Health Services & Health System Research

Prof. Dr. rer. medic. Dawid Pieper has been the new FGW professor for health services and health system research at the Brandenburg Medical School Theodor Fontane (MHB) since September 1st, 2021.

He heads the Center for Health Services Research (ZVF-BB) based in Rüdersdorf. In addition, he is head of the Institute for Health Services and Health Systems Research (IVGF), which is located at the Faculty of Health Sciences Brandenburg (FGW) and is responsible for the Master’s program in Health Services Research (M.Sc.).

The professorship is dedicated in particular to regional services research. When determining the need for care, analyses of the spatial layout of the planning regions as well as the consideration of changes in need and range of services are of particular importance.

With the involvement of patients and stakeholders, knowledge translation supports the implementation in rural areas. In this way, Brandenburg would like to develop into a model region for comparable regions in Germany and Europe.

Prof. Dr. Dawid Pieper
Prof. Dr. Dawid Pieper
Head of the Professorship Health Services and Health System Research
phone: +49 33638 83992

Location: Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562 Rüdersdorf, Polyclinic, Level 0, Office F.007

Research Focus

  • Regional Health Services Research
  • second opinion
  • Patient and public involvement (PPI)
  • Knowledge Translation
  • implementation research
  • Evidence Synthesis
  • Research on research/meta-research

The IVGF takes its responsibility in teaching and training very seriously.

The institute is responsible for the master’s degree in health services research (M.Sc.) starting in winter semester 2022/2023.

We are also always interested in applications for internships and/or theses. If possible at your university, we will be happy to take over the entire supervision of your work.

If you are interested in a doctorate or habilitation or are interested in our master’s degree in health services research, please contact Prof. Dr. David Pieper.

Teamportrait
Team IVGF 2023
Dr. rer. medic. Charlotte Kugler
Dr. rer. medic. Charlotte Kugler
Research Associate
Eni Shehu, M.Sc.
Eni Shehu, M.Sc.
Research Associate
Julia Scharfe, MPH
Julia Scharfe, MPH
Research Associate
Alexander Pachanov, M.Sc.
Alexander Pachanov, M.Sc.
Research Associate
Stefanie Pfisterer-Heise, M.Sc.
Stefanie Pfisterer-Heise, M.Sc.
Research Associate
Lena Fischer, M.Sc.
Lena Fischer, M.Sc.
Research Associate
Dr. Alexander Haarmann
Dr. Alexander Haarmann
Research Associate
Denise Gerlach, M. A.
Denise Gerlach, M. A.
Research Associate

National

Universitätsmedizin Göttingen,
Institut für Medizinische Statistik,
Prof. Dr. Tim Mathes

Universität Witten/Herdecke,
Institut für Forschung in der Operativen Medizin,
Prof. Dr. Rolf Lefering;
Lehrstuhl für Klinische Pharmakologie,
Prof. Dr. Petra Thürmann

Carl von Ossietzky Universität Oldenburg
Abteilung Ambulante Versorgung und Pharmakoepidemiologie
Prof. Dr. Falk Hoffmann

International

Catholic University of Croatia,
Center for Evidence-Based Medicine and Health Care,
Prof. Dr. Livia Puljak

Unity Health Toronto,
Knowledge Translation Program,
Dr. Carole Lunny

Western Norway University of Applied Sciences in Bergen,
Centre for Evidence-Based Practice,
Prof. Dr. Hans Lund

Selection

Weise A, Büchter R B, Pieper D, Mathes T. Assessing transferability in systematic reviews of health economic evaluations – a review of methodological guidance. BMC Med Res Methodol 22, 52 (2022). https://doi.org/10.1186/s12874-022-01536-6.

Prediger B, Koller D, Heß S, Könsgen N, Pieper D. Localization of Second Opinion Physicians in Germany: Do Regional Differences Exist? Gesundheitswesen. 2022 Jan 28. doi: 10.1055/a-1690-6728. Online ahead of print.

Goossen K, Becker M, Mathes T, Follmann M, Holtkamp U, Hostettler S, Meerpohl JJ, Nothacker M, Schaefer C, Schmidt S, Schünemann HJ, Sommer I, Tholen R, Skoetz N, Pieper D. German-language translation of the PANELVIEW instrument to evaluate the guideline development process from the perspective of the guideline group. Z Evid Fortbild Qual Gesundhwes. 2022 Jan 22:S1865-9217(21)00217-8. doi: 10.1016/j.zefq.2021.11.004. Online ahead of print.

Könsgen N, Prediger B, Schlimbach A, Bora AM, Hess S, Caspers M, Pieper D. Attitude toward second opinions in Germany – a survey of the general population. BMC Health Serv Res. 2022 Jan 15;22(1):76. doi: 10.1186/s12913-021-07422-z.

