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The protection of vulnerable populations is a central task in managing the Coronavirus disease 2019 (COVID-19) pandemic to avoid severe courses of COVID-19 and the risk of healthcare system capacity being exceeded. To identify factors of vulnerability in Austria, we assessed the impact of comorbidities on COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality.A retrospective cohort study was performed including all patients with COVID-19 in the period February 2020 to December 2021 who had a previous inpatient stay in the period 2015-2019 in Austria. All patients with COVID-19 were matched to population controls on age, sex, and healthcare region. Multiple logistic regression was used to estimate adjusted odds ratios (OR) of included factors with 95% confidence intervals (CI).Hemiplegia or paraplegia constitutes the highest risk factor for hospitalization (OR 1.61, 95% CI 1.44-1.79), followed by COPD (OR 1.48, 95% CI 1.43-1.53) and diabetes without complications (OR 1.41, 95% CI 1.37-1.46). The highest risk factors for ICU admission are renal diseases (OR 1.76, 95% CI 1.61-1.92), diabetes without complications (OR 1.57, 95% CI 1.46-1.69) and COPD (OR 1.53, 95% CI 1.41-1.66). Hemiplegia or paraplegia, renal disease and COPD constitute the highest risk factors for hospital mortality, with ORs of 1.5. Diabetes without complications constitutes a significantly higher risk factor for women with respect to all three endpoints.We contribute to the literature by identifying sex-specific risk factors. In general, our results are consistent with the literature, particularly regarding diabetes as a risk factor for severe courses of COVID-19. Due to the observational nature of our data, caution is warranted regarding causal interpretation. Our results contribute to the protection of vulnerable populations and may be used for targeting further pharmaceutical interventions.

UNSTRUCTURED Real-world data (RWD) collected in routine health care processes and transformed to real-world evidence have become increasingly interesting within the research and medical communities to enhance medical research and support regulatory decision-making. Despite numerous European initiatives, there is still no cross-border consensus or guideline determining which qualities RWD must meet in order to be acceptable for decision-making within regulatory or routine clinical decision support. In the absence of guidelines defining the quality standards for RWD, an overview and first recommendations for quality criteria for RWD in pharmaceutical research and health care decision-making is needed in Austria. An Austrian multistakeholder expert group led by Gesellschaft für Pharmazeutische Medizin (Austrian Society for Pharmaceutical Medicine) met regularly; reviewed and discussed guidelines, frameworks, use cases, or viewpoints; and agreed unanimously on a set of quality criteria for RWD. This consensus statement was derived from the quality criteria for RWD to be used more effectively for medical research purposes beyond the registry-based studies discussed in the European Medicines Agency guideline for registry-based studies. This paper summarizes the recommendations for the quality criteria of RWD, which represents a minimum set of requirements. In order to future-proof registry-based studies, RWD should follow high-quality standards and be subjected to the quality assurance measures needed to underpin data quality. Furthermore, specific RWD quality aspects for individual use cases (eg, medical or pharmacoeconomic research), market authorization processes, or postmarket authorization phases have yet to be elaborated.

Background The supply of COVID-19 vaccine was limited when introduced. We aimed to inform decision makers at an early stage about targeted COVID vaccination strategies, accounting for limited capacities and adherence to support vaccination prioritization in Austria. Methods We applied a dynamic agent-based population model to compare different vaccination prioritization strategies targeting the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW), to minimize COVID-19-related hospitalizations and deaths. First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed, deriving a prioritization sequence for 2.5 million people. We considered sterilizing and non-sterilizing immunity, with different assumptions of effectiveness, over a 6-month period. The project team was advised by a Standing Policy and Expert Panel, consisting of Austrian decision makers, clinical and ethical experts as well as international modeling specialists. Results Maximum reduction of hospitalizations and deaths was achieved by starting vaccinations with the elderly and vulnerable, followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.5 million individuals yielded the same prioritization and avoided about one third of deaths and hospitalizations. Starting vaccination with HCWs leads to slightly smaller reductions. The negative effects of COVID-19-related HCW absenteeism were not yet considered in our model. Conclusions Our decision-analytic study shows that the elderly and vulnerable should be prioritized for vaccination until further vaccines are available to minimize COVID-19-related hospitalizations and deaths. An important ethical aspect complementing our modeling results is the protection of HCW, maximizing their occupational safety and ensuring risk-compensatory justice. Key messages To minimize COVID-19-related hospitalizations and death the elderly and vulnerable should be prioritized for vaccination until further vaccines are available. Prioritizing health care workers for COVID-19 vaccination is slightly less effective in the simulation but they may be considered for occupational safety and to ensure risk-compensatory justice.

