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Schumacher-Schönert F, Boekholt M, Nikelski A, Chikhradze N, Lücker P, Kracht F, Vollmar HC, Hoffmann W, Kreisel S, Thyrian JR. [Closing care gaps after hospitalization: Study results [intersec-CM] on discharge and transfer management according to sect. 39 SGB V for people with cognitive impairments associated with dementia]. Z Evid Fortbild Qual Gesundhwes 2024; 185:35-44. [PMID: 38388280 DOI: 10.1016/j.zefq.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024]
Abstract
In Germany, there are 1.8 million people currently living with dementia, and the trend is rising. In particular, the health system at the transition from hospital to outpatient care is facing major challenges given the high increase in a difficult patient clientele. Legal efforts have been undertaken (sect. 39a of the Fifth Social Code Book [SGB V]) to close the care gaps in the discharge and transfer process. This article aims to provide an overview of the documentation process of the discharge and transfer management for people with cognitive impairments in everyday clinical practice according to SGB V sect. 39 para. 1a after the Discharge Management Act came into force. Furthermore, the manuscript answers the research question "How is the statutory discharge management of people with cognitive impairments (MmkB) aged 65 and over documented" and highlights further characteristics of the discharge documentation for MmkB starting with the transition from the inpatient setting to other care settings. In order to answer the research question(s), a qualitative content analysis of all discharge documents available at the time of discharge was carried out as part of the intervention study on cross-sector care management to support cognitively impaired people during and after a hospital stay [intersec-CM], which was funded by the Federal Ministry of Education and Research. The results of the analysis show that, despite legal efforts, there are currently no standardized, unified processes of discharge management for people with cognitive impairments that can be traced in writing. However, departments with a large proportion of vulnerable patient groups were able to offer valuable insights: for example, their discharge documents included a short social history. Further evidence-based research and development in the domain of discharge management for people with cognitive impairments remains essential.
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Affiliation(s)
- Fanny Schumacher-Schönert
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland.
| | - Melanie Boekholt
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland
| | - Angela Nikelski
- Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Universitätsklinik für Psychiatrie und Psychotherapie, Abteilung für Gerontopsychiatrie, Bielefeld, Deutschland
| | - Nino Chikhradze
- Ruhr-Universität Bochum, Abteilung für Allgemeinmedizin, Bochum, Deutschland
| | - Petra Lücker
- Institut für Community Medicine, Abteilung "Epidemiology of Health Care and Community Health", Universität Greifswald, Greifswald, Deutschland
| | - Friederike Kracht
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland
| | | | - Wolfgang Hoffmann
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland; Institut für Community Medicine, Abteilung "Epidemiology of Health Care and Community Health", Universität Greifswald, Greifswald, Deutschland
| | - Stefan Kreisel
- Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Universitätsklinik für Psychiatrie und Psychotherapie, Abteilung für Gerontopsychiatrie, Bielefeld, Deutschland
| | - Jochen René Thyrian
- Deutsches Zentrum für neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Deutschland
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Kracht F, Boekholt M, Schumacher-Schönert F, Nikelski A, Chikhradze N, Lücker P, Vollmar HC, Hoffmann W, Kreisel SH, Thyrian JR. Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital - cross-sectional results of the intersec-CM study. BMC Geriatr 2021; 21:425. [PMID: 34253180 PMCID: PMC8276375 DOI: 10.1186/s12877-021-02298-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments during hospital stays. The aim of the present research is to describe and analyze the treatment needs of people with cognitive impairments in acute hospital care. METHODS The analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depression, pharmacological treatment, utilization of health care services and health care related needs. RESULTS The sample under examination had been on average mildly cognitively impaired (MMSE M = 22.3) and had a mild to moderate functional impairment (Barthel Index M = 50.4; HABAM M = 19.1). The Edmonton Frail Scale showed a mean of 7.4 and half of the patients (52.3%) had been assigned a care level. About 46.9% had a geriatric diagnosis, 3.0% had a diagnosis of dementia. According to DSM-V 19.2% of the patients had at least one main symptom of depression. The mean number of regularly taken drugs per patient was 8.2. Utilization of health care services prior to the hospital stay was rather low. On average, the sample showed 4.38 care related needs in general, of which 0.60 needs were unaddressed at the time of assessment. CONCLUSIONS Descriptive analyses highlight an in-depth insight into impairments and different care needs of people with cognitive impairments. The results emphasize the need for gender-specific analyses as well as an increased attention to the heterogeneity of needs of people with cognitive impairments related to specific wards, settings and regions where they are admitted. Our results indicate also that people with cognitive impairments represent a high proportion of older patients in acute hospital care. TRIAL REGISTRATION The intersec-CM trial is registered at ClinicalTrials.gov ( NCT03359408 ).
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Affiliation(s)
- F Kracht
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany.
| | - M Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany.
| | - F Schumacher-Schönert
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
| | - A Nikelski
- Evangelisches Klinikum Bethel, Campus Bielefeld-Bethel, Division of Geriatric Psychiatry, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Germany
| | - N Chikhradze
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum (RUB), Bochum, Germany
| | - P Lücker
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - H C Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum (RUB), Bochum, Germany
| | - W Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - S H Kreisel
- Evangelisches Klinikum Bethel, Campus Bielefeld-Bethel, Division of Geriatric Psychiatry, Universitätsklinikum OWL der Universität Bielefeld, Bielefeld, Germany
| | - J R Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany.
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany.
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Thyrian JR, Kracht F, Nikelski A, Boekholt M, Schumacher-Schönert F, Rädke A, Michalowsky B, Vollmar HC, Hoffmann W, Rodriguez FS, Kreisel SH. The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany. BMC Geriatr 2020; 20:540. [PMID: 33375944 PMCID: PMC7770747 DOI: 10.1186/s12877-020-01957-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. METHODS This analysis is based on data of a telephone-based assessment in a convenience sample of n = 141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. RESULTS The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. CONCLUSIONS The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
- Institute for Community Medicine, Department of Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany.
| | - Friederike Kracht
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Angela Nikelski
- Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Melanie Boekholt
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Fanny Schumacher-Schönert
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr-University Bochum (RUB), Bochum, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
- Institute for Community Medicine, Department of Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Francisca S Rodriguez
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Stefan H Kreisel
- Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL - Campus Bielefeld-Bethel, Bielefeld, Germany
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