, and a lack of infrastructure prevent the optimal use and linking of these data. The Network University Medicine (NUM) is therefore developing a dedicated data infrastructure to link primary study data and routine clinical data with external healthcare-related data (e. g., data from statutory and private health insurance companies, data from cancer registries of the federal states, and data from registration offices). The position paper describes the various data worlds, including examples from epidemiological and clinical research that illustrate the added value and challenges of data linkage. In particular, it presents the new structures of the data acceptance and processing center (DAAeD) in the NUM, which is intended to enable quality-assured, data protection-compliant receipt and linkage of data. Standardized application and approval procedures as well as innovative privacy-preserving record linkage procedures are central to this. International experience, including from Scandinavia and the UK, demonstrates the benefits of such infrastructures for research and healthcare. In conclusion, we advocate rapid political and institutional implementation of the recommendations described in order to make health research in Germany competitive in international comparison and to ensure sustainable, patient-centered health care.

BACKGROUND:Most medical care for the approximately 14 million children and adolescents in Germany is provided on an outpatient basis, but data on the quality of care is lacking. We studied the quality of outpatient care for children and adolescents with common mental or physical conditions. METHODS:In pediatric, general medical, and child/adolescent psychiatric practices in the German federal state of Hesse, patient records of children and adolescents diagnosed with attention deficit/hyperactivity disorder, depression, conduct disorder, asthma, atopic dermatitis, otitis media, or tonsillitis were randomly selected, and data were extracted for the calculation of quality indicators. The quality indicators had been generated before the start of the study with a modified RAND/UCLA method. The extracted data were used to determine the extent to which the quality indicators were fulfilled. Potential influencing factors were examined as well. Study registration: DRKS00022408. RESULTS:In the overall sample (1156 patients; 55.2% male, average age 8.9 years, 20 513 diagnostic/therapeutic episodes evaluated), 45.5% of quality indicators were met (mental disorders: 38.7%, physical diseases: 50.9%). The highest degree of adherence was found for tonsillitis (78.8%) and conduct disorders (72.5%), and the lowest for depressive disorders (21.2%) and asthma (34.0%). No consistent picture emerged with regard to the influencing factors examined. CONCLUSION:The quality of outpatient care for children and adolescents in Germany is-with limited comparability, because of methodological and health system factors-comparable to that in the USA and lower than that in Australia. Potential for improvement was identified for some disorders. The assessment of quality of care proved to be feasible; in future, this could be done routinely on the basis of electronic secondary data.

Introduction Vulnerable groups are particularly affected by climate change. The healthcare sector is responsible for approximately 6% of the greenhouse gas emissions in Germany. It remains unclear to what extent hospitals and nursing homes in Germany have already implemented climate mitigation and adaptation measures. Materials and methods The study was conducted in the predominantly rural Marburg-Fulda region of Hesse, Germany, which has a population of 2,028,359. A total of 91 of the 300 nursing homes (30%) and seven of the 32 hospitals (22%) from this region participated in a semi-standardized telephone survey. Data were collected between January 28, 2025, and July 31, 2025. Data were first analyzed descriptively. In the next step, the Fisher‒Freeman‒Halton test was used to identify correlations between institutional characteristics and various climate mitigation and adaptation measures. Results Nursing home size was positively correlated with the presence of climate mitigation guidelines (p = 0.012). Simple climate mitigation measures for everyday use (e.g., switching off lights or lowering heating) are generally implemented in nursing homes and hospitals, whereas larger, cost-intensive climate protection measures are less frequently implemented. Except for heat protection, climate adaptation measures are not very widespread. Barriers to the implementation of measures include financial constraints, staffing shortages, and structural limitations. Conclusion Hospitals and nursing homes in the Marburg–Fulda region are not yet climate-resilient. Implementing such measures often fails because of a lack of resources. To create a climate-resilient healthcare system, targeted financial and structural support is needed from policymakers.

