Successful health services research at the Charité

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Innovation fund supports nine further research projects

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Berlin, 23.06.2022

The Innovation Committee at the Federal Joint Committee (G-BA) supports a total of 50 new projects in the field of health services research and medical guidelines. Charité – Universitätsmedizin Berlin is coordinating nine of these projects. Three Charité projects are concerned with the development of medical guidelines to improve the care of target groups with special needs – such as children, adolescents, the elderly and people in need of care. Six other projects on health services research deal with the evaluation of digital health care and data-based decision-making. In addition, the Charité is involved in three other projects in the field of health services research as a partner institution.

The Federal Joint Committee (G-BA) uses the resources of the Innovation Fund to support projects that go beyond the previous standard care provided by the statutory health insurance funds. With the new funding decisions, 32 open-topic and topic-specific health services research projects will be funded, as well as a further 18 projects that will develop or further develop medical guidelines.

„The newly funded projects at Charité are dedicated to the topics of care for all age groups, which will become increasingly important in the future – such as preventive approaches to avoid the need for care or to reduce complications,“ explains Prof. Dr. Elke Schäffner, spokesperson for the Platform – Charité Health Services Research. „Personalised treatment paths are increasingly coming into focus. In order to achieve the precision required for this and to offer decision-making aids, it is essential to bring together individual medical information and to take into account the treatment experiences of all healthcare professionals. Supported by digital technologies, this results in numerous possibilities to include all necessary perspectives – not least those of the patients – in the process and thus to further optimise decisions in everyday care“.

The following projects led by the Charité are funded by the Innovation Fund (in alphabetical order):

Medical guidelines

FrailtyOP: Perioperative care of frail patients (guideline development)

Due to the increasing life expectancy of the population and medical progress, more and more complex surgical interventions are being performed on elderly and frail patients. Up to 50 percent of people over 65 years of age on surgical wards suffer from the so-called frailty syndrome. Among other things, those affected are limited in their mobility and muscle strength. At the same time, they have a significantly higher risk of developing complications such as infections or long-term mental and physical impairments after an operation and of becoming dependent on nursing care. The risk of dying in the first year after an operation is also up to five times higher for those affected than for patients who are robust in health. In the FrailtyOP project, a guideline for the care of patients with frailty syndrome is to be developed for the first time. The aim is to introduce a gold standard for recording the clinical picture, to identify optimal treatment instruments and to define standards for the perioperative treatment of those affected – before, during and after an operation. After the guideline has been used and quality controlled in everyday clinical practice, it will finally be published in the database of the Association of the Scientific Medical Societies (AWMF).

Project management: Prof. Dr. Stefan Schaller, Deputy Director of the Clinic for Anaesthesiology with a focus on Operative Intensive Care Medicine, Campus Virchow-Klinikum and Charité Campus Mitte

S3 LL AA: Diagnosis and therapy of alopecia areata (S3 guideline)

Alopecia areata (circular hair loss) is a localised, immune-mediated skin disease that already occurs in childhood and adolescence – acutely or also chronically – and can lead to a complete loss of head, facial and body hair. The visible hair loss is associated with enormous emotional and psychosocial stress for the affected children, adolescents and young adults. So far, there are no scientifically sound diagnostic and therapeutic recommendations for these age groups. This is to be remedied by an evidence-based S3 guideline, which can serve as a decision-making aid for treating physicians for the diagnosis and therapy of the different forms of alopecia areata. The development of the guideline follows the rules of the Association of the Scientific Medical Societies in Germany (AWMF): Regular meetings of a guideline group with high-ranking experts from different fields of work – such as experts in the fields of dermatology, paediatrics and psychosomatics, social workers, hairdressers and self-help groups – will take place. A systematic search, selection and methodological evaluation of the results of existing studies will then provide the basis for the recommendations, which will be adopted after an external review and summarised in the guideline document. The new guideline should contribute to supporting both practitioners and patients in individual decision-making and thus to optimally treat alopecia areata at an early stage, according to age and stage.

Project management: Prof. Dr. Ulrike Blume-Peytavi, Deputy Director of the Clinic for Dermatology, Venereology and Allergology and Director of the Clinical Research Center for Hair and Skin Science (CRC), Charité Campus Mitte

TransitADI: Transition of young people with obesity from paediatrics to adult medicine (S3 guideline)

The transition to adulthood is characterised by far-reaching physical and psychosocial changes and demands increasing personal responsibility from adolescents. For young people with obesity, these developmental changes are a particular challenge. They often experience stigmatisation and discrimination due to their disease and are restricted by the disease-related characteristics. In addition, adolescents have to take responsibility for their own health and change medical care systems. The development of the S3 guideline in the TransitADI project is intended to help structure and standardise the treatment of young people with obesity and their transition from paediatric care to adult medicine. In this way, continuous multiprofessional care and treatment can be ensured in the vulnerable phase of life from adolescence to young adulthood. Since obesity is associated with a variety of concomitant diseases, the new guideline will compare relevant guidelines on the one hand and address contradictions in the recommendations on the other.