Pieper D, Rombey T. Where to prospectively register a systematic review. Syst Rev 11, 8 (2022). https://doi.org/10.1186/s13643-021-01877-1.

Burkamp JR, Bühn S, Schnitzbauer A, Pieper D. Preference between medical outcomes and travel times: an analysis of liver transplantation. Langenbecks Arch Surg. 2021 Jul 29. doi: 10.1007/s00423-021-02258-x. Online ahead of print.

Lunny C, Pieper D, Thabet P, Kanji S. Managing overlap of primary study results across systematic reviews: practical considerations for authors of overviews of reviews. BMC Med Res Methodol. 2021 Jul 7;21(1):140. doi: 10.1186/s12874-021-01269-y.

Breuing J, Könsgen N, Doni K, Neuhaus AL, Pieper D. Healthcare delivery and information provision in bariatric surgery in Germany: qualitative interviews with bariatric surgeons. BMC Health Serv Res. 2021 Jul 5;21(1):659. doi: 10.1186/s12913-021-06629-4.

Kugler CM, De Santis KK, Rombey T, Goossen K, Breuing J, Könsgen N, Mathes T, Hess S, Burchard R, Pieper D. Perspective of potential patients on the hospital volume-outcome relationship and the minimum volume threshold for total knee arthroplasty: a qualitative focus group and interview study. BMC Health Serv Res. 2021 Jul 2;21(1):633. doi: 10.1186/s12913-021-06641-8.

Jo CL, Burchett H, Bastías M, Campbell P, Gamage D, Henaff L, Kagina B, Lunny C, Marti M, Muloiwa R, Pieper D, Thomas J, Tunis MC, Wichmann O, Younger Z, Harder T. Using existing systematic reviews for developing vaccination recommendations: Results of an international expert workshop. Vaccine. 2021 May 27;39(23):3103-3110. doi: 10.1016/j.vaccine.2021.04.045. Epub 2021 May 6.

You can find a complete publication list under https://pubmed.ncbi.nlm.nih.gov/?term=Pieper+Dawid%5Bau%5D&sort=date&size=20

Clinical Practice Guideline Adherence in Germany – BaFa-CPG-G

The use of clinical guidelines leads to benefits for the health of patients, such as improved clinical endpoints and survival rates. The aim of this systematic review is to investigate the barriers and facilitators of guideline adherence from the perspective of healthcare professionals in Germany. The project is carried out in close collaboration with stakeholders in the field of guideline development and implementation. The results should lead to a better understanding of the topic and at the same time form a basis for developing strategies to improve guideline adherence in Germany. https://osf.io/gmfub

Eni Shehu; Dr. Charlotte Kugler

Use of health data in a regional context for health planning in Brandenburg – GeDa-BB

Use of health data in a regional context for health planning in Brandenburg (GeDa-BB) Health-related data in a regional context, such as the disease rate, life expectancy or the number of female doctors per inhabitant in a region, have long been processed in other countries. However, a low utilization rate in health planning and difficulties in the applicability of this data have been noted. Although there is some public health-related data available in the federal state of Brandenburg, there is no comprehensive data source as in other federal states (e.g. Bavarian Health Atlas), in which available data is bundled. The aim of the study is to investigate which data sources are currently used for regional health planning in Brandenburg and what challenges exist. The results of the study can provide a basis for the design of a cross-organizational data source for demand-oriented regional health planning in Brandenburg. To this end, semi-structured expert interviews will be conducted with stakeholders in regional health and needs planning in Brandenburg. https://osf.io/8zsqv

Dr. Charlotte Kugler ; Alexander Pachanov

Institutional Conflicts of interest – the case of hospital volume relationship in TKA – I-COI-TKA

Evidence of a link between the volume of services provided by a hospital and the quality of outcomes for certain clinical interventions has led to regulations in several health systems that aim to centralize these interventions. The authors of primary studies may have an interest in influencing health policy decisions by preferentially publishing research that favors the service volume of the hospital to which they belong (e.g., managers of high-volume hospitals may support centralization, while managers of low-volume hospitals may not). This can be seen as a form of institutional conflict of interest. The aim of this study is to investigate the presence of institutional conflicts of interest in volume-outcome studies. Methods: We will use studies included in a systematic review of the relationship between hospital volume and outcome in total knee arthroplasty. We will contact the authors of the studies to obtain their institutional volume. We will conduct two analyses comparing the authors’ conclusions for the categories 1) high vs. medium or low hospital volume and 2) hospital vs. non-hospital authors. We will also ask the authors by email for their views on institutional conflicts of interest in the area of volume-outcome studies.

