Current Projects

Arbeiten 5.0 – Hormonizing processes and working time models

Background
Existing staff shortages, rising workload and increasing complexity of tasks impose challenging working conditions for many healthcare professionals. However, in order to ensure a high quality of patient care, sufficient personnel capacities in general, as well as motivated and qualified staff, are necessary. Therefore, hospitals are increasingly confronted with the challenge of employing and retaining qualified healthcare workers. Investments in innovative employee recruitment and retention concepts that consider both the labor market circumstances of the healthcare sector and trends in “New Work” will be essential in the future. This is where the project “Arbeiten 5.0 - harmonizing processes and working time models” comes in.

Objective
The aim of the project is to make working hours more flexible and to harmonize and synchronize organizational processes between nursing staff, doctors, and other healthcare providers at the University Medical Center Hamburg-Eppendorf (UKE). This should lead to an improved work-life balance, increased employer attractiveness and efficient staff deployment. To this purpose, interventions will be introduced that (1) make working hours and organizational structures more flexible and (2) optimize processes between occupational groups. While interventions to make shifts and organizational structures more flexible are an optional offer for nursing staff, interventions to optimize processes between occupational groups are mandatory for nursing staff, medical assistants, and doctors. The project is being scientifically evaluated by the HCHE with the goal of assessing the effectiveness of the implemented interventions. Furthermore, factors are identified that should be considered for successful adoption and scaling of the project to other hospitals.

Approach
The evaluation is being conducted as a multicenter, prospective cluster-controlled trial with an open-cohort stepped wedge design over a period of three years. This study design entails a stepwise rollout of the interventions in all units of the participating hospital.

A multi-perspective, multi-dimensional evaluation approach is being applied, which makes it possible to include the perspectives of all occupational groups participating in the interventions (nursing staff, medical staff, ward management/central administration) in the evaluation of the degree of target achievement and the success of the project. For the evaluation, primary data stemming from annual surveys of the participating employees are combined with secondary data (personnel statistics, utilization statistics of the interventions) provided by the hospital.

Funding
The project is funded by the Techniker Krankenkasse (headed by the University Medical Centre Hamburg-Eppendorf).

STATAMED

Background
The StatAMed project is testing a new form of care that includes short inpatient general medical treatment for (sub-)acute treatment cases with a general medical background in structurally weak rural and urban regions. The aim is to avoid unnecessary emergency admissions through continuous communication between all those involved in the care process. Targeted and planned short-term inpatient treatment and rapid discharge ensure that patients can return to their familiar living environment as quickly as possible.

If patients are acutely ill or elderly people who require treatment, they are often brought to the emergency room by ambulance and receive full-time care in hospital for a longer period of time. From a medical point of view, it would be more appropriate for those affected to receive round-the-clock nursing and medical care in hospital for a few days and then continue treatment at an outpatient basis.

Objective
The aim is to create a bridge between outpatient and inpatient treatment that enables low-threshold care with a short inpatient stay. This new form of care should consist of three phases: (1) recommendation of inpatient treatment, e.g. due to acute complaints, (2) formulation of treatment goals and admission to hospital within 48 hours, (3) needs-based care during the inpatient stay and in aftercare. Cooperation between the medical and nursing staff takes place between the medical disciplines and the inpatient and outpatient areas. Treatment is provided by interdisciplinary care teams with continuous support from patient guides. After discharge, a nurse ("flying nurse") can continue to care for the patient at home.

If successful, the new form of care can guarantee basic care close to home and in line with demand in future, while at the same time avoiding inadequate or excessive care and rehospitalization. The concept is transferable to a large number of regions and other care settings.

Approach
The new form of care is being tested at three urban and three rural locations. In order to test whether the model is superior to standard care, suitable cases are selected, randomly assigned to groups and analyzed; health economic effects are also evaluated. The suitability of the model in terms of implementation and acceptance will be investigated by surveying patients and their relatives, as well as the facilities and specialists involved.

