title: [Regional geriatric care concept in the District of Lippe : Structural effects and network formation in the case management-based model project].
abstract: BACKGROUND
  Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment.
  
  
  METHODS
  The establishment of the geriatric care network (e.g. promoting networking acceptance and implementation) was formatively evaluated, e. g. with qualitative methods. Data were acquired by guideline-based interviews with experts and analyzed by qualitative content analysis according to Mayring.
  
  
  RESULTS
  Structural effects included forming a cross-sectoral and interdisciplinary network for a functioning care network and a geriatric care pathway. The practical work of case managers (CM) is essential for communication with patients, family members and care providers as well as integrating providers into the network. A critical factor was working together with general practitioners and the close cooperation with the hospital's department of geriatric. The quality of care is improved because of exchange of information between sectors and continuity in the course of care.
  
  
  CONCLUSIONS
  In the District of Lippe the quality of care was improved and structures of care were integrated by the network according to the needs of the target group. The integrative perspective was achieved in particular by the geriatric care pathway and integration of providers into the communication and care process; however, the scope of this care model could not be extended into routine care due to the rigid and subdivided health care system.
authors.affiliation: Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland. charlotte.assmann@uni-bielefeld.de.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Şahin
authors.affiliation: Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
authors.forename: Olaf
authors.initials: O
authors.lastname: Iseringhausen
authors.affiliation: Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaften (IMVR), Universität zu Köln, Köln, Deutschland.
authors.forename: Kira
authors.initials: K
authors.lastname: Hower
authors.affiliation: Ärztenetz Lippe GmbH, Detmold, Deutschland.
authors.forename: Constanze
authors.initials: C
authors.lastname: Liebe
authors.affiliation: Klinikum Lippe GmbH, Detmold, Deutschland.
authors.forename: Anja
authors.initials: A
authors.lastname: Rethmeier-Hanke
authors.affiliation: Klinikum Lippe GmbH, Detmold, Deutschland.
authors.forename: Bernd
authors.initials: B
authors.lastname: Wedmann
mesh_terms: D000368:Aged; D017028:Caregivers; D019090:Case Management / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005858:Germany; D006284:Health Plan Implementation / Q000458:organization & administration; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D009313:National Health Programs / Q000458:organization & administration*; D012040:Regional Health Planning / Q000458:organization & administration*
keywords: Case management; Formative evaluation study; Geriatric care pathway; Intersectoral care network; Structural quality