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  • Hildebrandt, Helmut  (187)
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  • 1
    Language: English
    In: International Journal of Integrated Care, 01 July 2011, Vol.11(7)
    Description: In Germany health policy-makers of all parties believe in competition as an incentive for creating innovation and to keep costs down. Sickness funds cover about 90% of the population=regulated market/10% are covered by health insurance plans=private market. The sickness funds in the regulated market have the same premium (this goes to a national agency and is distributed to the funds after a risk adjusted scheme that uses morbidity trees to develop a fair payment to the funds) but vary whether they have to ask for a separately paid surplus premium.Sickness funds compete about surplus premiums, services and offers to the patients and about selection (healthy vs. sick). They have to ask: What are the strongest interventions in increasing health status and keeping costs down?Who is offering a comprehensive and sustainable solution serving my population?With what kind of reimbursement scheme do I attract the right spirit … not too much interventions, but not too few as well …. tackling the right people … using the newest technology, but with as few costs as possible? For more information on integrated care in Germany, please follow the link to the power point presentation below.
    Keywords: Germany ; Population Based Integrated Care ; Medicine ; Public Health
    E-ISSN: 1568-4156
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  • 2
    Language: English
    In: Psychiatry Research, 2011, Vol.185(1), pp.54-59
    Description: Although many researchers agree that working memory (WM) impairments are a core symptom of schizophrenia, it remains unclear how the disturbances on specific WM components relate to one another. In this study, we presented a Delayed-Matching-To-Sample task to 24 schizophrenia patients and 24 healthy controls, matched on demographical variables. Verbal and visuospatial WM performance was investigated with pseudowords and Chinese characters as stimuli, respectively. Processing demands (maintenance and manipulation, measured with delay and mental rotation) were low or high. Reaction time and accuracy were recorded. All experimental factors had significant effects. In general, patients were slower and less accurate than controls. Patients were especially slower on verbal tasks but they were not less accurate. Accuracy differences did not increase when either maintenance or manipulation demands increased alone but they did when both maintenance and manipulation demands increased simultaneously. These findings indicate that performance impairment in patients was non-specific and that no specific deficit of any WM component was observed.
    Keywords: Neurocognition ; Working Memory ; Schizophrenia ; Delayed-Matching-To-Sample Task ; Medicine
    ISSN: 0165-1781
    E-ISSN: 1872-7123
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  • 3
    Language: English
    In: Neuropsychologia, May 2012, Vol.50(6), pp.1164-1177
    Description: ► Neglect patients often show an ipsilesional shift of their subjective auditory midline. ► Leftsided optokinetic stimulation (OKS) transiently normalized this auditory midline shift in leftsided neglect, and led to a significant positive after-effect 30 min post-stimulation. ► Repetitive leftward OKS (20 treatment sessions) led to a significant and enduring reduction of both visual auditory neglect phenomena while visual scanning therapy had no effect on auditory and only small effects on visual neglect. ► In conclusion, OKS induces significant recovery from auditory and visual neglect. Optokinetic stimulation (OKS) modulates many facets of the neglect syndrome. This sensory stimulation technique is known to activate multiple brain regions (temporo-parietal cortex, basal ganglia, brain stem, cerebellum) some of which are involved in auditory and visual space coding. Here, we evaluated whether OKS modulates auditory neglect and induces a sustained effect (Study 1), and whether repetitive OKS recovers auditory neglect (Study 2). In Study 1, 20 patients with visuospatial neglect and auditory neglect in an auditory midline task following rightsided stroke were randomly allocated to an experimental and a control group matched for neglect severity and socio-demographic factors. Both groups showed a stable, pathological shift of their auditory subjective median plane (ASMP) in front space to the right side. During leftward OKS the experimental group showed a complete normalization of the shift of the ASMP, which endured until 30 min poststimulation, and returned almost to baseline values 24 h after OKS. In contrast, the control group who viewed the identical but static dot pattern, showed neither change in their ASMP during this condition, nor any significant change at 30 min or 24 h poststimulation. In Study 2, we show in two samples of neglect patients ( = 3 each) that repetitive leftward OKS with smooth pursuit eye movements as a therapy induces lasting improvements in auditory (the ASMP) and visual neglect while visual scanning therapy yielded no measurable effects on auditory significantly smaller effects on visual neglect. In conclusion, the experiments show that a single session of OKS induces rapid though transient recovery from auditory neglect including a sustained effect after termination of stimulation, while OKS therapy yields enduring and multimodal recovery from auditory and visual neglect. OKS therapy with pursuit eye movements therefore represents a multimodally effective and easily applicable technique for the treatment of auditory and visual neglect.