Funding
The project is funded by the Innovation Fund of the Joint Federal Committee for a duration of 45 months (EUR 10.8 million).

HI-PRIX Health Innovation Next Generation Payment & Pricing Models

Background
The emergence of high-price innovative therapies and overall trends of increased drug prices are exerting strong financial pressure on healthcare payers worldwide. The number of approved cancer drugs and Advanced Therapy Medicinal Products (ATMPs) has also increased, raising issues of affordability for public and private third-party payers. Given the high per-patient prices, which can exceed one million Euros, payers’ ability to absorb multiple gene therapies while delivering affordable access to healthcare is questionable. The benefits of ATMPs usually accrue over a patient’s lifetime after a single administration, which runs counter to the traditional model where both treatment costs and benefits are spread out over time with yearly assessment of coverage. The most common approach in the EU so far has been the use of outcomes-based reimbursement schemes, where refunds can be made to payers in the case of patient non-response. However, such schemes can be difficult to develop and implement.

Objective
The aim of this project is to advance scientific knowledge by developing new schemes intended to address some of the most pressing issues like ensuring sustainability-minded pricing and reimbursement determinations, acknowledging the role of public investments in R&D, optimizing price dynamics for multi-indication products or when robust clinical evidence is missing, planning for purchasing, and delivering of novel technologies embedded into services. Furthermore, the project aims to thoroughly evaluate costs and benefits, barriers and enablers of existing schemes, in close collaboration with the stakeholders involved, underlining the project’s goal to ensure a successful implementation of effective pricing and payment models in real-world settings.

Approach
HI-PRIX is a three-year research project structured in 8 scientific Work Packages (WPs), which culminate in a crosscutting WP1 aimed at mapping pricing and payment models, together with the features that might sustain their effective implementation in real life. The methodology adopted in the scientific WPs is a mix of quantitative and qualitative methods, from theoretical inquiries, model-based simulations, econometric analyses, to focus groups, individual interviews and consensus generation methods, as it is typical of economics, sociology, political science, and social sciences in general.

Funding
This project has received funding from the European Union’s Horizon Europe Research and Innovation Programme under Grant Agreement Number 101095593.

Learning-by-Doing-Effects in Cardiac Surgery

Background
In the context of cardiac surgery, surgical experience and specialization is a key factor for the safety and effectiveness of surgical interventions. Learning-by-doing effects, i.e. the number of operations performed, are a crucial aspect for a possible reduction in mortality and perioperative complications. The concept of "learning by doing" in cardiac surgery can be viewed from two perspectives: On the one hand, short-term surgical experience, which manifests itself in the number of operations performed within a shorter time window (e.g. four weeks), and on the other hand, long-term experience, which is reflected in the total number of operations performed.

Objective
The research project is aimed at investigating "learning-by-doing" effects in cardiac surgery. The hypothesis that the surgical experience of cardiac surgeons, in particular the number of recently performed operations, could have a significant influence on patient outcomes will be investigated. Based on the analysis of "learning-by-doing" effects, recommendations for clinical practice can be derived, such as optimal team compositions, the frequency of operations for surgical training purposes and the development of supportive training programs for cardiac surgeons. 

Approach
A comprehensive data set from a German heart center is used for the analysis. In addition to the number of operations performed by the surgeons, it also contains their characteristics and those of the patients. For mitral valve reconstruction, aortic valve replacement and aortocoronary bypass surgery, the influence of learning effects on patient outcomes is examined using regression analysis.

Funding
This project is part of the research training group „Managerial and Economic Dimensions of Health Care Quality” funded by the German Academic Research Foundation, Grant No. GRK 2805/1.