Project management: Dr Susanna Wiegand, Social Paediatrics Centre, Campus Virchow-Klinikum; Dr Antje Tannen, Institute for Clinical Nursing Science, Charité Campus Mitte

Health services research

Digi-POD: Digitalised clinical decision support for the prevention of postoperative delirium

Postoperative delirium is a severe, acute brain disorder that occurs in 15 percent of all patients after an operation. As a result, attention, consciousness and thinking ability, and thus also quality of life, are often impaired in the long term. In order to prevent such long-term consequences or a need for care for those affected, timely and guideline-based treatment is important. The Digi-POD project is a self-updating, time- and person-independent support system that combines all current scientific findings in coordination with medical staff working in practice. This means that current medical knowledge can be immediately applied to patients according to the latest state of medical knowledge. This decision support ensures that current guideline recommendations are compared directly and in real time with structured data, can be applied as needed and implemented in a controlled manner. It also enables, for the first time, an automated evaluation of medical data individually for each patient according to their needs through artificial intelligence.

Project management: Prof. Dr. Claudia Spies, Director of the Clinic for Anaesthesiology with a focus on Surgical Intensive Care Medicine, Campus Virchow-Klinikum and Charité Campus Mitte

FAIR4Rare: Accompanying Evaluation in the Establishment Process of an Open National Registry for Rare Diseases (NARSE).

Medical registries are an important tool for research, but also for the care of rare diseases. If the findability, accessibility, interoperability and reusability of the data is successful – in short: the implementation of the FAIR principles (findable, accessable, interoperable, reusable) – the translation of new findings and therapy options can be accelerated. The National Registry for Rare Diseases (NARSE) is a medical registry that is currently in the pilot phase and collects data from patients on selected rare diseases for which a therapy option is already on the way. In the accompanying project FAIR4Rare, the project partners from health services research, clinics, registry operators and patient organisations are examining the extent to which NARSE meets with acceptance among users and which further developments are necessary to establish it in such a way that patients with rare diseases are enabled to participate more fairly in our health system. In addition to the survey of users of the registry, it is important to compare it with data from the Medical Informatics Initiative (MII) and with the well-established German Cystic Fibrosis Registry.

Project management: Dr. Josef Schepers, Coordinator for Medical Informatics of the Core Unit eHealth and Interoperability (CEI), Berlin Institute of Health at Charité (BIH)

IntSim-Onko: Integration of clinical and molecular data in precision oncology to develop a similarity measure-based algorithm for therapy recommendations

Precision oncology has a high goal: to develop an individualised treatment plan for cancer patients for whom standard procedures are not sufficiently effective, following an in-depth analysis of the tumour. For this purpose, an overall picture of the cancer disease must be developed from all the data collected – from clinical course data, laboratory information, pathological findings reports to molecular characterisations of the tumour tissue – and translated into a therapy recommendation. This overall picture is then compared with background knowledge and similar cases from the medical literature. The mathematical description of similarities in turn depends on the type of data. Here, bioinformatics tools and analyses play an essential role, which are becoming increasingly important in medicine and contribute to the continuous improvement of health care. In the IntSim-Onko project, the complex overall images are broken down into their individual factors, their influence on treatment results is systematically analysed and individually weighted with the help of machine learning methods. The algorithms developed from this and the corresponding search functions are intended to advance data-based recommendations in precision oncology and thus decisively support the individualised treatment of cancer patients.

Project management: Dr. Manuela Benary, Charité Comprehensive Cancer Center (CCCC), Charité Campus Mitte and Core Unit Bioinformatics (CUBI) of the Berlin Institute of Health at Charité (BIH); Prof. Dr. Ulrich Keilholz, Director of Charité Comprehensive Cancer Center (CCCC)

KIDS: AI improves diagnostics in elderly care

Injuries to the oral mucosa can be very painful and contribute to the development of oral cavity carcinomas. Correct diagnostics are the basis for early and appropriate therapy, especially in the case of senior citizens in need of care, where such tissue injuries occur frequently. The aim of the KIDS project is to improve the diagnosis of oral diseases in residents of inpatient care facilities for the elderly by using an artificial intelligence (AI)-based decision support system. Based on a database and applying general quality standards, the AI models will assist in the detection and classification of oral mucosal lesions. In this way, the artificial intelligence should reduce the referral and reassessment rate. In this way, a more targeted referral and reassessment of those in need of care could at the same time help to reduce transport costs and burdens, prioritise the need for therapy and reduce costs.