    Keywords: Auditory ; Visual ; Neglect ; Space ; Crossmodal ; Brain ; Treatment ; Medicine
    ISSN: 0028-3932
    E-ISSN: 1873-3514
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  • 4
    Language: English
    In: Clinical Neurophysiology, August 2015, Vol.126(8), pp.1532-1538
    Description: There are no reliable outcome predictors for severely impaired patients suffering from large infarctions or hemorrhages within the territory of the middle cerebral artery. This study investigated whether the amplitude of the event-related potential (ERP) component P300 predicts if a patient will be transferred to the next stage of rehabilitation (positive outcome) or to a nursing home (negative outcome). The second goal was to look for lesion locations determining the generation of the P300 amplitude. Forty-seven patients performed an auditory oddball task to elicit the P300 and were assessed with different scores for activities of daily living (ADL). Patients were divided in two groups according to their outcome. P300 amplitudes were compared between these groups controlling for age and gender. Post-hoc analyses were performed to analyse the relationship between P300 amplitude and neurological outcome scores. In addition, lesion overlaps were created to detect which lesion pattern affects P300 generation. Patients with a positive outcome showed higher P300 amplitudes at frontal electrode sites than those with a negative outcome. P300 amplitude correlated with ADL score difference. Lesions in the superior temporal gyrus, middle and inferior frontal and prefrontal regions led to visibly diminished P300 amplitudes. The findings suggest that an impairment of attention (P300 amplitude reduction) negatively influences successful neurological rehabilitation. Left superior temporal lobe and the left premotor/prefrontal areas are essential brain areas for the generation of the P300. P300 amplitude may be used as an outcome predictor for severely impaired patients suffering from middle cerebral artery strokes or hemorrhages.
    Keywords: Stroke ; Severe Impairment ; Early Rehabilitation ; Outcome Prediction ; P300 ; Lesion Localization ; Medicine
    ISSN: 1388-2457
    E-ISSN: 1872-8952
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  • 5
    Language: German
    In: Public Health Forum, March 2013, Vol.21(1), pp.2.e1-2.e4
    Description: Mit der Einführung der Integrierten Versorgung (IV) im Jahr 2000 verband sich die Hoffnung auf die Entwicklung von Versorgungsinnovationen. Zwölf Jahre später ist es an der Zeit, zu überprüfen, ob sich das Modell bewährt hat. Der Verfasser – selber aus dem Public Health Bereich kommend und an der Einführung der IV in 2000 beteiligt – sieht sie als Chance für einen Wettbewerb um die besten Gesundheits-Outcomes bei gleichzeitiger Berücksichtigung von Effizienzkriterien und einem Höchstmaß an Patientenorientierung. Im folgenden Beitrag gibt er einen Überblick über die bisherige Entwicklung der IV und entwickelt ein Public Health orientiertes Raster zur Bewertung der Modelle. Er kommt zu dem Ergebnis, dass sich zwar viele durchaus interessante Versorgungsinnovationen entwickelt haben. Das Potenzial der IV für eine Reformierung des deutschen Gesundheitssystems wurde bisher aber nur zu einem Bruchteil genutzt. The beginning of integrated care (IC) in 2000 was combined with hope for the development of health care innovations. Twelve years later it is time to check whether the model has proved itself. The author, who has a public health background and was involved in the introduction of IC in 2000 – considers IC as a chance for a competition for the best health outcomes by considering efficiency criteria and a maximum in patient's orientation. In the following article he presents an overview of the development of integrated care and presents a public health oriented scheme for the assessment of the different types of IC. He comes to the result that though many interesting health care innovations have been developed, however the potential of IC for a reformation of the German health care system was up to now only used for a fraction.