Heterogeneous Treatment Effects in Health Care

Background
Responses to a particular treatment can substantially differ between individual patients depending on their personal characteristics such as demographic, socio-economic, or clinical attributes. These factors can significantly influence the quality of healthcare that patients receive. Medical-decision making will become more precise if they are based on real-world evidence of treatment effect heterogeneity. Considering this information and recognizing heterogeneity of treatment effects helps to identify groups that benefit the most or least from a particular treatment, leading to personalized and effective health care.

Although we know that different patients react differently to treatments, much of the empirical evidence in medicine represents average treatment effects. While sample sizes in randomized clinical trials are suitable to estimate the average treatment effect well, they are often insufficient for estimation of treatment-covariate interactions that are crucial to precision medicine. Vast amounts of (routinely) collected real-world data together with data-driven methods has the potential to leverage these shortcomings and deliver new insights into treatment effect heterogeneities.

Objective
In this context, the following questions will be addressed: What influence does the heterogeneity arising from patient characteristics have on the assessment and measurement of quality of care? Which methods exist for this and how accurate are they?

Approach
First, a systematic literature review will be conducted to find out how frequently heterogeneous treatment effects are examined in health care research using observational data, and which methods are employed to do so. Second, unique real-world data from a community health center in socially disadvantaged neighbourhoods in the city of Hamburg will be used to investigate the presence of heterogeneities in treatment effects.

Funding
This project is part of the research training group „Managerial and Economic Dimensions of Health Care Quality” funded by the German Academic Research Foundation, Grant No. GRK 2805/1.

Predicting COVID-19 Vaccination Uptake from Public Discourse: A Machine Learning Approach

Background
Through increasing population density and the encroachment of settlements on animal habitats, human societies are increasingly vulnerable to epidemics. Newly emerging epidemics can be countered through (i) the development of a vaccine or cure and (ii) its deployment to a sufficiently large part of the population. In the case of the COVID-19 pandemic, the development of effective vaccines was initially far from assured, but ultimately much faster and more successful than its deployment. This task, in turn, encountered important but addressable logistical challenges, but ultimately failed to convince a significant minority of the population to get vaccinated.

Objective
In this project, we will explore the relationship between public discourse and COVID-19 vaccination uptake and how to use real world data from Germany and England to identify public opinion on COVID-19 vaccination, with the ultimate aim of identifying strategies to increase the uptake of COVID-19 vaccinations. The analysis will apply big data and machine learning techniques to Twitter data and will link these to data on local vaccination rates. From a policy perspective, the output of this project can be used to inform public health response in real time in future pandemics.

Approach
At the heart of the proposal is an interdisciplinary approach, combining health economics and linguistics with new methods from data science. Our project will contribute to several key areas of the University of Hamburg: The core research area Infection Research, the emerging field Health Economics and the profile initiative Linguistic Diversity.

Funding
It is funded through Excellence Strategy of the Federal and State Governments.

R2D - Ready to Discharge? Implementation, influencing factors and effects of discharge management in cardiological care

Background
Cardiovascular diseases represent a significant proportion of illnesses in Germany. Often, specialist in-hospital treatment is required. During and after an in-hospital stay, effective discharge planning is crucial to ensure patient-centered, seamless, and continuous transition from inpatient to outpatient care. Despite the introduction of the German regulatory agreement for discharge planning (“Rahmenvertrag Entlassmanagement”), its implementation varies significantly across hospitals. Often, problems arise at the intersection between actors involved in patient care. Specifically for cardiovascular diseases, there are currently no stringent guidelines for the implementation of discharge planning.

Objective
This project aims at analyzing the implementation, influencing factors, and outcomes of discharge planning in cardiological care in Germany. The evaluation focuses especially on the quality and continuity of care. Actionable recommendations will be derived based on the project’s results to sustainably improve discharge planning in German hospitals.

Approach
The project considers the perspectives of various stakeholder within the German healthcare systems (patients, hospitals, experts) by conducting interviews and surveys. In addition, data from a German statutory health insurance and other publicly available data sources (e.g., hospital quality reports) will be analyzed jointly.

