The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective

Study protocol for the health economic evaluation of outpatient long-term video EEGs for people with seizure disorders alongside the ALVEEG study - a randomized controlled equivalence trial

BACKGROUND

Epilepsy and other seizure disorders are medical conditions that impose a substantial health economic burden on society given their considerable costs of illness and use of healthcare resources. The ALVEEG trial aims to tackle resource shortages in clinical settings and optimize patient management by evaluating outpatient ambulatory long-term video electroencephalograms (ALVEEGs) as a new diagnostic pathway to diagnose and manage epilepsy and other seizure disorders. The health economic evaluation alongside this trial aims to determine the cost-effectiveness and cost-utility of ALVEEGs for affected patients presenting themselves at participating epilepsy centers in Germany.

METHODS

This study protocol comprises the rationale and methods of the health economic evaluation of ALVEEGs embedded into the ALVEEG project. We will perform cost-effectiveness and cost-utility analyses, with the outcomes being a priori defined endpoint measures of the main trial. We will consider the proportion of solved clinical queries (primary endpoint), the number of hospital stays, the in-patient length of stay, and quality-adjusted life years for the here presented health economic evaluation. Costs will be collected by the participating health insurance companies alongside the trial, with the evaluation being conducted from a statutory health insurance perspective within the German healthcare system. The reporting of the economic evaluation follows the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

DISCUSSION

The health economic evaluation of ALVEEGs for patients affected by epilepsy and other seizure disorders within the German healthcare system will deliver insightful evidence on the cost-effectiveness and cost-utility of the intervention and hence guide policy and decision makers regarding a potential inclusion of ALVEEGs into the health benefit basket of the statutory health insurance scheme.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00032220), date registered: December 11, 2023.

[Organizational context for the work of emergency departments in Germany: status quo, assessment of effects, and need for change for optimized care]

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.

Trends in burnout and related sick leave duration in working-age adults followed in general practices in Germany between 2012 and 2022

AIMS

This study investigated burnout trends and related sick leave duration in working-age adults followed in general practices in Germany.

METHODS

Participants were aged 20-65 years and were diagnosed with burnout in one of 442 general practices in this country in 2012-2014, 2016-2018, and 2020-2022. The prevalence of burnout and the duration of sick leave in all practices were compared between 2012-2014 and 2016-2018 and between 2016-2018 and 2020-2022. The association between diagnosis years (i.e., 2012-2014, 2016-2018, and 2020-2022) and long-term sick leave (i.e., more than 42 days of sick leave) was investigated using adjusted logistic regression.

RESULTS

The study included 39,793, 46,708, and 50,721 patients diagnosed with burnout in the periods from 2012 to 2014, 2016-2018, and 2020-2022, respectively, and the prevalence of burnout in all patients was 3.6%, 3.8%, and 3.6% during these three periods. This prevalence increased significantly in people aged 61-65 years and those with a Charlson Comorbidity Index of ≥1. The mean (SD) sick leave duration in the population of people with burnout rose from 24.1 (41.9) days in the period of 2012-2014 to 36.2 (65.6) days in the period from 2020 to 2022. Finally, compared with 2012-2014, burnout diagnosed in 2016-2018 and 2020-2022 was associated with higher odds of long-term sick leave.

CONCLUSIONS

In view of these findings, it is clear that public health measures are urgently needed to improve burnout prevention in Germany.

What helps hospital staff in times of crisis: qualitative results of a survey on psychosocial resources and stressors in German hospitals during the COVID-19 pandemic

Background

Even before the COVID-19 pandemic, hospital workers faced a tremendous workload. The pandemic led to different and additional strain that negatively affected the well-being of employees. This study aims to explore psychosocial resources and strategies that were used by hospital staff.

Methods

In the context of an intervention study, employees of three German hospitals were questioned in writing in summer and fall 2020. Five open-ended questions about the pandemic were asked to capture corresponding effects on daily work routine. Answers of 303 participants were evaluated using structuring qualitative content analysis.

Results

Significant stressors and resources were identified in the areas of work content and task, social relations at work, organization of work, work environment and individual aspects. Stressors included, for example, emotional demands, conflicts, an increased workload, time and performance pressure. Important resources mentioned were, among others, the exchange with colleagues and mutual support. Sound information exchange, clear processes and guidelines and a positive work atmosphere were also important. In addition, the private environment and a positive mindset were perceived as helpful.

Conclusion

This study contributes to a differentiated understanding of existing psychosocial resources of hospital staff in times of crisis. Identifying and strengthening these resources could reduce stress and improve well-being, making hospital staff better prepared for both normal operations and further crisis situations.