[Changes in number of emergency medical service deployments in an urban area during the first COVID-19 pandemic-related contact restriction phase]. / Veränderungen der rettungsdienstlichen Einsatzzahlen in einer Metropolregion während der ersten COVID-19-Pandemie-bedingten Kontaktbeschränkungsphase.

Background: To contain the coronavirus disease (COVID-19) pandemic, public life was reduced through contact restriction measures (referred to as "lockdown" in the further course for reading simplicity), among other things to make health system resources available for the treatment of COVID-19 patients. In parallel, a decrease in emergency patients was observed in the public health system. Methods: For two 10-week periods before and during the lockdown, ambulance service deployment rates were analysed in 6 ambulance service areas for 6 tracer diagnoses. Random effects were minimised by comparing the results with the corresponding 2018 and 2019 time periods and a calculated expected value. Results: For emergency ambulance service calls, there was a reduction in call numbers (-16%) during the lockdown. A 20% reduction for the categories cardiac and cerebral ischaemia was found. In the urban area, the reduction in cardiac ischaemia was less pronounced at 14% than in the surrounding area at 23%. The deployment figures for intoxications decreased by 27% and for psychiatric emergencies by 16%. Conclusion: The public ambulance service was not overwhelmed by the COVID-19 pandemic; there was a decrease in depolyments during the lockdown. For the reduction in cerebral or cardiac ischaemias, the explanatory models for the influence of the lockdown are missing. Further studies on the utilisation behaviour of the ambulance service during a lockdown appear necessary in order to detect potentially fatal reductions in utilisation for the patient outcome and to be able to counteract them through education.

[Contract of the German Health Insurance AOK Hessen Concerning Prolonged Weaning-Methods and First Experiences]. / Vertrag zur prolongierten Beatmungsentwöhnung der AOK Hessen-Methodik und erste Erfahrungen.

INTRODUCTION: In recent years, the number of patients requiring mechanical ventilation has increased steadily. In some cases, weaning is not successful. These patients depend on home mechanical ventilation and intensive outpatient care. Surprisingly, most of these patients were never treated in a weaning center. Thus, weaning might still be possible in at least some of them. Health insurance companies have recognized this problem. METHODS: AOK Hessen, a major health insurance company in the German federal state of Hesse, identified some starting points for improvement after having surveyed their patients in ambulant intensive care. Principal points for future measures are expertise of the treating medical center (weaning experience, weaning center), establishment of new centers for homecare ventilation for long term therapy of these patients and a coordinated follow up. RESULTS: Centers for homecare ventilation are wards with a non-hospital atmosphere affiliated to a weaning center. The main focus here is not weaning itself but daily physical and speech therapy. Patients in home care ventilation centers have time (up to 6 months) to improve their physical and mental strength. Afterwards, depending to their development, they can be transferred to the weaning center again. DISCUSSION: In this paper, we introduce the concept of the home care ventilation centers. Initial data suggests that home care ventilation centers can contribute to successful weaning.

[An outcome-oriented quality management strategy for the inpatient rehabilitation of orthopedic patients--towards an empirically based "best practice"]. / Outcome-orientiertes Qualitätsmanagement in der orthopädischen Rehabilitation--Auf dem Weg zu einer empirisch begründeten "best practice".

This paper presents the development and testing of an outcome-oriented quality management system for the inpatient rehabilitation of orthopaedic patients, with a special focus on the indication of knee-replacement. On the level of outcomes we describe the development of appropriate indication-specific outcome indicators, capable of being used to rank the performance of hospitals. With regard to the process-quality of the empirical analysis of the rehabilitative-therapeutic services possibilities and limitations are shown. Furthermore an inkling of the shape that an expert-consent-based base of evidence for identifying best practice--arrived at by using primary empirical findings--might assume is presented. The procedure for establishing the latter offers a methodical approach toward continuous quality development of orthopaedic inpatient rehabilitation, one that is characterised by guidelines and performance transparency. Development potentials are recognised in the formal and the content quality of the therapeutic services.