The care of people in need at the age of 60 years and older can place great stress and create support needs among informal caregivers. We assume that the perception and internalization of societal ideas about care and caregivers play a role in this process. However, the ideas associated with caregiving and the resulting emotional and behavioral reactions have rarely been investigated among informal caregivers. Particularly, research instruments with this focus have been lacking to date. Therefore, this project, funded by the Academy of Sciences and Humanities in Hamburg, aims to develop and validate an instrument to assess these ideas and associated emotions and behaviors regarding informal caregiving for older persons (≥60 years).

Sponsor: Academy of Sciences Hamburg, Young Academy Fellowship Individual Funding

Funding period: 2023-2024

Responsability: Professorship for Interdisciplinary Health Care Epidemiology

Sponsor: Innovationsfonds

Funding period: 2021-2024

Responsibility: Project group study data II

For old and very old people in the need of long-term home care, it is increasingly challenging to handle daily oral care and to attend routine appointments at the dentist. As frailty increases, these problems intensify. Without adequate oral care and regular control checkups, oral health deteriorates which in turn can negatively affect those systemic diseases that caused the care dependency.

However, the consequences of a discontinuation of professional dental care for oral and general health are often unknown. Moreover, there is no mandatory correspondence between general practitioners, dentists, nurses, and relatives or patients. The InSEMaP projects tries to shed light on this precarious situation of people in the need of home care and aims to improve their dental health.Factors that are associated with the dental care of ambulatory patients will be identified and corresponding health care processes will be described. An analysis of routinely collected health insurance claims data will be used to investigate associations between the need for long-term care, dental care, morbidity, and health care costs. Furthermore, examination by a dentist and radiologicdiagnostic will reveal any undiscovered oral health issues of ambulatory long-term care patients. The knowledge drawn from these results will be used to create a new health care plan for this population in which all stakeholders of the health care process are considered.

The project is funded for three years with 1.363 Million EURO in total. If the novel health care approach is successful, it could be continued to consequently achieve an improved oral health care of persons in need of ambulatory care. Due to a mutual association of oral and systemic health, this could lead to an overall increase of health and life quality of ambulatory long-term care patient

Sponser: Innovationsfonds

Funding period: 2021-2024

Responsibility: Project group study data III (Study coordination); Project group routine data I

As part of a multicenter randomized controlled trial, a multidimensional program for more par-ticipation of community-dwelling and increasingly frail persons in old age will be investigated. The aim of this program is to delay further loss of function and to improve participation. The core component of the multidimensional program is a twelve-month training program. Addi-tional components, such as counselling in issues of social participation and psychosocial is-sues as well as nutrition and home environment will be provided, if required. Accompanying to this trial, the department of health economics and health services research of the University Medical Center Hamburg-Eppendorf will estimate the intervention costs. Furthermore, a health economic evaluation will be performed. For assessing health effects, quality-adjusted life years will be calculated based on the EQ-5D-5L. Based on these, incremental cost-effectiveness ratios will be calculated and cost-effectiveness acceptability curves will be constructed.

Sponsor: Innovationsfonds

Funding period: 2020-2023

Responsibility: Project group study data I

In Germany, more than 400,000 hospital admissions per year are due to fractures of old and very old persons. These patients often suffer from functional impairment, multimorbidity or polypharmacy, which orthopaedic departments are increasingly faced with. To improve care in these geriatric patients a new health service approach of orthogeriatric comanagement has been recently implemented in several German hospitals. This project aims to analyse the influence of orthogeriatric comanagement on relevant outcomes like mortality, need of care, institutionalisation, rehospitalisation or costs in older patients after a fracture, and to conduct a health-economic evaluation. The study will be performed with routine data from a large health and long-term care insurance. The expected results will be of interest for countries with aging societies and will support the allocation of financial resources in Western health care systems.

Sponsor: Innovationsfonds

Funding period: 2020-2022

Responsibility: Project group routine data I

The project targets community-dwelling individuals aged 60-77 years who have an increased for developing dementia. The intervention consists of seven components, e.g. nutritional counseling, cognitive training, optimization of medication. By conducting a multicenter, two-armed, observer-blinded cluster-randomized controlled trail this intervention is compared to treatment as usual. Primary endpoint is cognitive performance assessed by a battery of neuropsychological tests after 24 months.

The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. Direct costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve based on the net-benefit approach.