Background Anti-programmed death 1 (PD-1) antibodies have evolved as a new standard of care in the adjuvant treatment of completely resected melanoma. Real-world data on treatment efficacy and safety as well as cost-effectiveness are still limited. Patients and methods Treatment outcomes were retrospectively analyzed in a continuous patient cohort receiving adjuvant nivolumab (91 patients) or pembrolizumab (9 patients). Based on the obtained clinical data, a semi-Markov model was developed to evaluate cost-effectiveness. Results After a median follow-up of 11.5 months, disease recurrence was observed in 39 patients (39 %). The site of first recurrence was locoregional in 17, distant in 19, and combined locoregional and distant in three patients. Twelve-month estimates for recurrence- and distant-metastasis-free survival were 64.8 % and 77.4 %, respectively. Sixteen patients experienced grade 3 or 4 treatment-related adverse events, while 22 patients discontinued treatment due to adverse events. The base-case Markov model yielded an incremental cost-effectiveness ratio of 13,330 € per quality-adjusted life year for adjuvant anti-PD-1 antibody treatment compared to a simulated observation cohort. Conclusions Real-world outcomes of adjuvant anti-PD-1 antibody therapy in completely resected melanoma appear comparable to clinical trial data. Moreover, our data suggests this treatment strategy to be cost-effective according to Austrian health economic standards.

Many countries face challenges like impending retirement waves, negative population growth, or a suboptimal distribution of resources across medical sectors and fields in supplying their healthcare systems with adequate staffing. An increasing number of countries therefore employs quantitative approaches in health workforce supply forecasting. However, these models are often of limited usability as they either require extensive individual-level data or become too simplistic to capture key demographic or epidemiological factors. We propose a novel population-dynamical and stock-flow-consistent approach to health workforce supply forecasting complex enough to address dynamically changing behaviors while requiring only publicly available timeseries data for complete calibration. We apply the model to 21 European countries to forecast the supply of generalist and specialist physicians until 2040. Compared to staffing levels required to keep the physician density constant at 2016 levels, in many countries we find a significant trend toward decreasing density for generalist physicians at the expense of increasing densities for specialists. These trends are exacerbated in many Southern and Eastern European countries by expectations of negative population growth. For the example of Austria, we generalize our approach to a multi-professional, multi-regional and multi-sectoral model and find a suboptimal distribution in the supply of contracted versus non-contracted physicians. It is of the utmost importance to devise tools for decision makers to influence the allocation and supply of physicians across fields and sectors to combat imbalances. Key messages The trend of increasing supply of physicians continues in most European countries—stronger for specialists than for general physicians. To avoid potential physician shortages, in particular in primary care, we need to combat imbalances of physicians across sectors and medical fields.

Background In order to reduce avoidable consultations but also avoidable self-referrals to hospital outpatient departments, the Austrian authorities agreed to establish a voluntary telephone-based triage system in the course of the health reform 2013. Three regions piloted the system in early 2017. Methods An economic evaluation aimed to assess the impact on health service demand after having consulted the telephone-based system. For analysing the impact, we used the conceptual model of “shift cases” from one particular service setting such as outpatient clinic to another (e.g. GP office) and calculated savings realised through patient shifts. Based on potential savings in private and public costs and running costs of the service, we identified threshold values for cost-effective operation. Results In total, approximately 45,000 completed telephone consultations were registered in the pilot phase. 2,500 persons were advised to conduct self-care whereas more than 40,000 were recommended to contact a health service provider with differing levels of priority. Adherence to the initial recommendation of the provider setting was 70%, the level of priority was met in 90%. With regard to the economic impact, public savings of shift cases range from €31 (self-care instead of GP consultation) to €198 (GP/specialist instead of hospital outpatient clinic). Public costs ranged between €10 and €50 depending on the degree of capacity utilisation, contingency costs and duration of calls. Therefore, economic net gains can be realized if approximately 15% to 25% of callers choose a lower care setting due to the consultation service. Conclusions The tele-triage service has shown to be a potentially cost effective tool but largely depends on user uptake, patient adherence and local maintaining costs. In order to exploit the full potential of the system, policy makers are advised to promote the use of the system in general and to evaluate the used algorithm. Key messages Telephone-based triage systems are a potentially cost-effective strategy in order to reduce avoidable encounters both on a primary care level but also at hospital outpatient clinics. The public savings of a shift in the provider setting vary substantially depending on the level of service delivery with diminishing savings for shifts in lower levels.

