Suchergebnisse

Es werden jedes Jahr Millionen von Euro in Projekte des Innovationsfonds investiert. Damit die Gelder nicht verpuffen und am Ende auch wirklich eine bessere Patientenversorgung erreicht wird, müssen die Projekte gut evaluiert werden. Dazu gehört es, dass sowohl Erfolge als auch Misserfolge veröffentlicht werden.

Der Beitrag untersucht den Zusammenhang der komplexen Sachverhalte Lärmexposition, soziale Schicht und Gesundheit. Dabei wird auf Basis der Daten des Bundesgesundheitssurvey 1998 in Deutschland der Frage nachgegangen, ob und ggf. in welcher Form die gesundheitlichen Auswirkungen zu sozialer Benachteiligung einerseits und zu Lärmexpositionen andererseits in einer Wechselwirkung stehen. Die stärksten Auswirkungen einer Lärmexposition auf die Gesundheit sind in der Mittelschicht zu beobachten. Zwar ist der Gesundheitszustand bzgl. aller Einzelitems in der unteren sozialen Schicht am niedrigsten, der Unterschied zwischen Lärmexponierten und Nichtexponierten ist jedoch bei Mittelschichtangehörigen am stärksten ausgeprägt. Letztendlich stellt sich im vorliegenden Datensatz die Lärmexposition als Effektmodifier des Faktors Sozialschicht dar und nicht die soziale Stellung als Effektmodifier des Faktors Lärmexposition. Die Autoren kommen zu dem Schluss, dass eine sozial ausgeglichene Verteilung innerhalb gesundheitsunbedenklicher Schallimmissionen anzustreben ist, und dass Grenzwerte und Lärmschutzmaßnahmen mehr als bisher an Kriterien wie soziale Ungleichbelastung und soziale Vulnerabilität orientiert werden sollten. (ICA2)

ABSTRACT
ObjectivesThe German GNC-Health Study (GNC) will have duration of at least ten years and will compile medical examinations, biomaterials and computer assisted interviews of intended 200.000 participants (funding code: 01ER1301A). For the first time, this data collection will be supplemented with a multitude of administrative and claims data such as data of statutory health insurance funds, statutory pension funds as well as the Federal Employment Agency. The GNC extends this field of research to private health insurance funds, epidemiologic and clinical cancer and mortality registers. This supplementary use of claims data is strictly regulated by legal requirements. The challenges and solutions for scientific use of such data in Germany will be described.
ApproachThe Social Security Code and data protection rules govern the scientific use of administrative data. These rules include requirements for the wording of important documents such as informed consent, release from confidentiality, participants' information, data protection concept etc. and often an authorization process by the supervisory authority of the data owner. These complex tasks, which are time consuming costly and labour intensive, are tied into the GNC-Competence Network for secondary and registry data (CNSRD).
ResultsThe GNC-CNSRD has helped to formulate legal informed consent for each data source, which describes the use of the information provided by the participants, as well as the period and limitation of its retro- and prospective use. Furthermore, only the GNC-trust agency is allowed to save the social security number but not the local study center. The modular consent process and the IT- and data protection concept of the GNC is a prototype to enable the large scale use of administrative and claims data of future epidemiologic studies in Germany.
ConclusionUnfortunately, one of the biggest obstacles for the scientific use of administrative and claims data still remains unsolved. The application for data use at the local supervisory authority of the data owner requires the description and limitation of the research question and the period of use of this data. This is in conflict with the modern longitudinal design of GNC because it wants to establish a research structure and data base in order to answer a variety of future and unspecified research questions. Hence, current legal requirements in Germany prevent the full utilization of the potential of administrative and claims data. Therefore, the German Federal Commissioner for Data Protection and Freedom of Information recommended an amendment to the social law.

It is a societal given, borne out by the facts: the higher one's social status, the better health, and the longer life expectancy. As the situation persists, an important question demands attention, namely whether health care systems contribute to the inequity. Drawing accurate conclusions requires workable theory, reliable data collection instruments, and valid analytical methods. Using one representative country to typify the industrial world, Health Care Utilization in Germany studies its subject in terms of social determinants. This singular volume offers systematic guidelines for research into health care access based on an acclaimed behavioral model of care utilization. Contributors focus on specific social factors, medical conditions, and sectors of care to examine why differences exist, their implications, and how care providers can better match supply with demand. And many of the book's topics, such as obesity, dementia, preventive services, and immigrant health, are of global interest. Included in the coverage: Updating a classic behavioral model of health care utilization (Andersen). Use of medical services in Germany: the statutory health insurance system. Insights from quantitative and qualitative research. The problem of repeated surveys: how comparable are their results? Gender, socio-economic status and utilization of health care. Care utilization by dementia patients living at home. Utilization of physiotherapy and self-help by patients with rheumatic diseases. Social determinants of utilization of psychotherapy, prevention, and integrated care in Germany. A volume certain to spark discussion among researchers across the community, the findings and methods in Health Care Utilization in Germany will be analyzed by medical sociologists, health psychologists, public health and behavioral medicine professionals, and epidemiologists.

Abstract
Objectives/Background
In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients' perspectives is helpful.

Methods
We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called "objective" characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016.

Results
According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients' subjective urgency and different items for objective care.

Conclusion
Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients' perceived urgency may affect the disposition, rapidness of the service and transport targets.

Zusammenfassung Auf der Grundlage der 303a bis 303f SGBV werden aktuell die Weichen fur eine innovative und leistungsstarke Informations- und Datenplattform gestellt. Dies erfordert die aktuelle und kurzfristige Bereitstellung ma ss geblicher Daten des Gesundheitswesens, vor allem von Prozessdaten der gesetzlichen Krankenversicherung und anderer Sozialversicherungstrager, unter Anwendung wissenschaftlich anerkannter Standards und unter gleichzeitiger Einhaltung datenschutzrechtlicher Bestimmungen. In zehn Empfehlungen werden aus der Sicht kunftiger Nutzer*innen Erwartungen an ein ideales FDZ Gesundheit gestellt. Der Beitrag richtet sich als Angebot der Wissenschaft und Versorgungsforschung an Entscheidungstrager im Bereich der Politik und der Selbstverwaltung im deutschen Gesundheitssystem, diese bei Aufbau und Weiterentwicklung des FDZ zu unterstutzen und kontinuierlich zu begleiten. Abstract Based on sections 303a to 303f social code book V, the course is currently being set for an innovative and high-performance national information and data platform. This requires short-term provision of current and relevant data on the health care system, especially process data on statutory health insurance and other social insurance carriers, using established methodological standards as well as taking into account data protection regulations. From the point of view of future users, expectations regarding an ideal research health data centre are formulated in ten recommendations. The present article is an offer from health services researchers intended to support decision-makers in the field of politics and self-administration in the German health system in their task of establishing and further development of a research health data centre.