Sponsor: Bundesministerium für Bildung und Forschung (BMBF)

Funding period: 2017-2021

Responsability: Project group study data II

Sponsor: Innovationsfonds

Funding period: 2017-2020

Responsibility: Project group study data III

Sponsor: Federal Ministry of Education and Research
Funding period: 2013-2017

Responsibility: Project group study data II , Professorship for Interdisciplinary Health Care Epidemiology

The project GeRas is a multicenter randomized controlled trial evaluating an intervention that aims to improve the sustainability of geriatric rehabilitation outcomes after discharge from inpatient rehabilitation clinics. Primary endpoints are improvement of physical function, participation and independence of the participants after returning to their homes. Participants are randomized into three study arms (2 intervention groups, 1 control group receiving regular care). The first intervention group consists of a structured training program, an interface management between the social service at the rehabilitation clinic and care managers (“Versorgungsmanager:innen”) of the health insurance company, and a structured review of the person-environment fit. These components are delivered via in-home visits and telephone calls. In the second intervention group, the same components are delivered via a telemedicine platform. The Department of Health Economics and Health Services Research of the University Medical Center Hamburg-Eppendorf is responsible for the accompanying economic evaluation of the project. This includes determining the intervention costs and analyzing the cost-effectiveness of the intervention(s). Health effects are determined by quality-adjusted life years based on the EQ-5D-5L. Health-related resource utilization is assessed via questionnaires and monetarily valued based on standardized unit costs. Results are presented as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.

Sponsor: Innovationsfond

Funding period: 2022 – 2025

Responsiblity: Project group study data I

Sponser: European Union

Funding period: 2018-2023

Responsibility: Project group study data I

Sponsor: Innovationsfonds

Funding period: 2020-2023

Responsibility: Project group study data III

Link: https://www.uke.de/barrierefreiass

In a multicenter, prospective randomized controlled trial patients with anorexia nervosa, who underwent inpatient treatment, receive 20 sessions of an individual psychotherapy, mainly delivered by videoconference, after discharge from hospital. The control group is treated by optimized treatment-as-usual. Primary efficacy endpoint is the Body Mass Index at the end of treatment after 8 months.

The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. The analysis uses data from the 14-months assessment and will be performed from the societal perspective. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve (CEAC).

Sponsor: Federal Ministry of Education and Research

Funding period: 2020-2024

Responsibility: Project group study data II

This web-based study is a three-arm observer-blinded randomized controlled trial with a six-months time horizon to assess the efficacy of feedback after depression screening. The control group only receives the depression screening, while the two intervention groups additionally receive a standard or a personalized feedback. Primary endpoint is depression severity after 6 month measured with the PHQ-9.

The Department of Health Economics and Health Services Research conducts a cost-utility analysis from the societal perspective based on interview data. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve (CEAC).

Sponsor: DLR

Funding period: 2020-2023

Responsibility: Project group study data II

The goal of IMPROVE-MH is to improve mental health in refugee families with young children. Mentally strained refugee parents (with children between 0-6 years) with Arabic language skills, who experience elevated stress, depressive or anxious symptoms are invited to take part in the study. The intervention is a 10 weeks program consisting of three aspects (4 consultations in the general practice, online parenting program and regular phone calls with a psychologist). By conducting a multicenter, two-armed, observer-blinded randomized controlled trail this intervention is compared to treatment as usual. Primary endpoints are parenting style and the mental health of parents and their child after 12 months.

The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. Direct costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve based on the net-benefit approach.

Sponsor: Federal Ministry of Education and Research

Funding period: 2019-2024

Responsibility: Project group study data II

The intervention implemented in GET.FEEDBACK.GP conducts routinely a depression screening in primary care and provides the patient and her/his primary care physician with feedback adapted to his/her specific requirements. By conducting a multicenter, three-armed, observer-blinded randomized controlled pragmatic trail this intervention is compared to feedback exclusively provided to the primary care physician and no feedback at all. Primary endpoint is depression severity assessed by the PHQ-9 after 6 months.

The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve based on the net-benefit approach.

Sponsor: Innovationsfonds

Funding period: 2019-2023

Responsibility: Project group study data II

In the project “ENHANCE”, a multi-center randomized controlled trial for the treatment of posttrau-matic stress disorder related to childhood maltreatment will be conducted. Treatment consists of out-patient trauma-focused cognitive behavioral therapy (STAIR-Exposure) or outpatient trauma-focused psychodynamic therapy (TF-PDT). Patients in the control group are on a 6-months waiting list. Outcome measures will be assessed at baseline, after 8 and 16 sessions, post-therapy as well as 6 and 12 months post-therapy.