Objective Self-care is considered as a possibility to empower patients and to achieve possibly efficiency gains. However, there is a lack of evidence whether, or not, self-care initiatives can contribute to achieve efficiency gains. The aim of this research is to perform an economic evaluation of the Minor Ailment Schemes (MAS), a self-care initiative in the UK. Methods To assess potential savings of the MAS through an economic evaluation we surveyed medical and non-medical costs and benefits under three different scenarios (GP consultation, self-care with medication, self-care with home remedies). We applied this framework to evaluate the effects of the MAS with regard to the treatment of five common minor ailments (Athlete’s foot, cold, cough, heartburn and lower urinary tract infection) from four different perspectives (patient, payer, provider and society). Results The evaluation shows that patients would be better off shifting to utilisation of MAS, particularly patients who pay prescription charges. From the pharmacists’ perspective MAS could lead to higher costs due to continuous training and a more time needed for consultation. The results from the physicians’ perspective were mixed depending on the payment mechanism and on the alternatives physicians used out of the freed resources. From a societal perspective, a positive net welfare impact will only be achieved if more than a fourth of the patients with minor ailments use the MAS. Conclusion MAS may have the potential to achieve positive net societal benefits and can have a role to play in the optimisation of health care systems. However, it needs to be considered that MAS may lead to negative net benefits for some stakeholders. Furthermore, MAS are embedded in the UK health care setting and its effects are determined by internal factors (e. g. “self-care culture”) and external factors (e. g. pharmaceutical policies). It is thus recommended carrying out a thorough analysis of the health care setting to which the self-care initiative is planned to be transferred.

ISSUE: Austria was amongst the first European countries introducing a DRG-based hospital payment system in 1997. Initially, the groups were based on 476 diagnoses related groups for non-surgical admissions and 374 procedure related groups. The DRGs are granted for any case between a distinct range of the length of stay. *** DESCRIPTION OF THE PROBLEM: While intended to decrease average length of stay (ALOS) as well as hospitalisation rates, Austria only experienced decreasing ALOS in the first 10 years of the DRG-system from 8.3 days in 1997 to 6.8 days in 2007. Hospitalisation rates, however, continued to increase from 23 discharges per 100 inhabitants to 26.1 discharges in 2007 albeit initial high rates. Overall, concerns on the effectiveness of DRGs as an appropriate payment system increased amongst policy makers resulting in an evaluation ten years after its introduction. *** RESULTS: Even though the evaluation did not propose any immediate measures it increased the awareness of actively adapting the DRG system as well as capacity planning in order to provide the right incentives. In 2006, the regions were put in charge of detailed capacity planning at hospitals level making them accountable for structural health reforms. Day cases were increasingly incentivised in the DRG system and with the health reform 2013 thresholds were set up as minimum day case rates for various procedures. The 2013 reform brought also the development of a DRG system for ambulant services provided in hospital outpatient clinics. Overall, hospitalisation rates started to decrease from 2008 onwards from 26.3 discharges to 23 discharges in 2016 per 100 inhabitants. *** LESSONS: Although effective with regard to reducing ALOS DRG-based hospital payment systems do not necessarily promote lower hospitalisation rates. For the Austrian case with a high density of hospitals beds joint effort with regard to capacity planning and permanent adjustment of the DRG-system were necessary to reduce hospital admissions.

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Two major reforms implemented in 2013 and 2017 are among the main issues today. The central aim of the reforms that put in place a new governance system was to strengthen coordination and cooperation between different levels of government and self-governing bodies by promoting joint planning, decision-making and financing. Yet despite these efforts, the Austrian health system remains complex and fragmented in its organizational and financial structure. The Austrian population has a good level of health. Life expectancy at birth is above the EU average and low amenable mortality rates indicate that health care is more effective than in most EU countries. Yet, the number of people dying from cardiovascular diseases and cancer is high compared to the EU-28 average. Tobacco and alcohol represent the major health risk factors. Tobacco consumption has not declined over the last decade like in most other EU countries and lies well above the EU-28 average. In terms of performance, the Austrian health system provides good access to health care services. Austrias residents report the lowest levels of unmet needs for medical care across the EU. Virtually all the population is covered by social health insurances and enjoys a broad benefit basket. Yet, rising imbalances between the numbers of contracted and non-contracted physicians may contribute to social and regional inequalities in accessing care. The Austrian health system is relatively costly. It has a strong focus on inpatient care as characterized by high hospital utilization and imbalances in resource allocation between the hospital and ambulatory care sector. The ongoing reforms therefore aim to bring down publicly financed health expenditure growth with a global budget cap and reduce overutilization of hospital care. Efficiency of inpatient care has improved over the reform period but the fragmented financing between the inpatient and ambulatory sector remain a challenge. Current reforms to strengthen primary health care are an important step to further shift activities out of the large and costly hospital sector and improve skill mix within the health workforce.