Project management: Prof. Dr. Falk Schwendicke, Director of the Department of Oral Diagnostics, Digital Dentistry and Health Services Research, Campus Benjamin Franklin

REPAIR: Recommendation for preoperative reduction and osteosynthesis planning of complex fractures through the use of artificial intelligence

Hundreds of thousands of bone fractures occur in Germany every year as a result of accidents at home or in traffic. A particular challenge for the treating trauma surgeon is the sometimes complex pattern of fractures, in which joints may also be involved. In order to reduce complications during and after the operation and to ensure the best possible healing process, perfect planning of operations is essential. The aim of the REPAIR project is to support trauma surgeons in complex fractures of the extremities with recommendations using artificial intelligence (AI) – both for the anatomical return (reduction) to the normal position and for the surgical connection of bone fragments (osteosynthesis). Through an analysis of preoperative computed tomographic (CT) data sets, an AI-guided virtual and interactive anatomical reduction recommendation will first be given. An AI-supported analysis of current guidelines and evidence-based guideline publications will then be used to find a suitable procedure for osteosynthesis. In the long term, this should speed up operations, reduce the number of complications and improve the success of the therapy.

Project management: PD Dr. David Back, Centre for Musculoskeletal Surgery (CMSC), Campus Virchow-Klinikum

WEGE: Analyses of care histories of older AOK-insured persons in the run-up to a need for long-term care

need for long-term care

Up to now, there has been a lack of systematic analyses that shed light on the role of care in the development or avoidance of the need for long-term care. The WEGE project, which is being carried out in cooperation with the Scientific Institute of the AOK (WIdO), starts here. The aim is to identify the constellations that could be particularly suitable for avoiding or delaying the need for long-term care by comparing different care histories – looking back over a period of five years. The data basis is formed by routine data from health and long-term care insurance funds as well as long-term care assessments by the Medical Service. The project tests the hypothesis that certain constellations in care allow predictions about the need for care and can thus be a starting point for prevention. The results should contribute to building up a continuity of care for older insured persons and thus largely prevent the need for long-term care.

Project management: Dr. Stefan Blüher and Prof. Dr. Adelheid Kuhlmey, Institute for Medical Sociology and Rehabilitation Science, Campus Charité Mitte

The Charité is involved as a consortium partner in three other projects in health services research (in alphabetical order):

BENITA: Exercise and Nutrition Intervention in Ovarian Cancer – Development of a Care Concept and Evaluation in Clinical Routine.

Consortium leader: University Medical Centre Hamburg-Eppendorf

Project management at the Charité: Prof. Dr. Jalid Sehouli, Director of the Clinic for Gynaecology with Centre for Oncological Surgery, Virchow Clinic Campus

IPS: Integrated psychosocial care in intensive care medicine – participatory development and piloting of an innovative care approach

Consortium leadership: University of Ulm

Project management at the Charité: Prof. Dr. Matthias Rose, Director of the Medical Clinic with a focus on psychosomatics, Benjamin Franklin Campus

IRIS: IT-based relapse monitoring for schizophrenia

Consortium management: Klinikum rechts der Isar of the Technical University of Munich

Project management at the Charité: Dr. Kerem Böge, working group leader at the Department of Psychiatry and Psychotherapy, Benjamin Franklin Campus.

Project funding by the Innovation Committee

The legislator has created an innovation fund for the qualitative further development of care in the statutory health insurance system in Germany. The Innovation Committee at the Federal Joint Committee (G-BA) determines the priorities and criteria for the allocation of funds and decides on the applications for funding received. The amount of funding available was 300 million euros annually between 2016 and 2019. Of this, 225 million euros were earmarked for the promotion of new forms of health care and 75 million euros for health services research. The innovation fund will now be continued with an endowment of 200 million euros per year until 2024, with further development of the funding procedure. Funding applications for the new forms of care are now decided in a two-stage selection procedure. In addition, a procedure was created for transferring successful approaches from projects to standard care. The Innovation Fund is financed by the statutory health insurance funds from the Health Fund. With the projects that have just been approved, Charité is now the consortium leader of a total of 49 ongoing or already completed projects that have been supported by the Innovation Fund since 2016 – of which 16 projects are in the area of new forms of care, 28 in the area of care research and five projects for the development and further development of medical guidelines. The Charité is a consortium partner in 32 other projects

Links:

Übersicht der neu geförderten Projekte zur Versorgungsforschung

Übersicht der neu geförderten Projekte zur Entwicklung medizinischer Leitlinien

G-BA Pressemitteilung „Innovationsausschuss: 32 neue Versorgungsforschungsprojekte können starten“ vom 07.06.2022

G-BA Pressemitteilung „Innovationsausschuss fördert 18 neue Projekte zu medizinischen Leitlinien“ vom 04.04.2022

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