In this context, the department of health economics and health services research will conduct an economic evaluation comparing STAIR-Exposure and TF-PDT with a control group (waiting list). Direct and indirect costs will be calculated from the societal perspective based on health care utilization, reduced productivity at work and work loss days. For assessing health effects, quality-adjusted life years (QALYs) will be calculated based on utilities derived from the EQ-5D-5L. Incremental cost-effectiveness ratios (ICER) will be calculated and cost-effectiveness acceptability curves (CEAC) will be constructed based on net-benefit regressions.

Sponsor: Federal Ministry of Education and Research

Funding period: 2019-2023

Responsibility: Project group study data I

Sponsor: Federal Ministry of Education and Research

Funding period: 2019-2024

Responsibility: Project group study data III

Depression and anxiety disorders are among the most common diseases in primary care practice. Due to the often unspecific symptoms and the frequent multimorbidity of patients in the primary care setting, diagnostics are often difficult and tedious.

The aim of the project is to make a significant contribution to better and more needs-based care for the mentally ill from primary care practice. The GP should be helped to recognize depression and panic disorders earlier and more reliably and to be able to quickly develop an adequate treatment strategy, ie to decide whether the patient has to be referred to a specialist immediately or if he can first treat himself. For this purpose, digital tools are provided that support both diagnostics and treatment. The intervention will be carried out in the trio of family doctors - medical specialist - patient and includes a 12-month, eHealth-based case management program.

A cluster randomized study compares intervention and control groups for effects on symptoms, quality of life, and care costs. In the control group, patients are treated conventionally, while in the intervention group the 12-month case management program is carried out. A qualitative study examines whether the new form of careSeite 2/2works in everyday practice in primary care and brings a noticeable improvement in care for patients and practices. If successful, it can be assumed that the new form of care can also be extended to other regions and other mental illnesses. The project will be funded for four years with a total of about 4.9 million euros.

Sponsor: Innovationsfonds

Funding period: 2018-2022

Responsibility: Project group routine data II

Sponsor: Innovationsfonds

Funding period: 2017-2020

Responsibility: Project group study data III

COMET is a cluster randomized controlled intervention trial. The aim is to evaluate a multi-profes-sional, integrated and stepped health care model for primary care patients with depressive, anxiety, somatoform and/or alcohol abuse disorders. Primary care patients in the control group will receive standard care. Data collection is carried out as telephone interviews at four measurement points within one year (baseline, 3, 6, and 12 months post baseline). In this context, we perform an economic evaluation of COMET compared with standard care. Direct and indirect costs will be calculated from the societal perspective based on health care utilization, reduced productivity at work and work loss days. For assessing health effects, quality-adjusted life years (QALYs) will be calculated based on utili-ties derived from the EQ-5D-5L. Based on these, incremental cost-effectiveness ratios (ICER) will be calculated and cost-effectiveness acceptability curves (CEAC) will be constructed.

Sponsor: Federal Ministry of Education and Research

Funding period: 2016-2021

Responsibility: Project group study data I

Sponsor: Innovationsfonds

Funding period: 2021-2024

Responsibility: Project group study data II

The pilot project StroCare involves the implementation and evaluation of cross-sectoral acute inpatient stroketreatment followed by neurological rehabilitation. The main advantage when compared to usual care is the explicitmanagement of the transition between acute treatment and subsequent rehabilitation. This transition isfacilitated by case-managers of the statutory health insurance company and an electronical portal solution,which supports the transfer of clinical data between providers.

The institute of health economics and health service research will determine how the costs for stroke carechange when compared to usual care. To that end, routine claims data of the statutory health insurance companyBarmer will be analyzed. Costs will also be assessed by sector to identify changes in individual cost segments(i.e. inpatient and outpatient costs, care expenses, costs for medications and remedies). To ensure comparabilitybetween groups, Entropy balancing will be used, in order to balance treatment and control group withrespect to sociodemographic and clinical sample characteristics. Subsequently, the costs in the different segmentswill be compared by employing two-part models and generalized linear models – with a difference in differenceapproach. To assess specific parameters of utilization such as the number of hospital days, count models(e.g. negative binomial models) will be employed.