It is possible to quantify the impact of medical care in specialised medical centers by measuring patient satisfaction. Modern quality management systems use this process as a part of result evaluation in the practice. This study describes an investigation of the influence of quality-management measures on patient satisfaction in ten specialist medical practices. One hundred patient questionnaires were issued between 2010 and 2011 in ten medical specialists practices before and after improvement of the quality management system. The evaluation of the patients were analysed using a Utest. By correlation analysis correlations between specific quality management activities and items of the patient questionnaire were identified. The results of the study indicate a generally positive reaction of patients to the improvement in the quality management of selected items. But in the totality of all practices, no clear improvement in patient satisfaction could be measured. There were weak but statistically significant correlations between specific quality-management-measure improvements and improvement of the patient questionnaire items identified. No significant improvements in patient satisfaction, which can be attributed directly to improvements in quality management, have been found by the study. But there were clues to correlations of specific quality-improvements and patient satisfaction issues. These can be used for directed quality management measures in practice and as a controlling tool of practice management regarding the evaluation of patients inside and on on-line doctor review sites.

The purpose of this study was to further investigate the relationship between perceived role quality (of the mother, partner, work and homemaker role), work family conflict (WFC) and maternal depression. We assume that role quality moderates the relation between WFC and depressive symptoms in working mothers. Data for the cross-sectional study were obtained from mothers (N = 148) with children up to 10 years of age. In order to analyze the relationship between role quality, WFC and depressive symptoms in mothers, we conducted moderated regression analyses. The central findings are (1) that positive role quality of the mother (p

The International Conference on Harmonisation’s electronic Common Technical Document (eCTD) endeavors to significantly change the pharmaceutical submission process. After decades of using paper, th...

The purpose of this study was to evaluate whether paid employment of mothers in Austria with children up to 10 years of age is related to depressive symptoms (N = 248). Three contrasting theories—scarcity theory, role enhancement theory, and role quality theory—have been discussed to explain the relation of multiple-role occupation and depressive symptoms. Results indicate that (a) in accordance with the assumptions of scarcity theory working mothers have higher levels of depressive symptoms than not-working mothers; (b) in accordance with role quality theory only mothers with low work-role quality have higher rates of depressive symptoms; and (c) besides work status the perceived quality of the mother role was significantly related to depressive symptoms.

ERP projects are complex purposes which influence main internal and external operations of companies. There are different research approaches which try to develop models for IS / ERP success measurement or IT-success measurement in general. Each model has its own area of application and sometimes a specific measurement approach based, for instance, on different systems or different stakeholders involved. This research paper shows some of the most important models developed in the literature and an overview of the different approaches of the models. An analysis which shows the strengths, weaknesses and the cases in which the specific model could be used is made.

This study aims to examine the academic motivation of students in two therapeutic health professions along with their individual attitudes toward professional training and continuing higher education in Germany. The self-determination theory was taken as a theoretical basis, and the intercultural validated German version of the original French “Echelle de Motivation Dans Les Etudes–Etudes Avancees” (EME) was used to show that occupational therapists and physiotherapists attending courses of continuing higher education are motivated by a specific complex of intrinsic and extrinsic motivating factors. In the sense of self-determination theory, older students already in employment feature higher autonomous motivation than younger, not yet employed students. The education of occupational therapists and physiotherapists in North America is compared with the special features of the German setting as a stimulus for further research.

Aim: Due to the steady increase in health care costs, a greater focus on maintaining wellness and preventing health issues has been established. Historically, Asian martial arts were closely associated with maintaining healthfulness. Thus, the aim of this investigation was to determine if people who practice Asian martial arts gain any health-related quality of life benefits compared to the general population. Subject and methods: Therefore, 343 martial artists practicing 8 varieties of martial arts answered the German standardized questionnaire 36 in a controlled setting at 24 martial arts schools (3 schools per martial art) between February 2008 and July 2008. These participants were not given information regarding the purpose of the study. Additionally, between July 2008 and December 2008, 2,512 martial artists completed an online version of the German standardized questionnaire 36. Results: The results of those completing the questionnaire in person differed from those responding to the online questionnaire. Compared to the general public, both martial arts groups rated their health-related quality of life to be better. Of the parameters evaluated, the greater differences were observed for physical aspects of health than for psychological aspects. Conclusion: Thus, these results indicate that participation in martial arts provides health-related quality of life benefits associated with the prevention of health problems. However, further studies are needed to understand the complex relationship between the practice of martial arts and improved health.

