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Abstract

According to SGB XI § 69, long-term care in Germany should be organised according to need. A particular challenge here is the increasing need for long-term care, especially due to age-related illnesses such as dementia. For those affected, this is associated with in-creasing restrictions on activities of daily living and usually leads to a need for care. Dementia is one of the most common diagnoses requiring nursing care. In Baden-Wuerttemberg, the aim is to meet these challenges with data-based care planning that is orientated towards regional care needs in accordance with the “Gesundheitsleitbild”. Particularly over the last two decades, administrative data from health and long-term care insurers throughout Germany has been increasingly made available and their potential for use in regionalised analyses, especially for medical care, have been developed. The growing number of data sources and indicators present local decision-makers with the challenge of selecting relevant indicators for policymaking. However, studies also show that data availability alone is not enough for policymaking to be data-based. And even if reports are available, there is little knowledge about how decision-makers use and read these quantitative data reports, a common format in which data is provided. This dissertation explores the potential of data-based policymaking in Baden-Wuerttem-berg using the example of needs-based long-term care for people with dementia. To this end, it was investigated (1) which data decision-makers consider relevant for regional policymaking in this area, (2) which data is available, in particular for assessing the need for care and its adequacy on a small-area level, and (3) how this data is used in the format of a report by individual decision-makers. Indicators on the absolute and relative fre-quency of dementia and comorbidities, on care utilisation, and on existing care services were identified as relevant indicators from the perspective of decision-makers in an online survey. The estimation of regional care needs on the basis of secondary data revealed differences between the administrative districts, both in absolute terms and relative to the size of the population. It was found that access to long-term homecare is fundamentally orientated towards need factors such as comorbidity and age. In addition, access to care was to a lesser extent also linked to factors such as sex, nationality and the density of outpatient care services. It could not be clearly determined whether there also is a relation between access to care and the social status of the place of residence of persons with dementia. A quantitative data report on care needs and services as part of a hypothetical decision scenario was generally read in full, but less attention was paid to the methods section. When prioritising the different care settings in the hypothetical allocation of financial resources, other sources of knowledge and personal aspects played a role along-side the information from the report. Also, an attempt was made to adopt different perspectives when making the decision. Overall, it was found that for data-based regional care planning the necessary information on the care needs of people with dementia and whether this care is equitable is available, however with significant data gaps. Available data on the care situation of people with dementia is used in regional settings, but it is unclear to what extent this goes beyond pilot projects. Finally, there are indications that information on data quality plays a subordinate role for (future) decision-makers.