Funding
The project is funded by the Innovation Fund of the Joint Federal Committee for a duration of three years (EUR 1.2 million).

European COvid Survey

Objective
The objective of the European Covid Survey (ECOS) is to assess the acceptance of the measures introduced and how pandemic-related concerns and problems are dealt with in European society. The overarching themes of ECOS are vaccination preparedness, individual, financial and economic concerns, perception and acceptance of regulations, and information policy and trust in information sources.

Approach
Under the direction of the Hamburg Center for Health Economics (HCHE) and in cooperation with the Nova School of Business and Economics (Portugal), Bocconi University (Italy) and Erasmus University Rotterdam (Netherlands), waves of surveys have been conducted for this representative survey in eight European countries at intervals of about two months since April 2020.

Together with cooperation partners, questionnaires are being developed that cover current issues and issues relevant to decision-makers with a view to the dynamic development of the pandemic. The questionnaires are translated by partnersfrom the respective countries into their native languages and made available via an online platform. With the help of the market research company Dynata, it will be ensured that the samples from the different countries are representative in terms of age structure, regional distribution, gender and education.

Funding
The project is funded by the Excellence Initiative of the University of Hamburg and by the German Research Foundation (KO 6492/1-1, STA 1311/5-1) and it received funding from the EU Framework Programme of the European Union for Research and Innovation "Horizon 2020" under Grant No. 721402.

ESV - Uniform, sector-equivalent remuneration

Background

Patients should be treated where they receive the most medically appropriate treatment. However, the current reimbursement structure stands in the way of this. This also affects "sector-equivalent" services that can be treated both as outpatient and inpatient care. Outpatient and inpatient service provision are reimbursed from different budgets which cements sector boundaries and prevents an understanding of joint service provision. Outpatient services are predominantly reimbursed according to individual services, while inpatient treatments are reimbursed via per-case flat rates. This includes financial incentives, whereby economic considerations can compete with the medical needs of the patient.

Objective

The objective is to develop a viable concept that shows how uniform, sector-equivalent reimbursement can be structured. It is intended to enable political decision-makers to initiate cross-sectoral reimbursement that is supported by service providers and health insurers. In this way, the German healthcare system can be aligned more closely to needs, made more efficient and the quality of service provision improved.

Procedure

Based on the experience of other OECD countries, a comparative literature review will identify which service areas are suitable for sectoral treatment and reimbursement. Subsequently, the status quo of sector-equivalent service provision will be surveyed and it will be investigated how comparable the patient groups in both sectors are in practice. A survey of service providers and health insurers will be used to determine how suitable the identified service areas are.

Funding

Innovation Committee of the Joint Federal Committee (Innovation Fund for the Promotion of Health Services Research (§§ 92a and 92b SGB V)

The Impact of Public Discourse on Health Care Utilization during the COVID-19 Pandemic

Background

To counteract potential long-term public health problems and better prepare for future pandemics, it is critical to develop effective public policy responses to pandemics. Estimating the effects of public discourse and measures taken during the current pandemic will be crucial to mitigate adverse effects on public health.

Objective

The primary objective of this study is to examine the relationship between public discourse on the COVID-19 pandemic and responses by the population considering policy measures taken to mitigate the pandemic, socioeconomic factors and political orientation. These responses include health care utilization and adherence to social distancing. This project is intended to provide essential lessons for public policy actors on how public policies are perceived by the population and to what extent they comply or respond to them.

Approach

The project focuses on a comparative analysis between England and Germany, as both countries are similar in many ways, but exhibit different policy responses and public discourses during the pandemic. An AI approach will be used to analyze newspaper and social media data in both countries while incorporating additional datasets. Modern analytic techniques will be used to examine the impact of public discourse, taking into account pandemic containment policies, socioeconomic factors, and political orientation, on health care utilization and adherence to social distancing.

Funding

German Research Foundation (DFG)

There are currently no projects with practical cooperation.