Objectives To explore perceptions of digitalisation and patient safety from the view of the German general public and related sociodemographic factors.Design Cross-sectional survey.Setting A nationwide survey was undertaken in 2024, using data from the Techniker Krankenkasse (TK) Monitor of Patient Safety. The TK Monitor of Patient Safety is an annual survey of the population on the state of patient safety in medical care.Participants 1000 German adults (18 years and older).Primary and secondary outcome measures Ordinal logistic regression analyses were performed to investigate the associations among sociodemographic factors (age, gender, education and household income) and perceptions on digitalisation and patient safety.Results The majority of respondents expected benefits from digital applications in healthcare. Over half of the respondents (58%) believed that artificial intelligence (AI) can help reduce complications and errors, while 49% of the respondents believed that the use of AI poses serious new risks for the healthcare sector. The results showed that sociodemographic variables are important factors influencing patient safety perceptions of digitalisation and AI. Female, older, less educated and/or lower-income individuals were less likely to perceive benefits from digital care applications and AI.Conclusions In our study, the German public appears to view digital technologies and AI as tools both for improving patient safety and as potential risk factors. Our findings also highlight the importance of analysing sociodemographic factors to identify specific disparities in how different groups are affected by digitalisation. Such analysis is essential for developing targeted strategies that mitigate current patient safety risks, ensuring that digital health solutions are equitable and safe across all demographic groups.

BACKGROUND:The COVID-19 pandemic entailed a global health crisis, significantly affecting medical service delivery in Germany as well as elsewhere. While intensive care capacities were overloaded by COVID cases, not only elective cases but also non-COVID cases requiring urgent treatment unexpectedly decreased, potentially leading to a deterioration in health outcomes. However, these developments were only uncovered retrospectively. Especially university hospitals, which were meant to take on a central coordinating role, did not have detailed information on expected healthcare utilization, available resources and capacities, and the quality of medical care. The experience of compromised healthcare and a lack of monitoring during the COVID-19 pandemic made it clear that healthcare systems should be better prepared. Therefore, the aim of this work was to develop a set of indicators suited to detect undesirable developments concerning the provision of inpatient healthcare. MATERIAL & METHODS:The study employed a literature review, online surveys, expert interviews, and a multistep evaluation process to develop a core set of quality indicators (QIs) suitable for assessing the resilience of university hospitals during pandemics. This initial set of indicators was refined through consultations with a) quality and risk management officials from German university hospitals via an online survey and b) a diverse panel of experts. RESULTS:The comprehensive evaluation identified two primary strands: organizational/management indicators (Strand A, 60 indicators) and disease-specific clinical quality and patient safety indicators (Strand B, 20 indicators for critical conditions like stroke, myocardial infarction, and cancer.) Three additional indicators were added after a final expert panel meeting, resulting in a final set of 83 indicators. DISCUSSION AND CONCLUSION:The developed QIs mark a significant advancement in the operational preparedness of university hospitals for pandemics. The study contributes to quality management in healthcare during pandemics by creating the basis for a structured approach to pandemic preparedness and response. This unique set of QIs within the German context presents an opportunity for establishing quality improvement, underscoring the importance of a robust, adaptable quality management framework as a basis for safeguarding against future health crises.

Background:In order to harmonize supply and demand in the outpatient sector, current figures are needed on the number of visits to physicians' offices and their rationale. Since the introduction of partially flat-rate remuneration in the outpatient sector in 2008, only uncertain estimates are possible on the basis of billing data. Objective:On the basis of direct observation in physicians' offices, the number and reasons for visits to the physician's office are to be recorded and their potential avoidability estimated. Methods:In 11 GP practices (4 practices), general specialist practices (6 practices) and specialized specialist practices (1 practice), all visits to the physician's office in a given week were documented with regard to the reason for and type of contact as well as the age and gender of the patients. To this number, the practices added the patients' utilization of the services in the entire quarter and previous quarter as well as the total number of all cases seen in the practice per quarter. Frequencies and differences in relation to practice types, age groups and gender were analyzed descriptively and using Chi2 tests. Results:A total of 3266 practice contacts (57% by women, 43% by men) were recorded. There were 2.9 visits to GPs and 1.9 visits to specialists per patient per quarter. In the case of GPs, 40% of patients aged<60 years visited the practice because of an acute illness, while the leading reason for patients aged 60+was to collect a referral or prescription (50%). The most prominent reason for visits to a specialist was the monitoring of chronic illnesses for younger patients (36%) and older patients (51%). Explicit contact with a GP was made by 58% of those under 60 and 32% of those over 59, while 70 and 73%, respectively of such patients saw a specialist. Extrapolated, every citizen had 16.9 contacts with a physician's office per year. Conclusion:The explorative study provides indications of the extent of avoidable contacts with physicians' offices, in that half of the contacts with over 59-year-olds were only to collect prescriptions, findings etc. and 41% of contacts with specialists were routine check-ups, the necessary frequency of which is unclear.

