Parkinson Network Eastern Saxony (PANOS): Reaching Consensus for a Regional Intersectoral Integrated Care Concept for Patients with Parkinson's Disease in the Region of Eastern Saxony, Germany

Abstract

As integrated care is recognized as crucial to meet the challenges of chronic conditions such as Parkinson's disease (PD), integrated care networks have emerged internationally and throughout Germany. One of these networks is the Parkinson Network Eastern Saxony (PANOS). PANOS aims to deliver timely and equal care to PD patients with a collaborative intersectoral structured care pathway. Additional components encompass personalized case management, an electronic health record, and communicative and educative measures. To reach an intersectoral consensus of the future collaboration in PANOS, a structured consensus process was conducted in three sequential workshops. Community-based physicians, PD specialists, therapists, scientists and representatives of regulatory authorities and statutory health insurances were asked to rate core pathway-elements and supporting technological, personal and communicative measures. For the majority of core elements/planned measures, a consensus was reached, defined as an agreement by >75% of participants. Additionally, six representatives from all partners involved in the network-design independently assessed PANOS based on the Development Model for Integrated Care (DMIC), a validated model addressing the comprehensiveness and maturity of integrated care concepts. The results show that PANOS is currently in an early maturation state but has the potential to comprehensively represent the DMIC if all planned activities are implemented successfully. Despite the favorable high level of consensus regarding the PANOS concept and despite its potential to become a balanced integrated care concept according to the DMIC, its full implementation remains a considerable challenge.

Keywords: Parkinson disease; clinical pathway; community networks; consensus; integrated delivery of health care; patient care team; patient monitoring; telemedicine.

Figure 1

Characteristics of the intervention region Eastern Saxony. Germany is shown in light blue, the state Saxony in dark blue, and the intervention region Eastern Saxony in red. Within the intervention region, the three specialized hospital-affiliated outpatient centers are shown that will serve as the structural backbone of Parkinson Network Eastern Saxony (PANOS). The table on the right side gives population characteristics of the six districts within the intervention region. Eastern Saxony has a population of 1.9 million people, of which approximately 15,000 have Parkinson’s disease (PD). * General population numbers were taken from public statistical resources (https://www.statistik.sachsen.de/html/bevoelkerungsstand-einwohner.html). PD cases were calculated based on secondary health data from the biggest local statutory health insurer (AOKPLUS). Criteria were: International Classification of Diseases 10^th revision (ICD10) G20.x and prescription of dopaminergic medication as a validation criterion. The resulting prevalence of 786.69/100,000 matches the one of another recent German-wide epidemiologic study based on secondary health data [12,13] and was the basis for the ^§ calculation of the number of patients per general practitioner (GP)/community-based neurologist. ^# Number of general practitioners (GPs) and number of neurologists was provided by the Association of SHI Physicians. Row “Total” gives the summed numbers for all six districts in the intervention region. Whereas the average number of PD patients per GP varies little between urban and rural districts (14 patients/GP), there was a huge variation in the average number of PD patients per neurologist between rural areas (up to 360 patients/neurologist in Mittelsachsen) and the city of Dresden (126 patients/neurologist).

Figure 2

The PANOS care pathway with its supporting workforce and technological infrastructure.

Figure 3

Survey results—perceived challenges in usual care reality (n = 33).

Figure 4

Survey results—relevant dimensions for PD treatment from physicians’ perspectives (n = 21).

Figure 5

Survey results—information about PANOS patients provided in the electronic health record (EHR) (n = 21).

Figure 6

Survey results—importance of the contents of a structured patient education program (n = 10).

Figure 7

Assessment of PANOS according to the Development Model for Integrated Care (DMIC) framework (A): Illustrative summary of the Developmental Model of Integrated Care (DMIC). A total of 89 components relevant to ICC implementation are grouped into 9 clusters and located on a cluster map with 4 axes (Organization of care, Quality care, Results and Effective collaboration). The model also considers 4 developmental stages ranging from phase 1—initiative and design phase, to phase 4—consolidation and transformation phase. (B): Current assessment of PANOS by 6 involved key representatives according to which elements already have been achieved (rated as “present”, shown in red) and how PANOS would represent the model if planned activities are implemented (rated as “planned or present”, shown in blue). (C): PANOS is still in an early maturation state. Achieved elements belong to phase 1 and 2; the percentage of relevant elements already planned but not yet achieved is much higher for phases 1 and 2 (90% each) than for phase 3 (60%) and phase 4 (40%). Reproduced with permission from Mirella Minkman, Journal of Integrated Care; published by Emerald Publishing Pty Limited, 2016.