Dr. Charlotte Kugler gemeinsam mit IFOM

Effects of minimum volume regulations in hospitals -MIVOS

For many surgical procedures, it has been proven that a larger hospital volume leads to better treatment outcomes; for other services, such as dialysis or the care of low birth weight babies, there is evidence of this so-called volume-outcome relationship. Against this background, inpatient healthcare services are centralized in many countries, in some countries on the basis of “minimum volume regulations”, i.e. the definition of a minimum number of a certain procedure. Achieving this minimum volume is then a necessary prerequisite for a hospital to be allowed to carry out this procedure in future.

The study has two objectives: Firstly, the effects of minimum volume regulations are to be analyzed with the help of a systematic review, taking into account all available international literature. The recorded outcomes can be assigned to the following groups: patient-related, process-related, (healthcare system) structure-related. Secondly, a core outcome set is to be developed for studies on the centralization of inpatient services. To this end, focus groups with patient representatives, semi-structured interviews with representatives of German medical associations and statutory health insurance funds and an online survey with healthcare researchers were conducted. The outcome parameters obtained in this way were evaluated in a subsequent Delphi study by all stakeholder groups with regard to their importance and combined in a core outcome set.
The project is funded by the BMBF (FKZ: 01KG2107). Protocol of the systematic review: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-022-02160-7
Protocol of the Core Outcome Set: https://bmjopen.bmj.com/content/13/3/e068138.long

Julia Scharfe; Stefanie Pfisterer-Heise; Alexander Pachanov

Increasing the rate of stoma site marking – INSTOSI

Marking the stoma site prior to the creation of a stoma (artificial bowel outlet) can reduce the risk of stoma-related complications, increase the acceptance of the stoma and improve the health-related quality of life of people with a stoma. Despite the benefits and guideline recommendations, this procedure is not fully implemented in daily clinical practice. Therefore, the aim of this study is to develop a strategy to increase the rate of preoperative stoma marking in three clinics of the Brandenburg Medical School (MHB). This project will be developed on the basis of the JBI-Evidence Implementation Strategy. All phases of the project will be carried out in close cooperation with the surgeons at the MHB. In this context, the project will develop and implement strategies based on the needs and preferences of the surgeons to reduce the gaps in evidence practice.

Eni Shehu; Dr. Charlotte Kugler

Patient participation in guideline development – PaBeLL

Guidelines are systematically developed recommendations for action that support doctors and patients in making decisions about the appropriate treatment of a disease. As patients can contribute their own expertise based on their experiences, their participation in the development of guidelines is essential. Against this backdrop, the regulations of the Association of Scientific Medical Societies in Germany (AWMF) stipulate that the perspective of patients must be represented in S3 guidelines. In 2018, however, an analysis of the S3 guidelines revealed that patient involvement was insufficiently implemented. The aim of the current study is to record the current status of patient involvement in the development of valid S3 guidelines and patient versions of guidelines. Furthermore, the S3 guidelines are examined to determine the extent to which their reporting on patient involvement follows the RIGHT checklist (Reporting Items for practice Guidelines in HealThcare).
https://www.protocols.io/private/65DA5F6AC43111EDBAF60A58A9FEAC02

Stefanie Pfisterer-Heise

Ethical Aspects in Robotic Surgery – EARS

Robots in surgery have been in clinical use since the mid-1990s. The latest technological advances (e.g. in the use of artificial intelligence) suggest that the use and further development of such devices will increase in the future. In view of this future perspective, questions of responsible use and ethical reflection arise. However, an in-depth ethical consideration of the various dimensions of robot-assisted surgical interventions is still rather rare. Against this background, this thesis develops a comprehensive overview of the ethical problems of robotic surgery and identifies research needs and approaches in view of future developments. To this end, a systematic review is compiled. All studies that address ethical aspects of the use of robotics in surgery are included.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023397951

Stefanie Pfisterer-Heise

Development and validation of a geographical search filter to identify studies conducted in Germany – DeVaS-Ger

The number of systematic reviews (SRs) focusing on specific countries, groups of countries or regions is increasing. A methodological review from 2016 showed that in such SRs with a focus on Germany, the search strategies applied were often not sufficiently elaborated to identify all studies from Germany. The application of a geographical search filter can be helpful to maximize the sensitivity of a search strategy. Systematically developed and validated search filters already exist for other countries (e.g. UK), but not for Germany. The aim of the DFG-funded research project is to close this gap and develop a sensitive geographical search filter to identify studies conducted in Germany. The methodological approach is divided into four steps (according to Jenkins 2004): 1. identification of a gold standard or test set, 2. identification of relevant search terms, 3. iterative evaluation and 4. validation of the search filter.

Catharina Münte; Alexander Pachanov

Research study for the Rosa-Luxemburg-Stiftung: Measures to combat the shortage of doctors in Brandenburg – successful approaches from other regions – RLS research study

There is a shortage of female doctors in Brandenburg, particularly GPs and neurologists, and some regions are considered to be seriously undersupplied. People in the state see improving healthcare provision as a key challenge. This briefing will use a literature review to clarify how other regions (throughout Germany and internationally) are successfully securing medical care in rural areas and which approaches can be transferred to the situation in Brandenburg. These can be model projects as well as fundamentally different forms of organization in the provision of healthcare in rural regions with few doctors.

