Geriatric Network and Geriatric Academy Brandenburg

Why was this example implemented?

The starting points were problems regarding older people’s care caused by insufficient gerontological and geriatric knowledge by health professionals, and by fragmented care planning and provision. The aims are to improve quality and continuity of care for older people at regional levels across professional & organisational boundaries including prevention and rehabilitation, aiming at allowing people to live at home or to return to home as long/as soon as possible.

The main approaches are the provision of a comprehensive quality concept for comprehensive geriatric care and regional network-building. Members of the networks commit to jointly developed quality criteria, such as qualifications of staff.

The target group are older people with complex cure and care needs who fit the characteristics of geriatric patients. Actual interventions (network building, quality management) are directed to all health professionals / service providers working with geriatric patients in the regions of Brandenburg (with altogether 2.5 million inhabitants, and a strongly ageing population).

The initiative is sustainable and aims at further extension, because the implementation so far has not succeeded in involving all or nearly all respective services in any local region. As providers are for-profit or not-for-profit enterprises in the German system, and in principle participation in the networks is voluntary. Members finance the network management themselves by membership fees. Applicants for participation are accepted based on quality guidelines by the executive committee of the respective network. Also non-members can participate in meetings and trainings of local networks.

Description

GeriNet is an ‘umbrella-network’ (at federal level, Land Brandenburg, Eastern Germany) of 12 regional networks for geriatric care in rural regions, with hospitals with geriatric wards, GP practices, home care providers, therapists and others participating. The networks are independent from each other, therefore different regarding the intensity of participation and cooperation. The initiative initially was brought forward mainly by hospital-based geriatricians. It aimed at involving all professions and services engaged in cure and care for older people. First steps were taken in the 1990s in Woltersdorf as the initial network. There was support by the regional (Länder-) government of Brandenburg. Main approaches are the provision of a comprehensive quality concept and regional network-building.

Given the fragmentation of care for older people, and underdeveloped knowledge and skills of professionals in the services involved, GeriNet was founded to improve coordination between professions and organisations (jointly developed pathways), and to improve the spread of geriatric/gerontological knowledge by qualification of generalists by certified trainings for all involved professions.

The ‘Geriatric Academy Brandenburg’ provides trainings for health professionals, some addressed to specific professions (doctors, nurses); the majority of training, however, consists of joint courses for doctors, nurses, therapists and others. GeriNet has developed and aims to implement comprehensive quality standards (structure, process and outcome measurements, including clinical, psychosocial, organisational and procedural aspects) and innovative care approaches like for example rehabilitation at home (‘Mobile Reha’ – as a specific innovation). All activities are oriented at supporting the patient to be able to live at home.

Care and care planning has to be patient-oriented. Family carers are addressed as ‘external members’ of the geriatric team, but also as having support needs of their own. Services and activities are mainly financed within the general financing system of the social health insurance and the long term care insurance. Rehabilitation at home has become refundable by the social health insurance. The ‘Geriatric Academy’ organises training for doctors and other health professionals as well as for informal carers.

Other activities include regular meetings of ‘quality circles’ on diverse topics. Joint discharge procedures have developed and been accepted in the country. Furthermore there are activities to inform the public, self help groups and care recipients about geriatric topics in the widest sense.

What are/were the effects?

The initial and most central of the 12 regional networks (Woltersdorf) had 33 members (hospital, primary care, therapists, nursing and social care providers etc) in 2008. Of the other 11 networks, 5 are active with visible network activities. Specified information about the other networks is low; however, a joint website is in the making and will be ready early in 2011.

Qualitative evaluations indicate improved interprofessional cooperation and improved care pathways for older people in the area of the first regional network. Moreover, geriatric knowledge is improved and distributed among general practitioners and care providers. Since these were network developments in a real world rather than an experimental context, not many process indicators were followed. Quite typically for complex interventions, outcomes at the patient level could not be measured.

A survey among referrers to the hospital about quality of and cooperation with the hospital (Consort Analyse-Systeme, 2009) indicated high and improving marks (information flow, communication and cooperation, patient-orientation) compared with other hospitals around; this held for the geriatric ward and the geriatric day hospital in particular. However, this cannot unambiguously be attributed to the influence of GeriNet activities. There are no evaluations published about the impact on older people themselves; also about the other five active networks there are no systematic evaluations available.

What are the strengths and limitations?

Strengths

• This initiative has the potential to overcome barriers to LTC integration, since medical as well as nursing, health and social services are addressed.
• The holistic approach to the needs of frail older people helps to adopt a preventive and rehabilitative attitude. 

Weaknesses

• In general, financial incentives do not seem to be strong enough to support a broad commitment of local service providers, as treatment of geriatric patients is time-consuming, and geriatric training has to be paid for by general practitioners themselves.
• The general reimbursement scheme does not make geriatric patients preferred patients and may act as a disincentive especially for general practitioners to join the networks. 
• The limited participation of general practitioners and therapists which, however, may be explained by the high threshold of geriatric training as a precondition for signing up to the network.

Credits

Author: Susanne Kümpers, Social Science Research Center Berlin
Reviewer 1: Sabina Mak
Reviewer 2: Tasos Mastroyannakis
Verified by: Dr. Paed. Marina Jakubowski, Evangelisches Krankenhaus Woltersdorf GmbH

External Links and References

• Arbeitsgemeinschaft Geriatrie Brandenburg & Geriatrische Akademie Brandenburg e.V. (n.d.) Konzept zum Qualitätsmanagement der Geriatrie in Brandenburg
• Concept 
• Training opportunities 
• Consort Analyse-Systeme (2009) Ergebnisse der Einweiserbefragung 2009 – Evangelisches Krankenhaus Woltersdorf. Berlin: Consort Analyse-Systeme.