The authors express their thanks for the readers’ responses to our article (1). PD Dr Schmitz considers the methods of the evaluation as weak since no randomized controlled trial was undertaken—unfortunately he did not discuss the chosen control group design—which was the best we could do under the circumstances. It is not correct that the “creators” (of integrated care, [I.S.]) themselves defined the quality criteria. The role of Gesundes Kinzigtal GmbH as the lead management body was dictated by the conditions associated with receiving funding from an innovation fund, whereas the evaluation was done independently by an evaluation team—the authors of the publication. The study objective was to investigate the quality of care. On the background of the shared savings contract it was of interest whether savings were made to the detriment of quality. The data did not indicate any such trend. We did not plan to carry out an evaluation in terms of health economics—the “second objective” named by Dr Schmitz therefore did not exist. Dr Schmitz explains that these data constitute the blueprint for the project Gesundheit in Billstedt/Horn in Hamburg. This is not the case as the project Billstedt/Horn received funding independently of the present evaluation.
Prof. Dr. Dr. Härter expresses regret that the evaluation took into consideration data only as far back as 2015. The routine data we used are available for scientific analyses much later than the real-life correlates (health services rendered) are generated. As far as we are aware, the number of members and partners in the integrated model Gesundes Kinzigtal did not expand notably. We therefore assume that even if data from additional years were included the results would not have changed substantially. Prof Härter emphasizes activating patients as the most important building block in the integrated care concept Gesundes Kinzigtal. This was something we did actually point out, including the fact that the associated parameters cannot be reproduced by using routine data. The objective of our study was to investigate the aspect of care quality on the basis of a wide set of indicators with routine data. Process indicators dominated, but only 39 of the 101 indicators related to pharmacotherapy. As far as quality indicators were affected by the general practitioner contract (family doctor centered health care), this was taken into account. For our evaluation, the comparator was “usual care,” and this entails care provision in the context of the GP contract. Any integrated care program will need to face up to this comparison. As we explained in our publication, a complex intervention such as “Gesundes Kinzigtal” requires a different set of evaluation methods in order to consider—for example—patient relevant experiences and results. We therefore fully agree with Prof. Härter that further evaluation studies are still needed.
On behalf of the authors
Dr. rer. soc. Ingrid Schubert
PMV forschungsgruppe an der Klinik und Poliklinik für Psychiatrie,
Psychosomatik und Psychotherapie des Kindes- und Jugendalters,
Medizinischen Fakultät und Uniklinik der Universität zu Köln
Prof. Dr. med. Max Geraedts
Institut für Versorgungsforschung und Klinische Epidemiologie,
Fachbereich Medizin, Philipps-Universität Marburg
Conflict of interest statement
Dr Schubert was involved in the evaluation of the IVGK set-up phase between
2008 and 2014, which was funded by third-party funds from AOK Baden-Württemberg and Gesundes Kinzigtal GmbH.
Prof. Geraedts declares that no conflict of interests exists.
|1.||Schubert I, Stelzer D, Siegel A, et al.: Ten-year evaluation of the population-based integrated health care system „Gesundes Kinzigtal“. Dtsch Arztebl Int 2021; 118: 465–72 VOLLTEXT|