INTRODUCTION:Endometriosis is a chronic disease associated with stigmatisation and delayed diagnoses. In order to create or improve positive healthcare encounters for patients, this study aimed to explore the experiences of women with endometriosis and to identify challenges and resources for these patients. METHODS:Qualitative, semi-structured interviews were conducted to explore lived experiences of endometriosis patients. A purposive sampling strategy was used, and patients were included if they had a laparoscopically confirmed diagnosis and at least one contact with the healthcare system in Hesse, Germany. Interviews were conducted between May and August 2023, transcribed, and analysed according to an interpretive phenomenological approach using MAXQDA 24. RESULTS:In total, 21 women aged 23-54 years (median: 32 years) were interviewed. Three themes were identified, with ambivalence emerging as the common essence of experiences. Patients reported that their experiences were influenced by the role of the healthcare provider, described as either a source of support or an inhibitor in the treatment process. Additionally, patients reported that provider-patient-communication was characterised by both trivialisation and dismissal of symptoms, as well as empathic, encouraging interactions. Limits in the healthcare system, such as the allocation of specialised care, and resources like increased awareness of endometriosis, represented systemic influences on experiences. CONCLUSION:This study provides an insight into the ambivalent nature of healthcare experiences from the perspective of endometriosis patients and contributes to a better understanding of patients' needs in healthcare encounters, which may help to create a more positive healthcare experience for them.

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are invasive treatment options for coronary artery disease (CAD), aiming to improve quality of life and reduce cardiovascular morbidity and mortality. Guidelines-based revascularization decisions should consider anatomical complexity, comorbidities, and patient preferences, with procedural risk assessed through validated scoring systems. However, the current legal quality assurance (QA) programs in Germany remain procedure specific and therefore lack a patient-centered, diagnosis-oriented approach. This study proposes a paradigm shift toward diagnosis-based QA to optimize individualized treatment selection, improve outcome attribution, and ensure transparent quality assessment. By integrating guideline recommendations with enhanced data linkage, this framework aims to standardize and improve CAD care quality while addressing limitations of existing QA schemes.This mixed-methods study aims to develop a cross-disciplinary QA framework for CAD patients undergoing elective PCI or CABG. Qualitative methods will be employed to formulate preliminary evidence-based quality indicators (QI), while secondary data analyses will provide empirical support for QI prioritization, modeling, and future evaluation. Findings from both approaches will undergo a structured consensus process to establish validated QI as basis of a redesigned QA scheme.The resulting framework seeks to standardize and improve QA procedures across CAD care pathways, integrating clinical expertise with real-world data to enhance patient outcome.The study proposes a patient-centered, diagnosis-based quality assurance framework for coronary artery disease care, aiming to improve treatment decisions and outcomes. By integrating guideline, expert input, and real-world data, it seeks to enhance transparency and standardization in quality assessment across CAD treatment pathways.

