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Background: The integrated care system Gesundes Kinzigtal (ICSGK), one of the most comprehensive population-based ICS in Germany, started its work nearly 9 years ago. The ICSGK is pursuing the Triple Aim: improving the health of the population, improving the individual's experience of care, and at the same time reducing the per capita costs of care., Objectives: To evaluate the impact of the ICSGK on the Triple Aim., Materials and Methods: The ICSGK is being evaluated externally and internally via a mix of diverse quantitative and qualitative methods. This paper presents selected results for each Triple Aim dimension., Results and Conclusions: Regarding population health, most of the quality indicators examined by the external scientific evaluation show positive development. For example, the prevalence of patients with fractures among all insurants with osteoporosis is presented. In 2011, this prevalence was approximately 26 % in the "Kinzigtal" population (aged ≥ 20 years old) in comparison to 33 % in the control group. As far as patient experience is concerned, to the question "Would you recommend becoming a member of Gesundes Kinzigtal to your friends or relatives?" 92.1 % of those questioned answered "Yes, for sure" or "Yes, probably." Twenty-four percent of those questioned further stated that they would now live "more healthy" than before enrolment in the ICSGK. In the subgroup of questioned insurants who had objective agreements with their doctors 45.4 % answered in this way. On the subject of cost-effectiveness, for both participating socil health insurance schemes, cost savings relative to the costs normally expected for the ICSGK population concerned are observed every year. In the seventh intervention year (2012) the total is 4.56 million Euros for the AOK Baden-Württemberg (BW), which is a contribution margin of 146 Euros per insurant for the 31.156 insurants concerned (LKK BW = 322 Euros per insurant relative to cost savings). The results presented in this paper indicate positive effects in all three Triple Aim dimensions. Further longitudinal studies are recommended to validate those first results together with a detailed analysis to obtain in-depth insights into the specific influence of subcomponents of the total intervention.

The diagnosis of fistula of the nose results from the history and inspection of the patient. The radiologist main function is to rule out other diagnoses and to obtain information about location and extension of the fistula-system. This can be obtained by contrast-filling of the fistula-system in a non-infectious interval over thin-catheters or canulas. The Water's view shows whether the fistula reaches of the nasal-septum nor the cribriform-plate. Other diagnoses which have to be excluded are meningoencephalocoeles, mukocoeles and neoplastic diseases. These can be ruled out by tomography of the visceralcranium and the base of the skull.

In order to obtain accuracy in the detection of the pre-invasive and early invasive laryngeal cancer microscopy and cytology can be jointly used. The cytologic picture of the early invasive laryngeal cancer is described including its precursors.