Institut für Health Care & Public Management

Permanent URI for this collectionhttps://hohpublica.uni-hohenheim.de/handle/123456789/25

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Embracing digital health: German otolaryngology patients’ usage and prospects of digital information and communication technologies for cross-sectoral care
(2024) Holderried, Martin; Hoeper, Ansgar; Stauss, Leonie; Holderried, Friederike; Herrmann-Werner, Anne; Kestler, Hans A.; Ernst, Christian; Baerhold, Friederike; Becker, Sven
Objective: The usage of digital information and communication technologies in European healthcare is growing. Unlike numerous technological possibilities, the present use of these technologies and perspectives towards them in relation to otolaryngology care have so far been of less interest. This study evaluates the utilisation of and attitudes towards digital information and communication technologies in cross-sectoral otolaryngology care among German patients. Methods: A structured interview-based study was conducted at the outpatient facility of a tertiary hospital in Germany. It focused on chief complaints, current use of digital technologies, estimated benefits of increased digital technology use in otolaryngology care, and sociodemographic data. The detailed statistical analysis employed Chi-squared tests and multivariate logistic regression. Results: A total of 208 otolaryngology patients completed the interview. Digital communication technologies exhibited a high penetration rate (91.8%) and were regularly used in daily life (78.7%) and for health reasons (73.3%). Younger age ( p ≤ 0.003) and higher education levels ( p ≤ 0.008) were significantly correlated with the increased digital communication technology use. The overall potential of eHealth technologies was rated significantly higher by younger patients ( p ≤ 0.001). The patients’ chief complaints showed no significant influence on the current and potential use of these technologies for cross-sectoral otolaryngology care. Conclusion: Regardless of their chief complaints, German otolaryngology patients regularly use digital information and communication technologies for health reasons and express interest in their further use for cross-sectoral care. To enhance digital patient communication in otolaryngology, attention should be given to treatment quality, usability, data security and availability and financial remuneration for service providers.
The long-term cognitive and schooling effects of childhood vaccinations in China
(2024) Oskorouchi, Hamid R.; Sousa-Poza, Alfonso; Bloom, David E.
By exploiting rich retrospective data from the China Health and Retirement Longitudinal Study on childhood immunization, socioeconomics, and health status, we assess the long-term effects of childhood vaccination on cognitive and educational outcomes in China. Applying an instrumental variable approach that resembles an unobserved natural experiment to different sets of control variables and subsamples, we estimate the average and local treatment effects of childhood vaccination. Our results confirm that immunization before the age of 15 has long-term positive and economically meaningful effects on non-health outcomes such as education and cognitive skills. These effects are strong, with vaccinated individuals enjoying about one additional year of schooling and performing better on several cognitive tests later in life. Finally, a causal mediation analysis shows that, although education mediates the effect of childhood immunization on later-life cognitive abilities, other factors (e.g., better child health) are more responsible for these long-term effects.
Selektivverträge in der medizinischen Versorgung
(2017) Arnegger, Silke; Ernst, Christian
In the past fifteen years, Germany has introduced several types of medical care and cooperation opportunities between actors in the healthcare market. The gatekeeper model known as Hausarztzentrierte Versorgung (HZV) is a primary physician model and is an example of selective or individual contracting that is now possible between physicians in private practice and health insurance companies. It is also an example of new policy instruments intended to increase competition in the healthcare system (e.g. between insurance companies, amongst physicians in private practice). Increased competition should lead to improvements in the quality of patient care and economic efficiencies in the provision of that care. The latter is an especially important goal in light of the fact that there are a growing number of patients with chronic diseases. Selective medical care contracts like the HZV are situated at this pivot point. Going forward, German health insurance companies and other healthcare market actors – in particular, physicians in private practice – are allowed to enter into individual contracts for the provision of medical care to a group of patients. For this purpose, physicians specializing in a particular field mandate their professional associations to negotiate contracts. Thereafter physicians who want to participate in these contracts can offer the applicable provisions to their patients. Previously, all insurance companies and all registered doctors in private practice were required to enter into collective agreements. Contracts like the HZV mean it should now be possible to study the individual patient care models of different health insurance companies and offer medical care that is better tailored to patients. Additionally, these contracts should encourage communication amongst different actors in the healthcare system and incentivize their