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Gesundes Kinzigtal Integrated Care - what is it about ?

Gesundes Kinzigtal Integrated Care

In the Kinzigtal region – a region surrounding the valley of the river Kinzig in Southwest Germany – an integrated health care project has started in late 2005, attempting to overcome the traditionally fragmented German health care system within this region. This project is managed by Gesundes Kinzigtal GmbH (Ltd.), a regional integrated care management company founded by the local physicians' network MQNK and the management company Optimedis AG. Gesundes Kinzigtal GmbH cooperates closely with the statutory health insurers AOK BW and LKK BW, offering their assureds to enrol in the integrated care system.

In general, the goal of integrated care systems is to improve the cooperation of health care providers within and between different health care sectors. First of all, integrated care projects attempt (i) to improve and intensify the cooperation between general practitioners (family physicians), specialists, and representatives of other health professions such as physio- or psychotherapists as well as (ii) to optimize the coordination of ambulatory (outpatient) care and hospital (inpatient) care.

This is to result in a better-coordinated health care and thus in a better quality of health services, leading to improved health outcomes. As a rule, a second goal of integrated care is to overcome the economic inefficiencies of the traditionally fragmented health system, resulting from a poor coordination of service interfaces between general and specialised care as well as between inpatient and outpatient care. Very often, the traditional reimbursement systems, usually leading to the conservation of the fragmented sectors (and the corresponding vested interests), are reorganized or at least modified when an integrated care system is established.

Why is there an external evaluation of Gesundes Kinzigtal Integrated Care?

When new ideas are implemented into everyday life, the results are not foreseeable in every important aspect. This truism holds in particular when new ideas are implemented within the framework of complex social systems – like e.g. health care systems. In such cases a professional evaluation of the results is adequate, evaluating e.g. which goals have been realized (and to what extent) and which unintended or even undesirable side-effects have developed.

Furthermore, if in the course of such an evaluation several kinds of data are to be analyzed, it is sensible to engage a professional institution for this evaluation – an institution working independently from those who attempt to implement the new ideas into practice. In case of Gesundes Kinzigtal Integrated Care, the management company and the contracting health insurers have provided a considerable budget for an evaluation by independent research institutions.

Who coordinates the evaluation by independent research institutions and who conducts the evaluation studies?

The evaluation by independent research institutions is coordinated by a separate coordination agency, EKIV („Evaluations-Koordinierungsstelle Integrierte Versorgung”). EKIV was established at the department of medical sociology at Freiburg University, Germany. EKIV is managed by Dr. Ulrich Stößel (head of EKIV) and Dr. Achim Siegel, M.P.H.

One of EKIV’s responsibilities consists in elaborating the evaluation plan and in designing “calls for evaluation studies” (invitation of tenders). These studies (“evaluation modules”) are to answer research questions which EKIV, Gesundes Kinzigtal GmbH and its project partners AOK BW and LKK BW have agreed upon beforehand. When research institutions have been engaged with conducting their evaluation studies, EKIV is to provide communication platforms for the concerned research institutions to stimulate the exchange of ideas.

In general, EKIV’s responsibility is to contribute to synergies of the various evaluation modules and initiate common activities including, e.g. publications on inter-modular research questions.

What are the basic research questions?

The evaluation of Gesundes Kinzigtal Integrated Care should answer the following research questions:

  1. Does an integrated care system (of the Gesundes Kinzigtal type) enhance patients’ self-management? Does integrated care of the Kinzigtal kind stimulate a shared decision-making of doctors and patients more than “normal care”?
  2. Does an integrated care system of the Kinzigtal type contribute to an increase in population health? Is such a system more effective than „normal care“?
  3. How satisfied are physicians and other providers with the integrated care system?
  4. Does the new integrated care system stimulate a more intensive interdisciplinary cooperation as compared with „normal care“?
  5. Is an integrated care system of the Kinzigtal type more efficient than normal care? If so, does the Kinzigtal system provide at least the same service quality as normal care?
  6. Does the new integrated care system lead to a better service quality and if so, does it increase service quality across all care sectors and health indications or only in a few sectors and/or indications?
  7. Does the new integrated care system contribute to reduce over-, under-, and misuse of health services which still exist in Germany’s health service system (according to the German Advisory Council on the Assessment of Developments in the Health Care System)?

Which evaluation studies have started so far?

Until now three research groups have been engaged to evaluate certain aspects of Gesundes Kinzigtal Integrated Care.

Does Gesundes Kinzigtal Integrated Care have an impact on health policy on the national level?

The above-mentioned research questions are important issues for health policy and health economic debates in the whole of Germany – a long history of health system reforms and reform attempts in Germany testify to this. If the evaluation of Gesundes Kinzigtal Integrated Care provides sufficient evidence of a significant improvement in effectiveness and/or efficiency of health services under conditions of a Kinzigtal type system, Gesundes Kinzigtal Integrated Care could become a role model for many similar regions in Germany.


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