1. Institut für Therapieforschung München Treatment Data Collection in Germany Dr. Tim Pfeiffer-Gerschel, Dipl. Psych., PPT

2. Legal Framework 2

3. German system of care for SUD ● General Practitioners, MDs ● General Hospitals, ER ● Psychiatric Clinics ● Low threshold units ● Treatment centres (counseling, treatment) ● „Interfaces“ between in-/outpatient treatment (e.g. adaptation) ● Specialised Clinics (Focus on Rehabilitation) Various partners 3

4. German Treatment System ● General Practitioners, MDs ● General Hospitals, ER ● Psychiatric Clinics ● Low threshold units ● Treatment centres (counseling, treatment) ● „Interfaces“ between in-/outpatient treatment ● Specialised Clinics (Focus on Rehabilitation) Various „cultures“ 4 Medical system „Specialised Treatment“ Rehabilitation

5. German Treatment System ● General Practitioners, MDs ● General Hospitals, ER ● Psychiatric Clinics ● Low threshold units ● Treatment centres (counseling, treatment) ● „Interfaces“ between in-/outpatient treatment ● Specialised Clinics (Focus on Rehabilitation) Various „cultures“ 5 Medical system „Specialised Treatment“ Rehabilitation

6. German treatment system (Very simplified) Various funding sources 6 Welfare Organisations Health Insurance Pension Funds Local/Regional Government Additional funds (e.g. studies) Mixed financing scheme

7. Various sources of information Available ● Hospital discharge register ● Statistics of national pension funds ● Health insurance statistics (numerous…) ● Other… (e.g. long-lasting national studies) Main limitations ● Not connected to each other ● Links very difficult to establish (data protection) 7

8. Current system ● Based on broad consensus among partners ● Core dataset became mandatory part of reporting embedded in various systems (funding linked to compatibility with core dataset) ● Large working group established many years ago, involving all relevant partners (health insurance, federal states, national MoH, treatment organisations,...) ● Main aim: To serve individual, regional and national needs, ensuring a common denominator 8

9. Core dataset 9

10. Information collected on centre level 10 European dataset (TDI) National dataset (KDS) Additional information

11. Network of reporting institutions 11

12. Many years ago... 12

13. Once upon a time... ● Since 1978 development of a common dataset for reporting SUD treatment/counseling ● Model project funded by MoH ● Content: Information necessary for trend analyses and to measure performance of participating centres („Bundesdatensatz“) ● Increasing pressure on centres not participating in national reporting between 1995 and 2000; parallel: development of TDI 2.0 13

14. Once upon a time... ● But: No consensus between regarding content of the national dataset („performance indicators“, too complex, too many items) ● Action taken in 2000 to develop a national core dataset ● 1998 first itemset (clients), 1999 itemset (centres), 2000 (national tables) ● 2007: New national itemset following a multi-disciplinary revision process 14

15. Development since 2000 – Outpatient 15

16. Development since 2000 - Inpatient 16

17. Participation by centre type 17 Einrichtungstyp2008200920102011 1Ärztliche oder psychotherapeutische Praxis1111 2Niedrigschwellige Einrichtung29243133 3Beratungs- und/oder Behandlungsstelle, Fachambulanz751777775768 4Institutsambulanz2221 5Ambulant Betreutes Wohnen39465048 6Arbeits-und Beschäftigungsprojekt3357 7Krankenhaus/-abteilung5556 8Teilstationäre Rehabilitationseinrichtung12131914 9Stationäre Rehabilitationseinrichtung94114134120 10Adaptionseinrichtung25303632 11Teilstationäre Einrichtung der Sozialtherapie87810 12Stationäre Einrichtung der Sozialtherapie17202134 13Pflegeheim0000 14Maßregelvollzug0000 15Interner Dienst zur Beratung/Behandlung im Strafvollzug0000 16Externer Dienst zur Beratung/Behandlung im Strafvollzug107814 Gesamt (Anzahl Nennungen)9961.0491.0891.088

18. Reporting (back) 18

19. Onlinereport, focused reports 19

20. 20

21. Other…. 21

22. www.suchthilfestatistik.de 22

23. Technical Issues 23

24. Software solutions - certification 24

25. ID Coding, double-counting ● Analysis of aggregated data on national level only – no individual data ● BUT: Regional solutions with interesting and even more „relevant“ outcome ● NO control for double-counting beyond centre (national statistics) 25

26. Summary 26

27. Limitations ● Aggregated data ● German medical system strictly follows ICD-coding system ● „Static“ data (some items measured at beginning of treatment, som at the end – only very few twice and no items illustrating changes) ● Many different interests and funding schemes ● No national law nor mandatory system for participation ● Result of negotiations between all parties involved ● Large variety of regional or even local adaptations and interests 27

28. Strengths ● Long data history ● Inclusive approach ● Large number of episodes reported ● Possibility to build up „indirect“ pressure ● „Reference“ for documentation ● Very detailed information available (compared e.g. to medical documentation) ● Well established structures ● High flexibility below national level 28

29. Thank you very much for your attention! Dr. Tim Pfeiffer-Gerschel IFT Institut für Therapieforschung Parzivalstraße 25, D-80804 München Tel.: 089 – 36 08 04 40 pfeiffer-gerschel@ift.de 29