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Die Bemessung des Kreditrisikos für Kreditforderungen erfolgte nach IAS 39 bisher nach dem Konzept der eingetretenen Verluste (dem sog. incurred loss model). Danach wurden Kreditausfälle erst dann bilanziell erfasst, wenn das Ausfallereignis bereits eingetreten war. IFRS 9 hat nun einen Pradigmenwechsel hin zur Bewertung nach den erwarteten Verlusten (expected loss model) anstelle der eingetreten Verluste vollzogen. Im vorliegenden Beitrag wird die praxisnahe Anwendung des expected loss model anhand verschiedener Rating-Szenarien dargestellt und mit einer rechnerischen Fallstudie veranschaulicht.
The IT architecture for meter reading and utility services is at the core of new business models and has a decisive role as an enabler for resource efficiency measures. The communication architecture used by those services has significant impact on cost, flexibility and speed of new service rollout. This article describes how the dominant system model for meter reading came about, what alternative models exist, and what trade-offs those models have for rollout of new services by different stakeholders. Control of a self learning home automation system by dynamic tariff information (Real-Time-Pricing) is given as an application example.
Zielsetzung
Seit 2011 werden in Deutschland neuartige Arzneimittel zum Zeitpunkt der Markteinführung einer frühen Nutzenbewertung (FNB) mit anschließender Preisverhandlung unterzogen (AMNOG). Zu diesem Zeitpunkt ist die Evidenz zum Nutzen des Arzneimittels limitiert. Eine erneute Nutzenbewertung (ENB) im gleichen Anwendungsgebiet auf Basis neuerer Evidenz ist allerdings nicht regelhaft, sondern nur in Einzelfällen vorgesehen. Ziel ist, die Ergebnisse von ENB im gleichen Anwendungsgebiet zu untersuchen.
Methodik Analyse sämtlicher Verfahren mit abgeschlossener ENB in den Jahren 2011–2016.
Ergebnisse
Unter den 228 Nutzenbewertungsverfahren sind 52 zu 26 Arzneimitteln mit FNB und ENB im gleichen Anwendungsgebiet. Überproportional viele ENB wurden bei Onkologika und Antidiabetika durchgeführt. Bei 15 Arzneimitteln mit nachgewiesenem Zusatznutzen hatte der G-BA den FNB-Beschluss befristet wegen unzureichender Datenlage zur Markteinführung, teils begründet durch bedingte Zulassungen. Die ENB fand nach 2,6 Jahren statt. Sie führte in 4 Fällen zu einer höheren und in 5 Fällen zu einer niedrigeren Nutzenbewertung. Für 7 Arzneimittel ohne Zusatznutzen beantragten die Hersteller eine ENB auf Basis neuer Evidenz nach ca. 1,7 Jahren. Drei dieser Arzneimittel konnten in der ENB einen Zusatznutzen nachweisen. 4 Orphan Drugs wurden gemäß gesetzlicher Vorgabe erneut bewertet, nachdem sie die Jahresumsatzschwelle von 50 Mio. € überschritten. Bei einem Orphan Drug kam es zu einer besseren, bei 2 zu einer schlechteren Nutzenbewertung. Die durchschnittliche Verbesserung beträgt 1,5 Punkte auf einer Bewertungsskala von −3 (Beleg für geringeren Zusatznutzen) bis 9 (Beleg für erheblichen Zusatznutzen) und ist begründet durch neue Datenschnitte und Studien. Die Verschlechterung beträgt durchschnittlich −1,4 Punkte. Es zeigt sich eine signifikante Korrelation der Veränderung der Nutzenbewertung mit der Veränderung des verhandelten Preises.