Introduction The complexity of Parkinson’s disease (PD) symptoms and the necessity for individualised, multidisciplinary and digital health technology-based care are widely acknowledged; however, access to specialist care remains limited, particularly in rural areas. Current healthcare systems are frequently ill-equipped to deliver timely, personalised interventions. In response to these challenges, the ParkProReakt project aims to enhance PD care through a proactive, technology-enabled, multidisciplinary approach designed to improve patient health-related quality of life (HRQoL) and alleviate caregiver burden.Methods and analysis A randomised controlled trial will assess the efficacy and cost-effectiveness of ParkProReakt—a proactive, multidisciplinary, digitally supported care model for community-dwelling people with Parkinson’s disease (PwPD)—compared with standard care. We will recruit a total of 292 PwPD and their informal caregivers living in two diverse regions in Germany. The primary outcome measure will be patients’ HRQoL as measured by the Parkinson’s Disease Questionnaire, obtained at baseline, monthly and at completion of participation. Secondary outcomes comprise patients’ subjective well-being, incidence or change of long-term care needs, global cognition and disease progression, utilisation of healthcare services, including hospitalisations, caregiver burden and healthcare costs. Statistical analysis will include t-tests for HRQoL changes, general linear model for confounders and multilevel models for centre effects. Secondary outcomes and cost-effectiveness (incremental cost-effectiveness ratio) will be analysed similarly using R and SPSS.Ethics and dissemination The study protocol has been approved by the Ethics Committees of the Medical Associations of Hesse and Hamburg. The results of our study will be reported to the funding body and disseminated through scientific publications and presentations at national and international conferences.Trial registration number This study was registered with the German Registry for Clinical Studies (DRKS) in both German and English; number: DRKS00031092.

In recent years, public perceptions of patient safety have evolved significantly, driven by media coverage, healthcare reforms, and greater awareness during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to examine trends in public perceptions of patient safety, knowledge and self-efficacy in Germany during this pandemic between 2019 and 2023. A repeated cross-sectional study was conducted, using data from TK Monitor of Patient Safety. TK Monitor of Patient Safety in a nationwide survey assessing public perceptions of safety in medical treatment and diagnosis. Self-reported data were collected annually from a randomly selected sample of 1,000 different adults aged 18 and older residing in Germany. Statistical analyses included descriptive statistics, chi-square tests, and linear regressions for trend analyses. Our results revealed high perceived patient safety risk during the years of the study. Up to one third of respondents considered it very likely or somewhat likely that patients would be harmed when receiving medical treatment in hospital or ambulatory care, with lower perceived levels of risk before the COVID-19 pandemic. Regarding perceived prevalence of preventable adverse events, over half of respondents considered it very likely or somewhat likely that an illness of theirs would be diagnosed incorrectly, or that they would contract a nosocomial infection, at some stage in their lives. The majority of respondents considered themselves overall well informed about patient safety and reported higher levels of self-efficacy with regard to error prevention before and after the pandemic than during it. Given the facts that patient safety remains an important issue and that the German public perceives the level of patient safety risk but also of patient safety knowledge, and self-efficacy as high, actively involving patients in safety initiatives is essential for shaping positive public perception.

Um Versorgungsangebot und Nachfrage im ambulanten Sektor in Einklang zu bringen, bedarf es aktueller Zahlen zur Anzahl und den Gründen für Arztpraxisbesuche. Seit der Einführung der zum Teil pauschalierten Vergütung im ambulanten Sektor im Jahr 2008, sind auf der Basis von Abrechnungsdaten nur noch unsichere Schätzungen möglich. Auf der Basis einer direkten Beobachtung in Arztpraxen sollen Anzahl und Gründe für Arztpraxisbesuche erfasst sowie deren potenzielle Vermeidbarkeit geschätzt werden. In 11 Praxen der hausärztlichen (4 Praxen), allgemeinen (6 Praxen) und spezialisierten fachärztlichen Versorgung (1 Praxis) wurden alle in jeweils einer Woche stattfindenden Arztpraxisbesuche im Hinblick auf den Kontaktanlass und die Kontaktart sowie Alter und Geschlecht der Patient*innen dokumentiert. Die Praxen ergänzten die Inanspruchnahme dieser Patient*innen im gesamten Quartal und Vorquartal sowie die Gesamtzahl aller Fälle der Praxis pro Quartal. Häufigkeiten und Unterschiede in Bezug auf die Praxisarten, Altersgruppen und das Geschlecht wurden deskriptiv und per Chi2-Tests analysiert. Insgesamt wurden 3266 Praxiskontakte (57% durch Frauen, 43% durch Männer) erfasst. Pro Patient*in fanden pro Quartal 2,9 Hausarzt- und 1,9 Facharztbesuche statt. Bei Hausärzten suchten Patient*innen<60 Jahre zu 40% die Praxis wegen einer akuten Erkrankung auf, bei Patient*innen 60+Jahre war der führende Anlass mit 50% die Abholung einer Überweisung oder eines Rezepts. Der prominenteste Anlass für Facharztbesuche war bei Jüngeren mit 36% und bei Älteren mit 51% das Monitoring chronischer Erkrankungen. Explizite Arztkontakte hatten beim Hausarzt 58% der unter 60- und 32% der über 59-Jährigen, den Facharzt sahen 70 bzw. 73%. Hochgerechnet sucht jeder Bürger 16,9-mal pro Jahr eine Arztpraxis auf. Die explorative Studie liefert Hinweise zum Ausmaß vermeidbarer Arztpraxiskontakte, indem die Hälfte der Kontakte bei über 59-Jährigen nur der Abholung von Rezepten, Befunden usw. dienten und 41% der Kontakte bei Fachärzt:innen Routine-Kontrolltermine darstellten, über deren notwendige Frequenz Unklarheit herrscht.

