标题：Impact of Integrated Care on patient satisfaction, perceived health behaviour and health maintenance in ´Gesundes Kinzigtal´: Interim results of a trend study
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : 'Gesundes Kinzigtal' (GK) is a population-based integrated care pilot in Germany and is commonly rated a ‚flagship project‘ among Germany’s integrated care approaches. Founded in 2006, GK is managed by Gesundes Kinzigtal Ltd., in which the local physicians’ network has the majority of shares. GK cooperates with two statutory health insurers, AOK and LKK, whose insurants (about 33.000 people) are entitled to enroll into GK Integrated Care. About 10.000 insureds have enrolled into GK until now as active members. Besides GK’s general emphasis on prevention and health promotion, an important focus of GK’s strategy is to activate and empower patients. Correspondingly, the majority of GK members participate in preventive or health management programs offered by GK, and members are encouraged to agree on individual health or treatment goals with their respective doctors of trust. Since 2013, a trend study surveys GK members’ satisfaction every two years. In this contribution we will give interim answers to the following questions: 1) How do GK members assess some key features of GK Integrated Care? 2) What is the level of global patient satisfaction with GK, i.e. in what degree would GK members recommend others to become a member? 3) To which degree do these parameters change over time? Methods : The first survey of the trend study was conducted in 2013, the first follow-up survey in 2015. In 2013, 3.034 GK members were randomly selected and received a standardized questionnaire by mail (in which they were asked to participate in the survey). In 2015, 3.471 members were asked to participate. Participating members sent their completed questionnaire to an independent research institution. Target variables in the questionnaire were: Satisfaction with the doctor of trust (Weisse-Liste-Ärzte questionnaire), patient activation (PAM-13-D), health-related quality of life (EQ-5D, EQ-VAS), satisfaction with GK (3 self-developed items), perceived health maintenance and health behaviour (2 self-developed items). In the following we present bivariate analyses of variables indicating patient satisfaction with GK, perceived change of overall care quality, perceived change of health behaviour and health maintenance. Results : The response rates (evaluable response) amounted to 23 % (n=711) in the first survey and to 25 % (n=863) in the first follow-up survey. Among the responders, women and older people were slightly over-represented. In 2013, 39.9 % (95% CI: 36.2 – 44.1) of the respondents felt “somewhat” or “considerably better cared for“ after they had enrolled into GK; in 2015 this proportion amounted to 41.1 % (95% CI: 37,5 - 44,3). When adjusted for age and sex, the results amount to 39.0% (95% CI: 35.4 - 42.7) in 2013 and 41.5% (95% CI: 38.1 - 45.0) in 2015. The proportion of respondents who indicated that they knew now “better how to maintain or improve“ their own health, compared to the time prior to their enrollment, practically remained the same (2013: 57,4%; 2015: 57,7 %; adjusted for age and sex: 56.9% in 2013 vs. 58.1% in 2015). The proportion of those who indicated a more effective health behaviour after their enrollment (2013: 26.1%, 95% CI: 22.8 – 29.8) increased remarkably in the first follow-up survey (2015: 30.6%, 95% CI: 27.3 – 33.7). When adjusted for age and sex, these proportions amount to 25.6% (95% CI: 22.3 - 28.9) in 2013 vs. 30.7% (95% CI: 27.6 - 34.0) in 2015; this increase is statistically significant (p<.05). Respondents’ willingness to recommend GK to friends or relatives (indicating global satisfaction with GK Integrated Care) remained almost stable over time: For 2013, the proportion amounts to 92.1 % vs. 91.7 % for 2015; when adjusted for age and sex, the results amount to 92.0% (2013) vs. 91.8% (2015). Discussion and conclusion : Members‘ global satisfaction with GK Integrated Care seems to be fairly high: more than 90% would recommend also their friends or relatives to become a member of GK. High global satisfaction values are a very common phenomenon. Therefore the changes of the respective parameters over time seem to provide more valid insights than the levels of these parameters at a given point of time. Our interim results show a largely stable satisfaction with GK Integrated Care over time. This is not surprising after only one follow-up survey. Nonetheless, one parameter displays a noteworthy increase between the first and the second survey: Members’ self-reported health behaviour has significantly improved between 2013 and 2015 (when adjusted for age and sex). This might be attributed to GK’s attempts to activate and empower their members. Biannual surveys will assess future trends of the above-mentioned indicators.
关键词：integrated care systems ; patient satisfaction ; health behaviour ; questionnaire survey ; trend study
