treatment data collection in germany
DESCRIPTION
Treatment Data Collection in Germany. Dr. Tim Pfeiffer-Gerschel, Dipl. Psych., PPT. Legal Framework. German system of care for SUD. General Practitioners , MDs General Hospitals, ER Psychiatric Clinics Low threshold units Treatment centres ( counseling , treatment ) - PowerPoint PPT PresentationTRANSCRIPT
Institut für TherapieforschungMünchen
Treatment Data Collection in Germany
Dr. Tim Pfeiffer-Gerschel, Dipl. Psych., PPT
Legal Framework
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German system of care for SUD
● General Practitioners, MDs● General Hospitals, ER● Psychiatric Clinics
● Low threshold units● Treatment centres (counseling, treatment)
● „Interfaces“ between in-/outpatient treatment (e.g. adaptation)
● Specialised Clinics (Focus on Rehabilitation)
Various partners
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German Treatment System
● General Practitioners, MDs● General Hospitals, ER● Psychiatric Clinics
● Low threshold units● Treatment centres (counseling, treatment)● „Interfaces“ between in-/outpatient treatment
● Specialised Clinics (Focus on Rehabilitation)
Various „cultures“
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Medical system
„Specialised Treatment“
Rehabilitation
German Treatment System
● General Practitioners, MDs● General Hospitals, ER● Psychiatric Clinics
● Low threshold units● Treatment centres (counseling, treatment)● „Interfaces“ between in-/outpatient treatment
● Specialised Clinics (Focus on Rehabilitation)
Various „cultures“
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Medical system
„Specialised Treatment“
RehabilitationTDI
German treatment system (Very simplified)
Various funding sources
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Welfare Organisations
Health Insurance
Pension Funds
Local/Regional Government
Additional funds(e.g. studies)
Mixed financing scheme
Various sources of information
Available● Hospital discharge register● Statistics of national pension funds● Health insurance statistics (numerous…)● Other… (e.g. long-lasting national studies)
Main limitations● Not connected to each other● Links very difficult to establish (data protection)
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Current system
● Based on broad consensus among partners● Core dataset became mandatory part of reporting embedded in various
systems (funding linked to compatibility with core dataset)● Large working group established many years ago, involving all relevant
partners (health insurance, federal states, national MoH, treatment organisations, ...)
● Main aim: To serve individual, regional and national needs, ensuring a common denominator
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Core dataset
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Information collected on centre level
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European dataset (TDI)
National dataset (KDS)Additional
information
Network ofreporting institutions
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Many years ago...
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1980 1990 1994 1998 1999 2000 20010
50100
150200250
300350400
450500
218
306
443 461 448
401368
218
306
443461
443
379
279
0 0 0 0 5 22
79
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Gesamt EBIS Horizont Sonstige
Once upon a time...
● Since 1978 development of a common dataset for reporting SUD treatment/counseling
● Model project funded by MoH● Content: Information necessary for trend analyses and to measure
performance of participating centres („Bundesdatensatz“) ● Increasing pressure on centres not participating in national reporting
between 1995 and 2000; parallel: development of TDI 2.0
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Once upon a time...
● But: No consensus between regarding content of the national dataset („performance indicators“, too complex, too many items)
● Action taken in 2000 to develop a national core dataset● 1998 first itemset (clients), 1999 itemset (centres), 2000 (national tables)● 2007: New national itemset following a multi-disciplinary revision process
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Development since 2000 – Outpatient
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2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
0
100
200
300
400
500
600
700
800
900
EpisodenEinrichtungen
Development since 2000 - Inpatient
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2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
05,000
10,00015,00020,00025,00030,00035,00040,00045,00050,000
020406080100120140160180200
EpisodenEinrichtungen
Participation by centre type
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Einrichtungstyp 2008 2009 2010 20111 Ärztliche oder psychotherapeutische Praxis 1 1 1 12 Niedrigschwellige Einrichtung 29 24 31 333 Beratungs- und/oder Behandlungsstelle, Fachambulanz 751 777 775 7684 Institutsambulanz 2 2 2 15 Ambulant Betreutes Wohnen 39 46 50 486 Arbeits-und Beschäftigungsprojekt 3 3 5 77 Krankenhaus/-abteilung 5 5 5 68 Teilstationäre Rehabilitationseinrichtung 12 13 19 149 Stationäre Rehabilitationseinrichtung 94 114 134 12010 Adaptionseinrichtung 25 30 36 3211 Teilstationäre Einrichtung der Sozialtherapie 8 7 8 1012 Stationäre Einrichtung der Sozialtherapie 17 20 21 3413 Pflegeheim 0 0 0 014 Maßregelvollzug 0 0 0 015 Interner Dienst zur Beratung/Behandlung im Strafvollzug 0 0 0 016 Externer Dienst zur Beratung/Behandlung im Strafvollzug 10 7 8 14Gesamt (Anzahl Nennungen) 996 1.049 1.089 1.088
Reporting (back)
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Onlinereport, focused reports
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Other….
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www.suchthilfestatistik.de
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Technical Issues
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Software solutions - certification
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ID Coding, double-counting
● Analysis of aggregated data on national level only – no individual data● BUT: Regional solutions with interesting and even more „relevant“
outcome● NO control for double-counting beyond centre (national statistics)
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Summary
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Limitations
● Aggregated data● German medical system strictly follows ICD-coding system● „Static“ data (some items measured at beginning of treatment, som at the
end – only very few twice and no items illustrating changes)● Many different interests and funding schemes● No national law nor mandatory system for participation● Result of negotiations between all parties involved● Large variety of regional or even local adaptations and interests
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Strengths
● Long data history● Inclusive approach● Large number of episodes reported● Possibility to build up „indirect“ pressure● „Reference“ for documentation● Very detailed information available (compared e.g. to medical
documentation)● Well established structures● High flexibility below national level
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Thank you very muchfor your attention!
Dr. Tim Pfeiffer-GerschelIFT Institut für Therapieforschung
Parzivalstraße 25, D-80804 MünchenTel.: 089 – 36 08 04 40
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