Vortragssitzung
Effizienzmessung im Gesundheitsbereich
Vorträge
Assessing telemedicine efficiency in German follow-up care - A randomized controlled trial of video consultations for orthopedics and trauma surgery patients
Jennifer Muschol
Einleitung / Introduction
Telemedicine can help mitigate important healthcare challenges, such as demographic change and the current COVID-19 pandemic, in high-income countries like Germany. It gives physicians and patients the opportunity to interact via video consultations regardless of their location, thus offering cost and time savings for both sides. This study aims to investigate whether telemedicine can be implemented efficiently in the follow-up care for orthopedics and trauma surgery patients with respect to patient satisfaction, physician satisfaction, and quality of care.
Methode / Method
A prospective randomized controlled trial conducted in a German university hospital enrolled 60 patients with different knee and shoulder conditions. For their follow-up appointments, patients received either an in-person consultation in the clinic (control group) or a video consultation with their physician (telemedicine group). Patients’ and physicians’ subsequent evaluations of these follow-up appointments were collected and assessed using separate questionnaires.
Ergebnisse / Results
Based on data from 52 consultations, it was found that patients were slightly more satisfied with video consultations than with in-clinic ones, although the difference was not statistically significant. After excluding video consultations marred by technical problems, no significant difference was found in physician satisfaction between the groups. Further analysis indicated that telemedicine can be applied to broader groups of patients, and that patients who have prior experience with telemedicine are more willing to use it for follow-up care.
Zusammenfassung / Conclusion
Telemedicine can be an alternative and efficient form of follow-up care in orthopedics and trauma surgery in Germany, and it has no significant disadvantages compared with in-person consultations in the clinic.
AutorInnen
Jennifer Muschol, Justus-Liebig-Universität Gießen
Christian Heiß
Ulrich Thormann
Kai Unzeitig
Henning Schneider
Johanna Uhlar
Christian Gissel
Determinanten und Auswirkungen von Geschäftsführungswechseln im Krankenhaus
Marius Hermes
Einleitung / Introduction
Chief Executive Officers (CEOs) shape the strategic direction and development of the hospitals they manage and thus make a significant contribution to their long-term sustainment and success. Wrong decisions or a lack of consistency in goal setting can have substantial consequences. Remarkably, the average annual CEO turnover rate in the German hospital market has been approximately one quarter over the last ten years, which is significantly higher than in other countries. High turnover rates among CEOs in the hospital and other sectors have been shown to be associated with several negative consequences, including deterioration in employee morale, patient care, and financial performance. Yet, the determinants and impact of hospital CEO turnovers have not been fully investigated. Especially findings regarding the impact of hospital CEO turnover on efficiency and patient satisfaction are scarce. Methodologically, most studies have relied on cross-sectional data so far, limiting causal inference. The purpose of this study is to bridge this research gap by empirically investigating the antecedents and consequences of hospital CEO turnover using a longitudinal dataset.
Methode / Method
This study draws on a comprehensive longitudinal dataset of 850 German hospitals from 2014 to 2018 and is mainly based on the annual financial reports, the mandatory quality reports, and data from the patient experience questionnaire. The Study proceeds in four steps: Calculating efficiency scores using data envelopment analysis; examining the determinants of CEO turnover using logistic regression; constructing a control group consisting of hospitals with similar structures and no CEO turnover using propensity score matching; and comparing changes in different outcomes like efficiency, patient satisfaction, and financial metrics between treatment and control group at different periods, applying a difference-in-differences approach.
Ergebnisse / Results
Preliminary results indicate that for-profit hospitals have a significantly higher CEO turnover rate compared to public and non-profit hospitals. Furthermore, poor financial performance measured by the EBITDA margin is a significant indicator for a pending turnover of CEOs. Regarding the effects, CEO turnover in hospitals has significant negative effects on efficiency and patient satisfaction. In addition, significant negative effects of CEO turnover on financial ratios such as ROA and EBITDA margin were also identified. Our results suggest that the effect sizes decrease over time.
Zusammenfassung / Conclusion
In summary, CEO turnover in hospitals exhibits negative effects on performance, especially in the early years. Given this background, and taking into account the high turnover rate of CEOs in German hospitals, there are several implications for practice and research.