The research project "Evaluation of quality of care in routine outpatient care for common childhood and adolescent diseases" (QualiPäd) measures the quality of care for seven common somatic and psychiatric diseases in children and adolescents based on a set of consensual and evidence-based quality indicators developed specifically for this purpose. Analyses of patient files of pediatricians, general practitioners and child and adolescent psychiatrists showed that in some cases, due to lack of information in the patient records, fullfillment of some of the quality indicators could not be measured or the degree of fulfillment of the quality indicators was found to be low. Therefore, the aim of the present study was to identify system-, physician- and patient-related factors that influence documentation in patient records as well as (non)fulfillment of quality indicators.Three specialist-specific focus group interviews were conducted with physicians (8 pediatricians, 5 general practitioners, 2 child and adolescent psychiatrists) already involved in the study. Interview guides were developed to pick up the previous results of the study and to enable discussions on the interpretation of results as well as possible influencing factors at different levels. The interviews were transcribed and content-analyzed using MAXQDA software.The following factors were identified that appeared to influence treatment, documentation, and therefore (non)fulfillment of quality indicators: Patient characteristics (e. g., age, disease burden), demands of everyday practice (e. g., time pressure), treatment continuity (e. g., cared for by several providers), preference for experiential knowledge instead of quality indicators/guidelines, and an individual approach to documentation behavior (e.g, short reports as a personal thought support). In addition, participants criticized the approach to quality measurement via indicators and patient records.The physicians we interviewed decide individually how to proceed and what to document when treating common medical conditions in children and adolescents. In some cases, this is in clear contrast to the documentation requirements for calculating quality indicators, which means that quality measurement based on patient records is only possible to a limited extent.

Background The research project "Evaluation of quality of care in routine outpatient care for common childhood and adolescent diseases" (QualiP & auml;d) measures the quality of care for seven common somatic and psychiatric diseases in children and adolescents based on a set of consensual and evidence-based quality indicators developed specifically for this purpose. Analyses of patient files of pediatricians, general practitioners and child and adolescent psychiatrists showed that in some cases, due to lack of information in the patient records, fullfillment of some of the quality indicators could not be measured or the degree of fulfillment of the quality indicators was found to be low. Therefore, the aim of the present study was to identify system-, physician- and patient-related factors that influence documentation in patient records as well as (non)fulfillment of quality indicators. Method Three specialist-specific focus group interviews were conducted with physicians (8 pediatricians, 5 general practitioners, 2 child and adolescent psychiatrists) already involved in the study. Interview guides were developed to pick up the previous results of the study and to enable discussions on the interpretation of results as well as possible influencing factors at different levels. The interviews were transcribed and content-analyzed using MAXQDA software. Conclusion The following factors were identified that appeared to influence treatment, documentation, and therefore (non)fulfillment of quality indicators: Patient characteristics (e. g., age, disease burden), demands of everyday practice (e. g., time pressure), treatment continuity (e. g., cared for by several providers), preference for experiential knowledge instead of quality indicators/guidelines, and an individual approach to documentation behavior (e.g, short reports as a personal thought support). In addition, participants criticized the approach to quality measurement via indicators and patient records. Conclusion The physicians we interviewed decide individually how to proceed and what to document when treating common medical conditions in children and adolescents. In some cases, this is in clear contrast to the documentation requirements for calculating quality indicators, which means that quality measurement based on patient records is only possible to a limited extent.