Sponsor: Innovationsfonds

Funding period: 2019-2022

Responsibility: Project group routine data II Project group routine data I

In the course of the project, a concept for a collaborative cross-professional and cross-sectoral case conference (KOPAL) for patients with severe congestive heart failure, advanced COPD and dementia will be developed. Based on a prospective multicentric cluster-randomized controlled intervention trial, the effectiveness, plausibility and acceptance of KOPAL in routine care will be investigated.

In this context, the department of health economics and health services research will conduct an eco-nomic evaluation in the form of a cost-effectiveness analysis, in order to compare costs from a societal perspective with effects of KOPAL and care as usual. Thereby, the effects will be measured by quality-adjusted life years gained based on EQ-5D-5L index values. Uncertainties in cost-effectiveness on the basis of different willingness to pay thresholds will be assessed based on the net-benefit approach using generalized linear mixed models, in order to adjust for sociodemographic differences and differ-ences in clinical parameters.

Sponsor: Innovationsfonds

Funding period: 2019-2022

Responsibility: Project group study data I

In Germany, 4.5 million adults currently have peripheral arterial disease (PAD). The disease has a serious impact on health and quality of life. 75 percent of those affected die from the consequences. The aim of the project is therefore to stop the progression of the disease, to improve walking impairment, to avoid amputations and to reduce hospital stays and thus care costs. Other goals include increasing the patient's quality of life as well as improving health literacy, patient activation and adherence.

PAD patients who have been diagnosed with stage IIa and IIb PAD in the past 12 months can participate in the coaching program. You will receive an activity tracker (fitness wristband) that records the walking distance and any heart rate and transmits it to health coaches trained in telemetry. Based on this data, they advise patients on pAD and support them in their daily walking training, which was created by the attending doctor. Since PAD with concomitant diseases and risk factors, such as B. Coronary heart disease, high blood pressure, diabetes, obesity and smoking, the coach motivates for lifestyle adjustment and therapy adherence. The measures are ultimately intended to change behavior.

A prospective randomized controlled study with a total of 2,244 participants was carried out to measure the effects. In particular, it is checked whether health coaching reduces care costs. Questionnaires are also used to examine whether quality of life, health literacy, activation and adherence to therapy can be positively influenced. The project will receive a total of around seven million euros for four years.

If successful, health coaching can continue to be offered on a selective contract basis. In addition, the telemedical solution can also be used for other diseases and indications.

Sponsor: Innovationsfonds

Funding period: 2017-2021

Responsibility: Project group routine data II

Sponsor: Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK)

Funding period: 2017-2021

Responsibility: Project group study data II

Around 40 percent of people over the age of 75 in Germany suffer from cardiovascular diseases; it accounts for more than half of all deaths in this age group. In particular, the frequency of progressive heart valve disease and coronary heart disease increases with age. Older people with multiple diseases are also at increased risk for heart surgery, which often involves a long recovery period. Only about half of the patients are able to leave the hospital directly after such an operation; every tenth person affected requires long-term care.
A cardiac rehabilitation program is particularly advisable for people who have suffered a heart attack, have cardiac insufficiency or coronary artery disease. However, it can be just as useful to prepare patients over the age of 75 in a targeted manner for an upcoming major heart surgery. Such a cross-sectoral two-week "prehabilitation program" is to be developed and evaluated in the PRECOVERY project. The program examines whether the health of the patients participating in the prehabilitation measure called "Karl-Heinz" (Kognitiv & cArdiale PRehabiLitation vor HErZINterventionen) improves in the following year compared to the participating control group.
In addition, health economic aspects are taken into account and the intervention costs of the program are determined. The project is designed as a randomized controlled study in which 211 patients are randomly assigned to an intervention group and a control group. Eight cardiological/cardiosurgical specialist centers throughout Germany are taking part. The project will be funded for four years with a total of around 5.3 million euros.
If successful, the postoperative recovery process can be supported and accelerated and the program can be included in standard care. This would improve overall cardiac care.