behaviour to generate efficiencies. This empirical study aims to explain whether the HZV, namely the selective contracts for primary care physicians in the state of Baden-Württemberg, contain the right incentives for participating doctors (agents) to produce efficient results for the insurance companies with which they have contracted (principals). Data on the quality and efficiency of care provided under these contracts is compared to data on their financial impact on participating doctors. New Institutional Economics inform the theoretical framework used in this study. Its theories of social contract, especially agency, and transaction costs play a central role in interpreting and analysing the data collected. Many studies of selective contracting in the field of healthcare economics focus on legal issues arising from actual and proposed changes to the law. By providing an empirical healthcare oriented economic account of such contracts for primary care physicians in Germany, this study supplements that literature with data and analysis that has been lacking on this important development.
Unleashing the potential of eHealth in outpatient cancer care for patients undergoing immunotherapy—a quantitative study considering patients’ needs and current healthcare challenges
(2024) Holderried, Tobias A. W.; Stasik, Isabel; Schmitz, Marie-Therese; Schmitz, Friederike; Meyer, Tizian K.; Stauß, Leonie; Kirschner, Martin; Skowasch, Dirk; Landsberg, Jennifer; Schmid, Matthias; Brossart, Peter; Holderried, Martin
Background: The use of online information and communication is globally increasing in the healthcare sector. In addition to known benefits in other medical fields, possible specific potentials of eHealth lie in the monitoring of oncological patients undergoing outpatient therapy. Specifically, the treatment with immune checkpoint inhibitors (ICI) requires intensive monitoring due to various possible negative side effects. The present study explores cancer patients’ perspectives on eHealth and demonstrates how eHealth applications, from the patients’ point of view, can contribute to further improving outpatient immunotherapy. Methods and findings: Our multicenter study was executed at the university hospitals in Bonn and Aachen. A structured questionnaire was distributed to patients receiving outpatient immunotherapy. Contents addressed were (1) the patients’ attitude towards eHealth applications, (2) the use of modern information and communications technologies (ICT) in (2a) everyday life and (2b) health-related information search including eHealth literacy, (3) the use of internet-enabled devices as well as (4) socio-demographic data. 164 patients were included in the study, of whom 39.0% were female and 61.0% male and the average age was 62.8 years. Overall, there was a high distribution of internet-enabled devices for everyday use and a great interest in integrating eHealth applications into outpatient immunotherapy. The assessment of eHealth potentials significantly depended on age. The younger participants demonstrated a broader use of modern ICT and a higher affinity for its use in outpatient immunotherapy. In some aspects, level of education and gender were also relevant factors influencing the patients’ view on eHealth. Conclusion: This study demonstrates the potential for further integration of eHealth applications into outpatient immunotherapy from the patients’ perspective. It indicates a dependency on age and educational level for the further integration of eHealth into patient care in oncology. Due to particular patient needs regarding age, level of education, gender and other subgroups, specific education and training as well as target-group specific digital health interventions are necessary to fully utilize the potentials of eHealth for outpatient immunotherapy. Future studies are required to specifically address target-group specific usability of eHealth applications and eHealth literacy, as well as to address information security and data protection.
Workplace stressors and burnout among healthcare professionals: Insights from the pandemic and implications for future public health crises
(2025) Daneshvar, Elahe; Otterbach, Steffen
This study evaluates the prevalence of burnout among healthcare professionals (HCPs) during the COVID-19 pandemic in Iran and examines its association with key occupational stressors (workload, job control, and leadership communication). Furthermore, it proposes relevant organisational interventions for future pandemic preparedness. A cross-sectional survey of HCPs (N = 723) was conducted in four hospitals in Tehran during the third peak of the COVID-19 pandemic in Iran, including the Copenhagen Burnout Inventory and items on perceived workload, job control, and leadership communication. The study found that 67.41% of HCPs reported substantial symptoms of burnout (moderate-to-high burnout, i.e. CBI ≥ 50), with a mean score of 59.6 points. The prevalence of burnout (CBI ≥ 50) was prominent across all three dimensions—personal, work, and patient-related—at 72.86%, 69.87%, and 65.37%, respectively. The analysis demonstrated significant associations between burnout and the three foundational workplace stressors. Multivariate linear regression analysis showed that frontline, female, and married HCPs reported the highest levels of burnout. This study provides practical implications for healthcare organisations and policy makers, highlighting the need for targeted organizational interventions that could mitigate burnout during ongoing and future health crises.

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