• Ingrid Schubert, Dominikus Stelzer, Achim Siegel, Ingrid Köster, Claudia Mehl, Peter Ihle, Christian Günster, Patrik Dröge, Andreas Klöss, Erik Farin-Glattacker, Erika Graf, and Max Geraedts.
• PMV research group at the Department of Psychiatry and Psychotherapy for Children and Young Adults, Faculty of Medicine and University Hospital Cologne; Institute for Health Services Research and Clinical Epidemiology (IVE), Philipps-Universität Marburg; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg; Institute for Occupational and Social Medicine and Health Services Research, University of Tübingen; Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research (SEVERA), Faculty of Medicine and Medical Center, University of Freiburg; Scientific Institute of the AOK (WIdO), Berlin.
• Dtsch Arztebl Int. 2021 Jul 12; 118 (27-28): 465472465-472.

BackgroundThe population-based integrated health care system called "Gesundes Kinzigtal" (Integrierte Versorgung Gesundes Kinzigtal, IVGK) was initiated more than 10 years ago in the Kinzig River Valley region, which is located in the Black Forest in the German state of Baden-Württemberg. IVGK is intended to optimize health care while maximizing cost-effectiveness. It consists of programs for promoting health and for enabling cooperation among service providers, as well as of a shared-savings contract that has enabled resources to be saved every year. The goal of the present study was to investigate trends in the quality of care provided by IVGK over the past ten years in comparison to conventional care.MethodsThis is a non-randomized observational study with a control-group design (Kinzig River Valley versus 13 structurally comparable control regions), employing data collected by AOK, a large statutory health-insurance provider in Germany, over the period 2006-2015. Quality assessment was conducted with the aid of a set of indicators, developed by the authors, that was based exclusively on claims data. The statistical analysis of the trends in these indicators over time was conducted with preset criteria for the relevance of any observed changes, as well as preset mechanisms of controlling for confounding factors.ResultsFor 88 of the 101 evaluable indicators, no relevant difference was seen between the trend over time in the region of the intervention and the average trend in the control regions. Relevant differences in favor of the IVGK were observed for six indicators, and negatively divergent trends compared to the controls were observed for seven indicators. In the main summarizing statistical analysis, no positive or negative difference was found between the Kinzig River Valley and the other regions with respect to trends in the health-care indicators over time.ConclusionAn evaluation based on 101 indicators derived from health-insurance data did not reveal any improvement of the quality of care by IVGK and the totality of the programs that were implemented under it. However, under the conditions of the shared-savings contract, no relevant diminution in the quality of care was observed over a period of 10 years either, compared with structurally similar control regions without an integrated care model.

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