Institut fr Therapieforschung Mnchen Treatment Data Collection in Germany Dr. Tim Pfeiffer-Gerschel, Dipl. Psych., PPT Legal Framework 2 German system of care for SUD General Practitioners, MDs General Hospitals, ER Psychiatric Clinics Low threshold units Treatment centres (counseling, treatment) Interfaces between in-/outpatient treatment (e.g. adaptation) Specialised Clinics (Focus on Rehabilitation) Various partners 3 German Treatment System General Practitioners, MDs General Hospitals, ER Psychiatric Clinics Low threshold units Treatment centres (counseling, treatment) Interfaces between in-/outpatient treatment Specialised Clinics (Focus on Rehabilitation) Various cultures 4 Medical system Specialised Treatment Rehabilitation German Treatment System General Practitioners, MDs General Hospitals, ER Psychiatric Clinics Low threshold units Treatment centres (counseling, treatment) Interfaces between in-/outpatient treatment Specialised Clinics (Focus on Rehabilitation) Various cultures 5 Medical system Specialised Treatment Rehabilitation German treatment system (Very simplified) Various funding sources 6 Welfare Organisations Health Insurance Pension Funds Local/Regional Government Additional funds (e.g. studies) Mixed financing scheme Various sources of information Available Hospital discharge register Statistics of national pension funds Health insurance statistics (numerous) Other (e.g. long-lasting national studies) Main limitations Not connected to each other Links very difficult to establish (data protection) 7 Current system Based on broad consensus among partners Core dataset became mandatory part of reporting embedded in various systems (funding linked to compatibility with core dataset) Large working group established many years ago, involving all relevant partners (health insurance, federal states, national MoH, treatment organisations,...) Main aim: To serve individual, regional and national needs, ensuring a common denominator 8 Core dataset 9 Information collected on centre level 10 European dataset (TDI) National dataset (KDS) Additional information Network of reporting institutions 11 Many years ago... 12 Once upon a time... Since 1978 development of a common dataset for reporting SUD treatment/counseling Model project funded by MoH Content: Information necessary for trend analyses and to measure performance of participating centres (Bundesdatensatz) Increasing pressure on centres not participating in national reporting between 1995 and 2000; parallel: development of TDI Once upon a time... But: No consensus between regarding content of the national dataset (performance indicators, too complex, too many items) Action taken in 2000 to develop a national core dataset 1998 first itemset (clients), 1999 itemset (centres), 2000 (national tables) 2007: New national itemset following a multi-disciplinary revision process 14 Development since 2000 Outpatient 15 Development since Inpatient 16 Participation by centre type 17 Einrichtungstyp rztliche oder psychotherapeutische Praxis1111 2Niedrigschwellige Einrichtung Beratungs- und/oder Behandlungsstelle, Fachambulanz Institutsambulanz2221 5Ambulant Betreutes Wohnen Arbeits-und Beschftigungsprojekt3357 7Krankenhaus/-abteilung5556 8Teilstationre Rehabilitationseinrichtung Stationre Rehabilitationseinrichtung Adaptionseinrichtung Teilstationre Einrichtung der Sozialtherapie Stationre Einrichtung der Sozialtherapie Pflegeheim Maregelvollzug Interner Dienst zur Beratung/Behandlung im Strafvollzug Externer Dienst zur Beratung/Behandlung im Strafvollzug Gesamt (Anzahl Nennungen) Reporting (back) 18 Onlinereport, focused reports 19 20 Other. 21 22 Technical Issues 23 Software solutions - certification 24 ID Coding, double-counting Analysis of aggregated data on national level only no individual data BUT: Regional solutions with interesting and even more relevant outcome NO control for double-counting beyond centre (national statistics) 25 Summary 26 Limitations Aggregated data German medical system strictly follows ICD-coding system Static data (some items measured at beginning of treatment, som at the end only very few twice and no items illustrating changes) Many different interests and funding schemes No national law nor mandatory system for participation Result of negotiations between all parties involved Large variety of regional or even local adaptations and interests 27 Strengths Long data history Inclusive approach Large number of episodes reported Possibility to build up indirect pressure Reference for documentation Very detailed information available (compared e.g. to medical documentation) Well established structures High flexibility below national level 28 Thank you very much for your attention! Dr. Tim Pfeiffer-Gerschel IFT Institut fr Therapieforschung Parzivalstrae 25, D Mnchen Tel.: 089