Präferenzen von Patienten, pflegenden Angehörigen, Leistungserbringern, Kostenträgern und politischen Entscheidungsträgern bei der integrierten Versorgung in Deutschland: Ein Discrete Choice Experiment

Zusammenfassung

Ziel Ziel dieser Studie ist Präferenzen zu erheben, die multimorbide Patienten, pflegende Angehörige, Leistungserbringer, Kostenträger oder politische Entscheidungsträger verschiedenen Endpunkten von integrierten Versorgungsprogrammen (IV-Programmen) in Deutschland beimessen und diese zu vergleichen.

Methodik Mit Hilfe eines Discrete Choice Experiments (DCE) wurden die Präferenzen der Befragten für die Endpunkte von zwei IV-Programmen ermittelt. Jedes IV-Programm wurde anhand von Attributen, bzw.Endpunkten präsentiert, die das „Triple Aim“ abbilden. Sie waren in die Endpunkte Wohlbefinden, Erfahrung mit Versorgung und Kosten unterteilt, mit insgesamt acht Attributen und jeweils drei Ausprägungen.

Ergebnisse Die Ergebnisse von 676 Fragebögen zeigen, dass die Attribute „Lebensfreude“ und „Kontinuität der Versorgung“ interessengruppenübergreifend die höchsten Bewertungen erhalten. Am geringsten blieben die relativen Bewertungen für alle Interessengruppen bei dem Attribut „Kosten“. Die Präferenzen der Leistungserbringer und pflegenden Angehörigen unterschieden sich am deutlichsten von denen der Patienten. Diese Unterschiede betrafen meist die „körperliche Funktionsfähigkeit“, die von Patienten am höchsten bewertet wurde, die „Personenzentrierung“ und „Kontinuität der Versorgung“, die die höchsten Bewertungen von den Leistungserbringern erhielten.

Schlussfolgerung Die identifizierten Präferenzheterogenitäten in Bezug auf die Endpunkte von IV-Programmen zwischen den Interessengruppen verdeutlichen, wie wichtig es für eine optimale Ausgestaltung von IV-Programmen ist, Vertreter der Praxis und politische Entscheidungsträger über die unterschiedlichen Perspektiven zu informieren. Die Ergebnisse unterstreichen zudem die Relevanz von gemeinsamen Entscheidungsfindungs- und Abstimmungsprozessen zwischen Leistungserbringern, pflegenden Angehörigen und Patienten.

Abstract

Aim of the work The aim of this study was to measure and compare the relative importance that patients with multimorbidity, partners and other informal caregivers, professionals, payers and policy makers attribute to different outcome measures of integrated care (IC) programmes in Germany.

Methods A DCE was conducted, asking respondents to choose between two IC programmes for persons with multimorbidity. Each IC programme was presented by means of attributes or outcomes reflecting the Triple Aim. They were divided into the outcomes health/ wellbeing, experience with care and costs with in total eight attributes and three levels of performance.

Results The results of n=676 questionnaires showed that the attributes “enjoyment of life” and “continuity of care” received the highest ratings across all stakeholder groups. The lowest relative scores remained for the attribute “total costs” for all stakeholders. The preferences of professionals and informal caregivers differed most distinctly from the patients’ preferences. The differences mostly concerned “physical functioning”, which was rated highest by patients, and “person centeredness” and “continuity of care”, which received the highest ratings from professionals.

Conclusions The preference heterogeneities identified in relation to the outcomes of IC programmes between different stakeholders highlight the importance of informing professionals and policy makers about the different perspectives in order to optimise the design of IC programmes. The results also support the relevance of joint decision-making and coordination processes between professionals, informal caregivers and patients.

Schlüsselwörter

Integrierte Versorgung - Multimorbidität - Discrete Choice Experiment - Präferenzen - Interessengruppen - Triple Aim

Key words

integrated care - multimorbidity - discrete choice experiment - preferences - stakeholders - triple aim

Publikationsverlauf

Artikel online veröffentlicht:
20. Oktober 2021

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