German Clinical Trials Register

Acronym/abbreviation of the study

ACD

URL of the study

http://www.acd-projekt.de

Brief summary in lay language

In international comparison, Germany’s health care system is efficient and provides a high standard of care covering nearly the entire population. The overall numbers of physicians as well as hospital beds (per population) in Germany are significantly above EU average. Due to absence of gatekeeping, patients generally have free choice of GPs, medical specialists and hospitals for their care. However, the system has been traditionally fragmented within and across levels of care. Vertical integration is complicated by a multiplicity of structural factors, such as the differing provider remuneration schemes between primary health care (PHC) and secondary health care (SHC), which can give rise to competition instead of cooperation across the care trajectory. This fragmented nature of the system specifically affects optimal management of multi-morbid patients with chronic diseases like the selected ACSCs, for whom optimal care would require well-coordinated, integrated health services delivery structures encompassing providers across the care trajectory. The project "Accountable Care in Germany" aims to improve coordination and communication among providers within the ambulatory care sector and across the sectors. Using routine data for 150 000 patients with ambulatory care sensitive diagnoses in Germany, providers who treat the same patient population will be identified and be grouped into physician networks. The networks will be randomised in two groups, one of which will receive exhaustive information on processes (hospitalisations following ambulatory care sensitive diagnoses as the primary outcome) and characteristics of their networks generated using routine data. Following the feedback the networks will be invited to so called “quality circles” to discuss the indicators and potential measures to improve coordination among their network.

Brief summary in scientific language

In international comparison, Germany’s health care system is efficient and provides a high standard of care covering nearly the entire population. The overall numbers of physicians as well as hospital beds (per population) in Germany are significantly above EU average. Due to absence of gatekeeping, patients generally have free choice of GPs, medical specialists and hospitals for their care. However, the system has been traditionally fragmented within and across levels of care. Vertical integration is complicated by a multiplicity of structural factors, such as the differing provider remuneration schemes between primary health care (PHC) and secondary health care (SHC), which can give rise to competition instead of cooperation across the care trajectory. This fragmented nature of the system specifically affects optimal management of multi-morbid patients with chronic diseases like the selected ACSCs, for whom optimal care would require well-coordinated, integrated health services delivery structures encompassing providers across the care trajectory. The project "Accountable Care in Germany" aims to improve coordination and communication among providers within the ambulatory care sector and across the sectors. Using routine data for 150 000 patients with ambulatory care sensitive diagnoses in Germany, providers who treat the same patient population will be identified and be grouped into physician networks. The networks will be randomised in two groups, one of which will receive exhaustive information on processes (hospitalisations following ambulatory care sensitive diagnoses as the primary outcome) and characteristics of their networks generated using routine data. Following the feedback the networks will be invited to so called “quality circles” to discuss the indicators and potential measures to improve coordination among their network.