Sponsor: Innovation Fund

Funding period: 2022-2026

Responsibility: Project group routine data II

The InterResilience project explores different understandings of resilience, particularly in the various social science disciplines that have adopted the term. Resilience is broadly understood in terms of adaptive response(s) to stresses of different kinds. InterResilience explores the concept(s) as a framework for improved crisis management and as a means to analyze how complex adaptive systems (from the individual to social and social-ecological systems) respond to stresses such as natural catastrophes, climate change, and societal transformations that cause ruptures in local environments. Further, the project aims to identify mechanisms of resilience in different contexts, from economic crises and political instability to demographic change and public health pandemics, while also addressing how the politics of resilience tap into a neo-liberal way of conceptualizing individual responsibilities for daily life and one’s own wellbeing.

Sponsor: Lund-Hamburg Funding Programme 2023-2025

Funding period: 2023-025

Responsibility: Professorship for Interdisciplinary Health Care Epidemiology

Description: Climate change is associated with an increase in weather conditions that affect health. The aim of this retrospective cohort study is to investigate the effects of weather conditions on health, as well as to assess health attributable to weather conditions. Merging health insurance claims data and weather data enables an investigation at patient level where individual characteristics such as age, sex and care dependency, as well as pre-existing and current health conditions can be considered. We will use a broad and representative population sample to find associations between weather and health by using multilevel machine learning methods (WP 1). Based on these results, we will create a risk prediction tool based on both weather and health conditions to assess the risks for vulnerable groups and forecast health service use during health-affecting weather condition periods (WP 2). Furthermore, mortality, hospital admissions, sick leave days, DALYs and health care costs, that are directly attributable to weather conditions (“excess” effects), will be identified and separated from time trends and seasonal effects (WP 3) by applying the following analyses: Time-series analysis of persons over time and related weather conditions, and cross-sectional comparisons of all persons between periods with relevant and average weather conditions will be carried out.
We expect to reveal partly unknown associations between weather and health in Germany. The risk prediction tool will identify relevant weather conditions and vulnerable groups and assign risk scores accordingly, and may help to establish preventive lifestyles and forecast health service use. Moreover, we expect to estimate the amount of excess health care use, mortality, sick leave days and health care costs attributable to certain weather conditions.

Funding: German Federal Ministry of Education and Research

Funding period: 2023-2028

Responsibility: Project group routine data I

Climate change causes weather conditions of higher intensity and longer duration, which negatively affect population health. In this research project we investigate the associations between weather conditions and mortality, morbidity as well as health care costs in German inpatient care using data of the German Meteorological Service and the Diagnosis-related Group (DRG) statistic of 2010 - 2019 provided by the Federal Statistical Office of Germany. The latter offers a comprehensive, anonymized quantitative description of all German hospital cases in the observation period. Owing to the rich data, advanced statistical methods such as Generalized Linear Models can be applied, accounting for weather conditions as well as regional clusters. We will identify the excess health outcomes and health-economic burden of hospital admissions attributable to weather conditions, thereby enriching and further emphasizing discussion regarding climate change and climate change adaption with epidemiological and health-economic findings.

Sponsor: Forschungsförderungsfonds der Medizinischen Fakultät des UKE

Funding period: 05/2022 – 04/2023

Responsibility: Project group routine data I

Sponsor: Innovationsfonds

Funding period: 2021-2024

Responsibility: Project group routine data I ; Project group routine data II

In the course of the pilot project i2TransHealth, a cross-sectoral, interdisciplinary and internet-based healthcare program for people with transgender (TG: ICD-10) and/or gender dysphoria (GD: DSM-5) will be established. The program shall reduce structural disadvantages for treatment seekers in regions with a lack of health care coverage. In the context of a prospective randomized-controlled intervention trial, the reduction of symptom severity of patients by establishing an initial access to expedient care through primary care physicians and specialist physicians located nearby will be investigated.

In this context, the department of health economics and health services research will conduct an economic evaluation of the i2TransHealth project compared with a control group (waiting list). Thereby, excess costs of TG and/or GD compared with the German general population will be determined. Health care utilization of the German general population and of people with TG and/or GD will be contrasted by means of entropy balancing. Differences between both will be determined by general-ized linear models and two-part models. Furthermore, a cost-effectiveness analysis based on quality-adjusted life years (QALY) gained will be conducted. The probability of cost-effectiveness will be calculated based on the net-benefit approach using generalized linear models.

Sponsor: Innovationsfonds

Funding period: 2018-2020

Responsibility: Project group study data I

Sponsor: European Union

Funding period: 2018-2020

Responsibility: Project group study data III

Funding period: 2017-2020

Responsibility: Project group study data I