Background:Endometriosis is a chronic gynaecological disease with an estimated prevalence of 10-15%. The German guideline provides evidence-based recommendations for diagnosis and treatment, but care provided is inadequate care due to long diagnostic pathways. Recent German research focused on regional variations in outpatient care, however research on inpatient endometriosis care is still lacking. Aim of the Study:The aim of the study was to examine inpatient endometriosis care - hospital locations and their caseloads. Spatial coverage, caseload distribution patterns and possible clusters, including certified endometriosis centres (CEC) and non-certified hospitals nationwide were analysed. Method:German hospital quality report data from 2021 was used as data source. The location, certification status and caseload, meaning coded ICD-10 N80 Endometriosis cases, were collected for all hospitals. Then, 20-, 40- and 60-minutes' drive radius of CEC and non-certified hospitals were determined. Global and Local Moran's I was calculated to assess spatial clusters in caseload. Results:A CEC 60-minutes' drive radius covers 78.15% of the area in Germany. Including all hospital locations that coded endometriosis, a maximum driving time of 40-minutes provides almost nationwide coverage. High caseload clusters appeared in urban areas and low caseload clusters especially in eastern Germany. Conclusion:The results indicate spatial clusters in providers caseload and difficulties in access to CEC for patients depending on location. Further research with patient-level data is needed to investigate the spatial distribution of patients and precise travel time for inpatient care.

Patient safety (PaSi) is no longer understood as merely the prevention of adverse events, but rather as all activities aimed at ensuring a safe care environment and a culture of patient safety. PaSi is considered one of the most pressing goals in healthcare. Consequently, a large number of stakeholders in joint self-administration in Germany are now working to improve PaSi. The methods used to determine PaSi range from patient surveys and voluntary reports by healthcare providers using critical incident reporting systems (CIRS) to analyses of medical records and routine data, while the search for the prerequisites for safe care makes use of classic quality management methods. Evaluation results from Germany indicate that most PaSi incidents (PSI) remain undetected and that there is still a great need for research to investigate PSI incidences, determinants of PSI, and interventions to prevent PSI as well as to create a PaSi culture.

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.

Introduction Considering the rising popularity of American football (AF) in Germany, particularly in the Federal State of Hesse, this study explores the concerning issue of analgesic consumption among players. The study aims to investigate analgesic use patterns and players’ awareness of risks, focusing on gender differences, medical care impact, positional intensity, league level and knowledge influence. The study aims to collect data that will contribute to the development of targeted preventive health measures, such as education and sensitising coaches during coaching licence courses and strategies to enhance medication safety in AF.Methods and analysis The cross-sectional study includes an online questionnaire targeting adult AF players in Hesse, Germany, during the 2024 season. Data collection, from October 2024 to April 2025, will cover dosage, timing, frequency of analgesic use and players’ knowledge of risks. The study will also explore the relationship between analgesic use and players’ skill levels, medical care availability, player activities and pain profiles. A pretest will ensure the questionnaire’s validity. Data analysis encompasses descriptive and logistic regression analyses to study the association between independent variables and analgesic use.Ethics and dissemination The responsible ethics committee of the faculty of Medicine at the Philipps University Marburg confirmed that no ethics vote was necessary if participants’ anonymity and research integrity are maintained. The results will be published in the form of an article and congress presentation. The findings aim to contribute to the development of tailored health measures, fostering a safer and healthier sporting environment for AF players in Germany.