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. 2019 Jan 26;18(1):12.
doi: 10.1186/s12904-019-0398-5.

Study protocol for a multi-methods study: SAVOIR - evaluation of specialized outpatient palliative care (SAPV) in Germany: outcomes, interactions, regional differences

Antje Freytag  1 , Markus Krause  1 , Anna Bauer  2 , Bianka Ditscheid  1 , Maximiliane Jansky  3 , Sabine Krauss  2 , Thomas Lehmann  4 , Ursula Marschall  5 , Friedemann Nauck  3 , Werner Schneider  2 , Kathleen Stichling  1 , Horst Christian Vollmar  1   6 , Ulrich Wedding  7 , Winfried Meißner  8 ; SAVOIR Study group
Collaborators, Affiliations

Study protocol for a multi-methods study: SAVOIR - evaluation of specialized outpatient palliative care (SAPV) in Germany: outcomes, interactions, regional differences

Antje Freytag et al. BMC Palliat Care. .

Abstract

Background: Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care. The research project SAVOIR is funded by G-BA's German Innovations Fund to evaluate the implementation of the SAPV directive.

Methods: The processes, content and quality of SAPV will be evaluated from the perspectives of patients, SAPV teams, general practitioners and other care givers and payers. The influence of different contracts, team and network structures and regional and geographic settings on processes and results including patient-reported outcomes will be analyzed in five subprojects: [1] structural characteristics of SAPV and their impact on patient care, [2] quality of care from the perspective of patients, [3] quality of care from the perspective of SAPV teams, hospices, ambulatory nursing services, nursing homes and other care givers, content and extent of care from [4] the perspective of General Practitioners and [5] from the perspective of payers. The evaluation will be based on different types of data: team and organizational structures, treatment data based on routine documentation with electronic medical record systems, prospective assessment of patient-reported outcomes in a sample of SAPV teams, qualitative interviews with other stakeholders like nursing and hospice services, a survey in general practitioners and a retrospective analysis of claims data of all SAPV patients, covered by the health insurance fund BARMER in 2016.

Discussion: Data analysis will allow identification of variables, associated with quality of SAPV. Based on these findings, the SAVOIR study group will develop recommendations for the Federal Joint Committee for a revision of the SAPV directive.

Trial registration: German Clinical Trials Register (DRKS): DRKS00013949 (retrospectively registered, 14.03.2018), DRKS00014726 (14.05.2018), DRKS00014730 (30.05.2018). Subproject 3 is an interview study with professional caregivers and therefore not registered in DRKS as a clinical study.

Keywords: Ambulatory care; Claims data; End-of-life care; General practitioner; Health service research; Mixed methods; Palliative care; Patient reported outcomes; Quality of care; Specialized outpatient palliative care.

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Conflict of interest statement

Ethics approval and consent to participate

Votes from the local ethics committees of the respective institutions were obtained from Jena University Hospital (No. 5312–10/17, 5316–10/17, 5317–10/17), University Medical Center Göttingen (No. 31/8/17) and University of Augsburg (06.09.2018). Written consent for participation in the study was obtained from all patients and interviewees. For patients without capacity, the written consent was obtained by a legally authorized representative.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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