Since the year 2000, prospective dental students at Innsbruck Medical University, Innsbruck, Austria, have undergone both theoretical and practical preadmission exams, called the Dental Admission Test (DAT). The aim of this investigation was to assess the suitability and outcome of this selection practice. Five classes from 2001 to 2005 (N=97; forty-three female, fifty-four male) were retrospectively reviewed. DAT results were compared with student performance, gender, ability to graduate on time, and dropout rates. Furthermore, the influence of a previous medical degree was evaluated. The t-test was used to analyze correlations between the results of the DAT and the following: gender, students who graduated on time, and students who had previously completed a medical degree. Pearson's correlation coefficient (r) was applied to analyze correlations among test scores, age, and students' performance during the first clinical year. Students graduating on time were noted to have significantly better DAT results; students with a previous medical degree showed significantly better grades during their first clinical year. The difference between the performance of male and female applicants on the DAT was not significant. Correlation was found between DAT results and dental school performance (r=-0.462). We conclude that the DAT may reduce dropout rates by excluding applicants unlikely to be successful in practical courses and that DAT scores are a reliable tool to predict student performance during the first clinical year of dental school in Innsbruck.

In Deutschland werden in offentlichen Apotheken zunehmend Kommissionierautomaten als Lagersystem eingesetzt. Es soll geklart werden, wie sich der Personalaufwand fur den Wareneingang in Apotheken mit Kommissionierautomat von Apotheken ohne Kommissionierautomat unterscheidet. Eine offentliche Apotheke mit konventionellem Lagersystem (ohne Kommissionierautomat) und eine Apotheke mit Kommissionierautomat der Firma ROWA Typ ROWA select ® wurden unter realen Bedingungen untersucht. Dabei wurden die Zeiten fur den Wareneingang mit einer Stoppuhr gemessen. Fur den Wareneingang ergibt sich ein Personalaufwand von 11,96 HM (HM = hundertstel Minuten) pro Packung fur die Apotheke ohne Kommissionierautomat und 7,67 HM pro Packung fur die Apotheke mit Kommissionierautomat. Kommissionierautomaten verringern den Personalaufwand im Wareneingang signifikant. Personalkosten konnen eingespart werden, wenn der Personalbestand an den geringeren Personalbedarf angepasst wird.

In den letzten Jahren seit dem sich das Internet etabliert hat suchen Patienten dort verstarkt auch nach Gesundheitsinformationen. Gegenstand dieser Untersuchung ist die Frage, ob eine strukturierte, angeleitete und am Bedarf des Nutzers orientierte Internetsuche bessere Informationen liefern kann. Zu diesem Zweck wurde ein Prototyp entwickelt und evaluiert, der ein Expertensystem mit einer Metasuchmaschine kombiniert, um auf Patienten zugeschnittene Informationen bereitzustellen. Zur Evaluation wurde die FITT-Theorie verwendet. Entwicklung und Evaluation des Prototyps verliefen erfolgreich. Es ist damit moglich, 199 Kopfschmerz- und Kopfschmerzunterarten zu diagnostizieren. Die evaluierenden Betatester kamen mit dem System gut zurecht. Die Auswertung der im System genutzten 528 Internetseiten ergab jedoch, dass die Bereitstellung von diagnosebezogenen qualitatsbewerteten Gesundheitsinformationen eine Herausforderung darstellt. Der Ansatz, medizinische Expertensysteme in Verbindung mit einer Portale durchsuchenden Metasuchmaschine zur angeleiteten Informationsversorgung einzusetzen, kann die Lucke in der Versorgung von Patienten mit Gesundheitsinformationen fullen. Es sind allerdings weitere Optimierungen an der Bedarfsfeststellung der Nutzer notwendig.

ERP projects are complex purposes which influence main internal and external operations of companies. The success of the project directly influences the performance and the survival of the organisation. Recent research has me- thodically collected plausible data in the field of critical success factors (CSFs) within ERP projects. This article describes how the collected publications were used to identify the main CSFs and how they can be ranked according to the impor- tance of success or failure through a literature review. Because of the influence of CSFs to ERP-projects in general, the term "ERP project" is used in the further parts of this paper. The second part of this paper proposes how CSFs can be in- tegrated into classical ERP project phases. Past researches did nearly not investigate how CSFs which were mentioned in different publications can influence the ERP-project phases. At the end of the paper the trend of CSF in relation of the publication year and the origin of the author are shown.

