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Schloemer T, De Bock F, Schröder-Bäck P. Implementation of evidence-based health promotion and disease prevention interventions: theoretical and practical implications of the concept of transferability for decision-making and the transfer process. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:534-543. [PMID: 33891132 PMCID: PMC8087543 DOI: 10.1007/s00103-021-03324-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
Abstract
Evidence-based health promotion and disease prevention require incorporating evidence of the effectiveness of interventions into policy and practice. With the entry into force of the German Act to Strengthen Health Promotion and Prevention (PrävG), interventions that take place in people’s everyday living environments have gained in importance. Decision-makers need to assess whether an evidence-based intervention is transferable to their specific target context. The Federal Centre for Health Education (BZgA) recommends that transferability of an intervention should be clarified before any decision to implement it. Furthermore, transferability needs to be finally determined after an evaluation in the target context. In this article, we elaborate on theoretical and practical implications of the concept of transferability for health promotion and disease prevention based on the Population–Intervention–Environment–Transfer Models of Transferability (PIET-T). We discuss how decision-makers can anticipate transferability prior to the intervention transfer with the help of transferability criteria and how they can take transferability into account in the further process. This includes the steps of the analysis of a health problem and identification of effective interventions, the steps of the initial transferability assessment and identification of the need for adaptation, and the steps of the implementation and evaluation. Considering transferability is a complex task that comes with challenges. But it offers opportunities to select a suitable intervention for a target context and, in the transfer process, to understand the conditions under which the intervention works in this context. This knowledge helps to establish an evidence base, which is practically relevant.
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Affiliation(s)
- Tamara Schloemer
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, Limburg, The Netherlands. .,Head of Division "Effectiveness and Efficiency of Health Education", Federal Centre for Health Education (BZgA), Cologne, North Rhine-Westphalia, Germany. .,Department of Applied Health Sciences, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany.
| | - Freia De Bock
- Head of Division "Effectiveness and Efficiency of Health Education", Federal Centre for Health Education (BZgA), Cologne, North Rhine-Westphalia, Germany
| | - Peter Schröder-Bäck
- Department of International Health, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, Limburg, The Netherlands.,University of Applied Sciences for Police and Public Administration in North Rhine-Westphalia (HSPV NRW), Campus Aachen, Aachen, Germany
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Schubert I, Siegel A, Graf E, Farin-Glattacker E, Ihle P, Köster I, Stelzer D, Mehl C, Schmitz J, Dröge P, Günster C, Klöss A, Vach W, Geraedts M. Study protocol for a quasi-experimental claims-based study evaluating 10-year results of the population-based integrated healthcare model 'Gesundes Kinzigtal' (Healthy Kinzigtal): the INTEGRAL study. BMJ Open 2019; 9:e025945. [PMID: 30782755 PMCID: PMC6340628 DOI: 10.1136/bmjopen-2018-025945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Patients often experience interface problems when treated by different specialists and in different healthcare sectors. Integrated care concepts aim to reduce these problems. While most integrated healthcare models focus on individual diseases, the integrated care model 'Gesundes Kinzigtal' applies a population-based approach and addresses the full spectrum of morbidities for a population defined by area of residence-the Kinzigtal. A special feature of the model is the joint savings contract between the regional management company and the statutory health insurers. The INTEGRAL study aims at assessing the effectiveness of 'Gesundes Kinzigtal' under routine conditions in comparison to conventional care over a period of 10 years in order to understand the benefits but also the potential for (unintended) harms. METHODS AND ANALYSIS: Database Claims data from statutory health insurance funds 2005-2015. The evaluation consists of a quasi-experimental study, with Kinzigtal as intervention region, at least 10 further regions with a similar population and healthcare infrastructure as primary controls and an additional random sample of insurees from the federal state of Baden-Württemberg as secondary controls. Model-specific and 'non-specific' indicators adopted from the literature and enriched by focus group interviews will be used to evaluate the model's effectiveness and potential unintended consequences by analysing healthcare utilisation in general. Temporal trends per indicator in the intervention region will be compared with those in each control region. The overall variation in trends for the indicators across all regions provides information about the potential to modify an indicator due to local differences in the healthcare system. ETHICS AND DISSEMINATION Ethic Commission of the Faculty of Medicine, Philipps-University Marburg (ek_mr_geraedts_131117). Results will be discussed in workshops, submitted for publication in peer-review journals and presented at conferences. TRIAL REGISTRATION NUMBER DRKS00012804.
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Affiliation(s)
- Ingrid Schubert
- PMV Research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Cologne, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Peter Ihle
- PMV Research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Cologne, Germany
| | - Ingrid Köster
- PMV Research group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Cologne, Germany
| | - Dominikus Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Claudia Mehl
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Jutta Schmitz
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
| | - Patrik Dröge
- Health Services and Quality Research, AOK Research Institute (WIdO), Berlin, Germany
| | - Christian Günster
- Health Services and Quality Research, AOK Research Institute (WIdO), Berlin, Germany
| | - Andreas Klöss
- Health Services and Quality Research, AOK Research Institute (WIdO), Berlin, Germany
| | - Werner Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, University of Marburg, Marburg, Germany
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