    Keywords: Integrierte Versorgung ; Evaluation ; Gesundheitsoutcome ; Populationsorientiert ; Public Health ; Versorgungsmanagement ; Vernetzung ; Integrated Care ; Evaluation ; Health Outcome ; Population Oriented ; Public Health ; Care Management ; Network ; Public Health
    ISSN: 0944-5587
    E-ISSN: 1876-4851
    Source: ScienceDirect Journals (Elsevier)
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  • 6
    Language: English
    In: International Journal of Integrated Care, 01 July 2011, Vol.11(7)
    Description: Shared savings contracts between physician networks/health maintenance organisations and insurances or sickness funds in Germany and Switzerland showed quite impressive results of between 5 and 15% savings, similar to those being demonstrated in the US during the 1990s in the beginning of managed care last century. While managed care in the US got into a lot of ethical questions the European examples are on the rise and a new international debate on integrated care is emerging.The ‘triple aim’ as Donald M. Berwick emphasized in his famous Health Affairs article in 2008 called for better health, improved care and lower health care costs and the Obama administration took this notion into its new accountable care organisation approach. The author suggests that it is time to develop comprehensive integration policies for whole regional populations. He can tear on at least five years of experiences in Germany (GesundesKinzigtal) as well as on several years of experiences of other networks in Switzerland and other parts of Germany.These experiences are indicating that effective trans-sector organisation of health care and increased investments in well-designed preventive programmes will lead to a reduction in morbidity, and in particular to a reduced incidence and prevalence of chronic diseases and offer substantial efficiency gains for sickness funds and health insurances.
    Keywords: Health Care Costs ; Medicine ; Public Health
    E-ISSN: 1568-4156
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  • 7
    Language: English
    In: International Journal of Integrated Care, 01 August 2012, Vol.12(7)
    Description: ‘Triple Aim’ is the buzzword for the initiatives of the Obama-administration in the US and is referring to a famous article of Don Berwick et al. in 2008 in health affairs asking for better health, better health care, and lower per capita costs. A similar venture started already in 2006 in Germany. One of the most challenging ventures towards reorienting health care in the direction of outcome-orientation is the measurement of the produced value and health gain in a local area. In this keynote the financial architecture and the specific way to measure the produced value and health gain in the integrated care pilot ‘Gesundes Kinzigtal’ will be described—as well some of the operating details and the results within.Located in Southwest Germany, Gesundes Kinzigtal is the only population-based integrated care approaches in Germany, organising care across all health service sectors and indications, that is thoroughly scientifcally evaluated on its medical outcomes in regard to normal care. The system serving nearly half of the population of the region is run by a regional health management company in cooperation with the physicians’ network in the region, a German health care management company with a background in medical sociology and health economics and with two statutory health insurers.Having started in 2006 the more effective trans-sector organisation of the local health care system and increased investments in well-designed preventive and health promotion programmes have led to a reduction in morbidity and mortality, and in particular to reduced overall costs for the insurees of these sickness funds. The results for one of the insurers show a substantial morbidity adjusted efficiency gain already for the years 2007–2010, rising to more than 16% of total costs (included are pharmaceutical, hospital, nursing, emergency as well as physiotherapist and sick leave costs).More Information can be found on www.optimedis.de and www.gesundes-kinzigtal.de and on the evaluation (in German and English) www.ekiv.org.
    Keywords: Preventive and Health Promotion Programmes ; Trans-Sector Organisation ; Gesundes Kinzigtal ; Population-Based Integrated Care ; Integrated Care Pilot ; Germany ; Medicine ; Public Health
    E-ISSN: 1568-4156
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  • 8
    Language: English
    In: International Journal of Integrated Care, 01 October 2013, Vol.13(5)
    Keywords: Efficiency ; Ethics ; Financial Incentives ; Population Health ; Triple Aim ; Integrated Networks ; Risk Adjusted ; Medicine ; Public Health
    E-ISSN: 1568-4156
    Source: Directory of Open Access Journals (DOAJ)
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  • 9
    Language: German
    In: Zeitschrift fur Orthopadie und Unfallchirurgie, August 2013, Vol.151(4), pp.325-7
    Keywords: Evidence-Based Medicine ; Health Policy -- Economics ; Hospitalization -- Economics ; Quality Assurance, Health Care -- Economics ; Reimbursement, Incentive -- Economics
    E-ISSN: 1864-6743
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 10
    Language: English
    In: International Journal of Integrated Care, 01 May 2014, Vol.14(5)
    Keywords: Health Care ; Public Health ; Integrated Care ; Data Analysis ; Patient Care ; Health Management ; Non-Communicable Disease ; Medicine ; Public Health
    E-ISSN: 1568-4156
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