Nach Teil 1*, Definition, Geschichte und Situation der heutigen stationaren Padiatrie, prasentieren wir Ihnen nun Teil 2: Situation in Deutschland, Osterreich und der Schweiz

PurposeAfter salary and wages, facility and real estate expenditure are the largest cost items in the semi‐public sector. Especially, for long‐term care facilities, there is high‐saving potential from more efficient and effective use of property. The main purpose of this paper is an exploratory research study in order to analyse the operating costs of long‐term care facilities.Design/methodology/approachThe survey is based on empirical data questionnaires, data generation and semi‐structured interviews at 18 long‐term care facilities in Tyrol, Austria carried out during Summer 2007. In order to determine the volume and to prioritize the cost drivers computer‐aided real‐estate benchmarking software was used, which was developed by the Institute of Real Estate Benchmarking at the University of Applied Sciences KufsteinTirol, Austria. Statistic analyses were conducted to investigate saving potential, determine the best case of the sample and submit recommendations to the decision makers.FindingsThe main findings are the investigation and visualization of saving potential of long‐term care facilities and identification of the volume and structure of the cost drivers and illuminated current best practices in effective building upkeep and operating costs of long‐term care facilities in Tyrol. Furthermore, the study reveals the immense saving potential in the costs of various services.Research limitations/implicationsThis survey is based on the operating costs of long‐term care facilities. Other running costs such as costs for healthcare personnel as well as quality indicators are not considered in this survey. Further research activities will be necessary regarding the identification of these cost drivers by the application of regression models.Practical implicationsProfessional property management of long‐term care facilities will be shown to decrease the cost share in the healthcare sector. The results should help to establish cost benchmarking increasingly and develop it as a strategic planning tool in order to support management in the healthcare sector in the decision‐making process.Originality/valueThe paper presents a new measuring method, which allows an holistic view of three influencing factors, namely the amount of beds, occupancy and the space consumption, to investigate weak points in cost efficiency on one chart.

Currently the number of medicinal products labelled for paediatric use is limited. Clinical trials involving children are surely amongst the most challenging types of studies performed from a scientific, ethical and medical perspective. The article provides an outline of critical issues to be considered when developing drugs in this population. Copyright © 2008 John Wiley & Sons, Ltd.

Objectives: The Austrian Health 2006 Structural Plan of 28 June 2006 requires that reference centres for cardiac surgery ‘participate in result-quality registers (e.g. heart registers)’. The aim of the project was to determine the conditions under which existing hospital information systems (HIS) would be suitable for the intended heart register system. Methods: Between November 2004 and December 2005, a survey was performed in the Austrian heart centers in order to ascertain the medical requirements, the existing technical and organizational situation, and the demands potential users would make on a comprehensive, national heart register. The possibilities of using existing hospital information systems for this purpose were evaluated on the basis of a criteria catalogue. Results: From the medical point of view, the requirements of a heart register covering the whole of Austria, though complex, are readily definable. The reality of heterogeneous information technology (IT) landscapes, coupled with demands for interactivity (on-line queries to a central cardiac database) and benchmarking the users within a single system, combined with what must objectively be regarded as a small group of users, are the reasons why this function is not provided as standard in any HIS. Conclusion: The level of standardization of predictive models and data records is too low in the light of the local and national demands and expectations of a heart register, so that an adequate Quality Assurance (QA) function for cardiac surgeries, which is based on statistical data, is not offered as a standard module in today's HIS. Copyright © 2008 John Wiley & Sons, Ltd.

The Austrian Health 2006 Structural Plan of 28 June 2006 requires that reference centres for heart surgery 'participate in result-quality registers (e.g. cardiac registers)'. The aim of the present study was to identify a suitable scoring model for the Austrian register during the run-up to its creation. During the period from November 2004 to December 2005 a survey was done of the actual situation, the organisational and economic possibilities, and the requirements of all Austrian heart centres. General and also specific Austrian basic conditions were defined. Scoring models were then classified and evaluated. The characteristics 'national and international comparability', the associated 'distribution of the scoring system' and 'detailed scientific discussion of the applicability' were found as the main criteria for selection. Economic aspects such as survey and analysis costs, and the everyday practicability of gathering data in the actual situation revealed by the survey, were also included in the evaluation framework. It could be demonstrated that under the given circumstances, the EuroSCORE represented the suitable predictive model.