Dr. Charlotte Kugler

Development and testing of an instrument for the inclusion of shared decision making in guidelines – EDELL

Medical guidelines (MGs) are systematically developed statements that are intended to support healthcare professionals in their decisions. However, they should also take into account the views and preferences of patients who are faced with a medical decision. Shared decision making (SDM) is an established process that supports patients and healthcare professionals in making joint decisions on health issues. In order to reach a shared decision, discussing the possible options and supporting patients to become aware of their individual preferences are essential SDM steps that should be considered in practice. Decision-making tools, such as patient-directed decision aids, can be used to facilitate the decision-making process. However, initial studies suggest that, in their current form, LL are only of very limited use to support physicians in the implementation of SDM.
The aim of this project is therefore to develop a tool for LL that can be used to systematically identify and prioritize SDM-relevant LL recommendations. Such a tool would for the first time provide German and international guideline authors with a guide to systematically consider SDM during the guideline development process. In addition, such a tool would facilitate the provision of decision support tools to support shared health decisions between patients and physicians.

The project consists of six modules. Modules 1 to 3 serve as preparation for the subsequent development of the tool in modules 4 to 6. Module 1 aims to summarize the methods currently used to develop and integrate decision support tools in LL. In Module 2, expert interviews will be conducted to find out how preference-sensitive LL recommendations can be identified and how SDM can be successfully implemented in LL. In Module 3, a Delphi study will be conducted to define and operationalize ‘preference sensitivity’. In Module 4, the actual instrument development takes place, for which items are first generated that are important for the identification of SDM-relevant LL recommendations. This is followed by the evaluation of the first version of the instrument. In Module 5, the aim is to develop the database for decision aids and thus create the necessary practical conditions for subsequent transfer into clinical practice. Finally, in Module 6, the tool will be tested in practice in the context of selected clinical trials.
The project is funded by the German Innovation Fund of the Federal Joint Committee (G-BA) (FKZ: 01VSF23022).

Lena Fischer

Effects of the new minimum volumes in visceral surgery on care in Brandenburg – MinBraVi

Minimum volume regulations have been introduced in Germany since 2004 in view of the correlation between the volume of services provided by a hospital and the quality of treatment. The minimum volumes for complex operations on the oesophagus and pancreas will be raised by 2023 and 2025 respectively. According to simulations, these changes will have an impact on care in the federal state of Brandenburg, as several clinics that currently perform complex oesophageal/pancreatic procedures are not expected to reach the minimum volumes and will then no longer be allowed to offer these operations. The study answers the questions of what effects those involved in the provision of care expect from the new minimum volumes and how the state of Brandenburg can prepare for the introduction of the new minimum volumes. Semi-structured expert interviews with regional healthcare professionals and patient representatives will be conducted for this purpose.

Dr. Charlotte Kugler

Routine data-based quality indicators for nursing care: practical transfer and accompanying implementation research – QCare Transfer

Over 700,000 people in Germany currently live in nursing homes – and the trend is rising. Until now, relatively few official quality indicators were available. In the project “Quality measurement in care with routine data (QMPR)”, 12 additional quality indicators were identified using routine data, which are capable of revealing potentially problematic areas.
The aim of the current QCare Transfer project is to pilot the use of these new indicators and to examine how they can best be taken up by healthcare professionals in the long term. To this end, around 40 participating nursing homes in Bavaria will be randomized into two groups: Group 1 will receive a comparison of their own results with other nursing homes, Group 2 will receive additional support from professional quality circles. The control group receives standard information in line with the legal standard. The study is accompanied by comprehensive research, will last three and a half years and is financed by the innovation fund of the Federal Joint Committee. In addition to the MHB, the lead partner is the WIdO, aQua and AOK Bayern.

Alexander Haarmann

Locally adapted guidelines 

Clinical guidelines are often not fully implemented in practice. One reason for this is that there are too many differences between the guideline recommendations and clinical practice under everyday conditions. Specifically, this can be for many reasons: patients, staff, structure, availability of resources or cultural or ethical aspects. To take this into account, it is possible to adapt national guidelines for a local context (e.g. a hospital). This can be beneficial for implementation without jeopardizing the validity of the guideline. This process is also known as guideline adaptation. Our aim is to identify randomized controlled trials (RCTs) that have investigated the effects of locally adapted guidelines. For this purpose, we conduct a scoping review following the JBI methodology. The protocol can be found in the Open Science Framework (https://osf.io/3ed2w).

Prof. Dr. Dawid Pieper

Joint faculty
The University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg