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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 )
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Treatment Data Collection in Germany Dr. Tim Pfeiffer-Gerschel, Dipl. Psych., PPT
German systemofcarefor SUD General Practitioners, MDs General Hospitals, ER PsychiatricClinics Low thresholdunits Treatment centres (counseling, treatment) „Interfaces“ between in-/outpatienttreatment (e.g. adaptation) SpecialisedClinics (Focus on Rehabilitation) Variouspartners
German Treatment System Medical system „Specialised Treatment“ Rehabilitation General Practitioners, MDs General Hospitals, ER PsychiatricClinics Low thresholdunits Treatment centres (counseling, treatment) „Interfaces“ between in-/outpatienttreatment SpecialisedClinics (Focus on Rehabilitation) Various „cultures“
German Treatment System Medical system TDI „Specialised Treatment“ Rehabilitation General Practitioners, MDs General Hospitals, ER PsychiatricClinics Low thresholdunits Treatment centres (counseling, treatment) „Interfaces“ between in-/outpatienttreatment SpecialisedClinics (Focus on Rehabilitation) Various „cultures“
German treatmentsystem(Verysimplified) Additional funds(e.g. studies) Local/Regional Government Mixed financingscheme Pension Funds Health Insurance WelfareOrganisations Variousfundingsources
Varioussources of information Available Hospital dischargeregister Statistics of national pensionfunds Healthinsurancestatistics (numerous…) Other… (e.g. long-lasting national studies) Main limitations Not connectedtoeachother Links verydifficulttoestablish (dataprotection)
Currentsystem Based on broadconsensusamongpartners Core datasetbecamemandatorypartofreportingembedded in varioussystems (fundinglinkedtocompatibilitywithcoredataset) Large workinggroupestablishedmanyyearsago, involving all relevant partners (healthinsurance, federalstates, national MoH, treatmentorganisations, ...) Main aim: Toserve individual, regional and national needs, ensuring a commondenominator
Information collected on centrelevel European dataset (TDI) Additional information National dataset (KDS)
Once upon a time... Since1978developmentof a commondatasetforreporting SUD treatment/counseling Model projectfundedbyMoH Content: Information necessaryfortrendanalysesandtomeasureperformanceofparticipatingcentres („Bundesdatensatz“) Increasingpressure on centres not participating in national reportingbetween 1995 and 2000; parallel: developmentof TDI 2.0
Once upon a time... But:Noconsensusbetweenregardingcontentofthe national dataset(„performanceindicators“, toocomplex, toomanyitems) Action taken in 2000 todevelop a national coredataset 1998 firstitemset (clients), 1999 itemset (centres), 2000 (national tables) 2007: New national itemsetfollowing a multi-disciplinaryrevisionprocess
ID Coding, double-counting Analysis of aggregateddataon national levelonly – no individual data BUT: Regional solutionswithinterestingandevenmore „relevant“ outcome NO controlfor double-countingbeyondcentre (national statistics)
Limitations Aggregateddata German medicalsystemstrictlyfollows ICD-codingsystem „Static“ data (someitemsmeasuredatbeginningoftreatment, somatthe end – onlyveryfewtwiceandnoitemsillustratingchanges) Many different interestsandfundingschemes No national lawnormandatorysystemforparticipation Resultofnegotiationsbetween all partiesinvolved Large varietyof regional orevenlocaladaptationsandinterests
Strengths Long datahistory Inclusiveapproach Large numberofepisodesreported Possibilitytobuildup „indirect“ pressure „Reference“ fordocumentation Verydetailedinformationavailable (compared e.g. tomedicaldocumentation) Wellestablishedstructures High flexibilitybelow national level
Thankyouverymuchforyourattention! Dr. Tim Pfeiffer-Gerschel IFT Institut für Therapieforschung Parzivalstraße 25, D-80804 München Tel.: 089 – 36 08 04 40 pfeiffer-gerschel@ift.de