Background Recently, European health systems are compelled to implement cost containment measures while simultaneously maintaining or even enhancing high quality health care. To achieve this, initiatives promoting patient involvement in case of minor ailments (“self-care”) are considered promising. Methods A cost/benefit analysis (CBA) was conducted covering modified access to prescription drugs, extended range of authorized prescribers and internet/telephone information portals. Subject to limited data availability costs …

INTRODUCTION:The medical equipment sector is characterized by a large share of overall health budgets spent for the provision of capital investment goods such as medical scanners and radiotherapy units. A high variability in provision and utilization rates of medical equipment can be observed too. The objective for this study was to contribute to effective cross-border cooperation between European Union (EU)-Member States by pooling resources for high-cost medical equipment investments (1).METHODS:Potential cost-intensive and highly specialised medical equipment, where cross-border investment resource pooling may be recommended, were identified by a combined evidence search and expert consultation. An efficiency assessment of medical equipment potential savings for EU-countries was done by a benchmark-approach and a best-practice-approach. Furthermore six examples for cross-border cooperation were investigated and two surveys have been conducted.RESULTS:The following medical equipment can be considered as cost-intensive and highly specialized across EU-Member States: Magnetic Resonance Imaging (MRI) scanners, Computed Tomography (CT) scanners, Stereotactic systems and Surgical robots.The efficiency assessment using the benchmark approach was performed for MRI, CT scanners, Positron Emission Tomography (PET) scanners, Angiography units, Gamma cameras and Lithotriptors. The results of the best-practice approach showed potential cost savings due to under-or overutilization per device group and EU-Member State. However, as this analysis offers a view on health systems on a very macro level it was not possible to give detailed insights at the country-level.The six selected cross-border examples demonstrated a wide variety of options regarding the structure, extent and organization of cross-border cooperation: Five of six cross-border examples were cooperation close to the border, in four of six examples EU funds played an important role.CONCLUSIONS:The study highlighted that cross-border cooperation in the field of cost-intensive/highly specialized medical equipment could bring economic advantages for many EU-Member States. Despite this, still only little is done by EU-Member States in terms of cooperation. Reasons are diverse and can be ascribed to lacking information, differences of national health systems, organizational and administrative hurdles, and lacking political support.

Background The Austrian diabetes disease management program (DMP) was introduced in 2007 in order to improve health care delivery for diabetics via the promotion of treatment according to guidelines. Considering the current low participation rates in the DMP and the question of further promotion of the program, it is of particular interest for health insurance providers in Austria to assess whether enrollment in the DMP leads to differences in the pattern of the provision of in- and outpatient services, as well as to the subsequent costs in order to determine overall program efficiency. Methods Historic cohort study comparing average annual levels of in- and outpatient health services utilization and its associated costs for patients enrolled and not enrolled in the DMP before (2006) and 2 years after (2009) the implementation of the program in Austria. Data on the use of services and data on costs were extracted from the records of the Austrian Social Insurance Institution for Business. 12,199 persons were identified as diabetes patients treated with anti-diabetic medication or anti-diabetics with insulin throughout the study period. 314 diabetics were enrolled in the DMP. Results Patients enrolled in the diabetes DMP received a more evolved pattern of outpatient care, featuring higher numbers of services provided by general practitioners and specialists (79 vs. 62), more diagnostic services (22 vs. 15) as well as more services provided by outpatient care centers (9 vs. 6) in line with increased levels of participation in medical assessments as recommended by the treatment guideline in 2009. Hospitalization was lower for DMP patients spending 3.75 days in hospital, as compared to 6.03 days for diabetes patients in regular treatment. Overall, increases in costs of care and medication throughout the study period were lower for enrolled patients (€ 718 vs. € 1.684), resulting in overall costs of € 5,393 p.c. for DMP patients and € 6,416 p.c. for the control group in 2009. Conclusions Seen from a health insurance provider’s perspective, the assessment of the Austrian diabetes DMP shows promising results indicating improved quality of outpatient care as well as overall cost advantages due to the lower hospitalization rates. Due to methodological limitations of the retrospective study and to the restricted data access, further promotion of the DMP must be accompanied by prospective research and preferably controlled trials in order to provide a solid basis for the decision of whether to include diabetes DMP into the insurer’s basic benefit package.

There are different success factors that influence the outcome of ERP-projects. According to Bullen and Rockart (1981), these success factors depend on five main influencing variables. One of these variables is industry. This shows that each industry has certain requirements on success measurement other industries, in general, do not. In healthcare for example the legal constraints are different from other branches. Each success measurement model has a specific aim and covers specific needs. It measures different success dimensions and can be used at different stages of ERP-projects. Some of the models consider different phases within ERP-projects others can be used to determine overall ERP-success after the implementation of an IS. One important factor for the use of such models is if the models covers branch specific needs in a way that allows the researchers to allocate meaningful results and recommendations for actions. This chapter investigates the specific needs on ERP-success measurement of the healthcare industry and the fit of the existing success measurement models for this use case.

