treatment data collection in germany

Institut für TherapieforschungMünchen

Treatment Data Collection in Germany

Dr. Tim Pfeiffer-Gerschel, Dipl. Psych., PPT

Legal Framework

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German system of care for SUD

● General Practitioners, MDs● General Hospitals, ER● Psychiatric Clinics

● Low threshold units● Treatment centres (counseling, treatment)

● „Interfaces“ between in-/outpatient treatment (e.g. adaptation)

● Specialised Clinics (Focus on Rehabilitation)

Various partners

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German Treatment System

● General Practitioners, MDs● General Hospitals, ER● Psychiatric Clinics

● Low threshold units● Treatment centres (counseling, treatment)● „Interfaces“ between in-/outpatient treatment

● Specialised Clinics (Focus on Rehabilitation)

Various „cultures“

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Medical system

„Specialised Treatment“

Rehabilitation

German Treatment System

● General Practitioners, MDs● General Hospitals, ER● Psychiatric Clinics

● Low threshold units● Treatment centres (counseling, treatment)● „Interfaces“ between in-/outpatient treatment

● Specialised Clinics (Focus on Rehabilitation)

Various „cultures“

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Medical system

„Specialised Treatment“

RehabilitationTDI

German treatment system (Very simplified)

Various funding sources

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Welfare Organisations

Health Insurance

Pension Funds

Local/Regional Government

Additional funds(e.g. studies)

Mixed financing scheme

Various sources of information

Available● Hospital discharge register● Statistics of national pension funds● Health insurance statistics (numerous…)● Other… (e.g. long-lasting national studies)

Main limitations● Not connected to each other● Links very difficult to establish (data protection)

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Current system

● Based on broad consensus among partners● Core dataset became mandatory part of reporting embedded in various

systems (funding linked to compatibility with core dataset)● Large working group established many years ago, involving all relevant

partners (health insurance, federal states, national MoH, treatment organisations, ...)

● Main aim: To serve individual, regional and national needs, ensuring a common denominator

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Core dataset

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Information collected on centre level

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European dataset (TDI)

National dataset (KDS)Additional

information

Network ofreporting institutions

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Many years ago...

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1980 1990 1994 1998 1999 2000 20010

50100

150200250

300350400

450500

218

306

443 461 448

401368

218

306

443461

443

379

279

0 0 0 0 5 22

79

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Gesamt EBIS Horizont Sonstige

Once upon a time...

● Since 1978 development of a common dataset for reporting SUD treatment/counseling

● Model project funded by MoH● Content: Information necessary for trend analyses and to measure

performance of participating centres („Bundesdatensatz“) ● Increasing pressure on centres not participating in national reporting

between 1995 and 2000; parallel: development of TDI 2.0

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Once upon a time...

● But: No consensus between regarding content of the national dataset („performance indicators“, too complex, too many items)

● Action taken in 2000 to develop a national core dataset● 1998 first itemset (clients), 1999 itemset (centres), 2000 (national tables)● 2007: New national itemset following a multi-disciplinary revision process

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Development since 2000 – Outpatient

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2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

0

100

200

300

400

500

600

700

800

900

EpisodenEinrichtungen

Development since 2000 - Inpatient

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2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

05,000

10,00015,00020,00025,00030,00035,00040,00045,00050,000

020406080100120140160180200

EpisodenEinrichtungen

Participation by centre type

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Einrichtungstyp 2008 2009 2010 20111 Ärztliche oder psychotherapeutische Praxis 1 1 1 12 Niedrigschwellige Einrichtung 29 24 31 333 Beratungs- und/oder Behandlungsstelle, Fachambulanz 751 777 775 7684 Institutsambulanz 2 2 2 15 Ambulant Betreutes Wohnen 39 46 50 486 Arbeits-und Beschäftigungsprojekt 3 3 5 77 Krankenhaus/-abteilung 5 5 5 68 Teilstationäre Rehabilitationseinrichtung 12 13 19 149 Stationäre Rehabilitationseinrichtung 94 114 134 12010 Adaptionseinrichtung 25 30 36 3211 Teilstationäre Einrichtung der Sozialtherapie 8 7 8 1012 Stationäre Einrichtung der Sozialtherapie 17 20 21 3413 Pflegeheim 0 0 0 014 Maßregelvollzug 0 0 0 015 Interner Dienst zur Beratung/Behandlung im Strafvollzug 0 0 0 016 Externer Dienst zur Beratung/Behandlung im Strafvollzug 10 7 8 14Gesamt (Anzahl Nennungen) 996 1.049 1.089 1.088

Reporting (back)

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Onlinereport, focused reports

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Other….

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www.suchthilfestatistik.de

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Technical Issues

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Software solutions - certification

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ID Coding, double-counting

● Analysis of aggregated data on national level only – no individual data● BUT: Regional solutions with interesting and even more „relevant“

outcome● NO control for double-counting beyond centre (national statistics)

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Summary

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Limitations

● Aggregated data● German medical system strictly follows ICD-coding system● „Static“ data (some items measured at beginning of treatment, som at the

end – only very few twice and no items illustrating changes)● Many different interests and funding schemes● No national law nor mandatory system for participation● Result of negotiations between all parties involved● Large variety of regional or even local adaptations and interests

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Strengths

● Long data history● Inclusive approach● Large number of episodes reported● Possibility to build up „indirect“ pressure● „Reference“ for documentation● Very detailed information available (compared e.g. to medical

documentation)● Well established structures● High flexibility below national level

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Thank you very muchfor your attention!

Dr. Tim Pfeiffer-GerschelIFT Institut für Therapieforschung

Parzivalstraße 25, D-80804 MünchenTel.: 089 – 36 08 04 40

pfeiffer-gerschel@ift.de

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