This chapter explores how social software tools can offer support for innovative learning methods and instructional design in general and those related to self-organized learning in an academic context in particular. In the first section the theoretical basis for the integration of wikis, discussion forums and weblogs in the context of learning are discussed. The second part presents the results of an empirical survey conducted by the authors and explores the usage of typical social software tools which support learning from a student’s perspective. The chapter concludes that social software tools have the potential to be a fitting technology in a teaching and learning environment.

As a result of more economising in German hospitals, changes evolve in organising the deployment of senior medical staff. New demands are made of senior hospital management. Leadership competencies in the training and development of physicians are of prime importance to the successful perception of managerial responsibilities. The present study investigates the actual and targeted demands of leadership made of senior medical staff in terms of how these demands are perceived. To this end, the demands of leadership were surveyed using a competence-based questionnaire and investigated with a view to potentials in professional development by way of example of the senior management of psychiatric hospitals in Germany. In all, the results show high ratings in personal performance, the greatest significance being attributed to value-oriented competence in the actual assessment of demands on leadership. Besides gender-specific differences in the actual assessments of single fields of competence, the greatest differences between the targeted and the actual demands are, in all, shown to be in the competencies of self-management and communication. Competence-based core areas in leadership can be demonstrated for the professional development of physicians and an adaptive mode of procedure deduced.

The connection between the ratio 'efficiency of adjusted working capital' and the prognosis of future profitability is investigated on the basis of 4351 annual financial statements of corporate clients of the German savings bank Kreissparkasse Augsburg during the period 2004-2007. The results of the study indicate that consideration of the new ratio 'efficiency of adjusted working capital' improves the content of financial analyses with regard to the prognosis of future corporate profitability in comparison with most of the ratios considered up until now. Apart from this, for the period covered by the study, no correlation was found between corporate profitability and the ratio 'efficiency of adjusted working capital.'

Aim: The aim of this study was to analyse the health-related quality of life (HRQOL) of primary family caregivers in comparison to the reference values of the average population. Subjects and methods: Data collection took place in the Werra-Meißner district in 2009 with a response rate of 102 primary family caregivers of frail elderly people. The health-related quality of life was measured with the Short Form 36 health survey (SF 36) and compared with the German reference values. Results: Compared to the health values of the normative sample, primary caregivers show significantly lower rates in all dimensions of health-related quality of life. In particular, caregivers between the ages of 53 to 61 report extremely low health values. Caregiving women compared to non-caregiving women have highly significant differences in all subscales of the SF 36. Caregiving men also report highly significant differences to non-caregiving men in all dimensions of the SF 36 except for Physical Functioning and General Health (p

An increasing number of people search for health information online. During the last 10 years various researchers have determined the requirements for an ideal consumer health information system. The aim of this study was to figure out, whether medical laymen can find a more accurate diagnosis for a given anamnesisviathe developed prototype health information system thanviaordinary internet search.In a randomized controlled trial, the prototype information system was evaluated by the assessment of two sample cases. Participants had to determine the diagnosis of a patient with a headacheviainformation found searching the web. A patient’s history sheet and a computer with internet access were provided to the participants and they were guided through the study by an especially designed study website. The intervention group used the prototype information system; the control group used common search engines and portals. The numbers of correct diagnoses in each group were compared.A total of 140 (60/80) participants took part in two study sections. In the first case, which determined a common diagnosis, both groups did equally well. In the second section, which determined a less common and more complex case, the intervention group did significantly better (P=0.031) due to the tailored information supply.Using medical expert systems in combination with a portal searching meta-search engine represents a feasible strategy to provide reliable patient-tailored information and can ultimately contribute to patient safety with respect to information foundviathe internet.

The call to enlarge or merge nursing homes in order to lower costs rests on the assumption that economies of scale exist within the cost structure of these homes. Economies of scale means that an increasing number of residents will reduce the costs per person needing care. However, the existence and the extent of economies of scale as such in nursing homes are the subject of controversy because studies of this issue performed in nursing homes up to now have yielded contradictory results. In this study, researchers demonstrated economies of scale in Tyrolean, Austria, nursing homes and showed that the composition of the nursing home residents in respect to their care needs influences the development of the average costs. Changing the size of the facility and/or influencing the average care level can have a considerable influence on the progression of average costs in nursing homes. Cost reductions can be achieved by increasing the size of the facility or by improved distribution of the care levels of the persons in need of care.