Schlussfolgerungen
Die ENB auf Basis einer breiteren Evidenzgrundlage führt nicht zu einer wesentlichen Änderung der Nutzenbewertung und kann die Aussagesicherheit auch nur geringfügig erhöhen. Eine generelle ENB erscheint daher vor dem Hintergrund des administrativen Aufwands nicht gerechtfertigt. Das selektive Verfahren, erneute Nutzenbewertungen durchzuführen, ist hinreichend für Adjustierungen der Nutzenbewertung, wenn die Datenlage zur Markteinführung unzureichend erscheint.
Wenn sich Berufsfachschulen für Gesundheits- und Krankenpflege an ausbildungsintegrierenden Bachelorstudiengängen beteiligen, lernen Studierende dort häufig gemeinsam mit Auszubildenden der traditi-onellen Ausbildung in heterogen zusammengesetzten Berufsfachschulklassen. Das Ziel der vorliegenden Studie bestand darin, die Lernvoraussetzungen von Auszubildenden und Studierenden sowie die Auswir-kungen des gemeinsamen Lernens aus der Sicht von Pflegelehrenden darzustellen. Die Ergebnisse zeigen, dass sich die Lernvoraussetzungen von Auszubildenden und Studierenden unterscheiden. Zudem verweisen die Ergebnisse darauf, dass das gemeinsame Lernen von Auszubildenden und Studierenden bereichernde Effekte für das Lernklima hat.
Functioning information constitutes a relevant component for determining patients’ service needs and respective resource use. Diagnosis-Related Group (DRG) systems can be optimized by integrating functioning information.
First steps toward accounting for functioning information in the German DRG (G-DRG) system have been made; yet, there is no systematic integration of functioning information. The G-DRG system is part of the health system; it is embedded in and as such dependent on various stakeholders and vested interests.
This study explores the stakeholder’s perspective on integrating functioning information in the G-DRG system. A qualitative interview study was conducted with national stakeholders in 4 groups of the G-DRG system (health policy, administration, development, and consultations).
Interviews were analyzed using inductive thematic analysis. In total, 14 interviews were conducted (4 administration and 10 consultation group). Three main themes were identified: (1) functioning information in the G-DRG system: opportunities and obstacles, (2) general aspects concerning optimizing G-DRG systems by integrating additional information, and (3) ideas and requirements on how to proceed.
The study offers insights into the opportunities and obstacles of integrating functioning information in the G-DRG system. The relevance of functioning information was evident. However, the value of functioning information for the G-DRG system was seen critically. Integrating functioning information alone does not seem to be sufficient and a systems approach is needed.
Objective Specifying the content in electronic health records (EHRs) through standardized headings based on international reference classifications will facilitate their semantic interoperability. The objective of this study was to specify potential chapter headings for EHRs aligned with the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) based on the perspectives of people living with chronic health conditions, carers, and professionals.
Methods A multistage process was established including (1) a patient workshop, (2) an online survey of both patients and carers, and (3) an online consultation with patient and professional bodies. The ICF served as a starting point. Based on the first stage, a first draft of the headings was developed and further refined based on the feedback at each stage. We examined in a fourth step whether items from existing assessment tools support the operationalization of the identified headings. Therefore, we used the WHO Disability Assessment Schedule 2.0 (WHODAS2.0), a patient-reported instrument, and interRAI, a clinician-administered instrument.
Results The first workshop was attended by eight people, the survey was completed by 250 persons, and the online consultation received detailed feedback by 18 professional bodies. This study resulted in 16 potential chapter headings for EHRs which capture aspects related to the body, such as emotions, motivation, sleep, and memory or thoughts, to being involved in social life, such as mobility, social activities, and finances, as well as to the care process, such as understanding of health issues and treatment or care priorities and goals. When using the WHODAS2.0 and interRAI together, they capture all except one of the proposed headings.
Conclusion The identified headings provide a high level structure for the standardized recording, use, and sharing of information. Once implemented, these headings have the potential to facilitate the delivery of personalized care planning for patients with long-term health problems.
Objective: To examine the use of the term ‘metric’ in health and social sciences’ literature, focusing on the interval scale implication of the term in Modern Test Theory (MTT).
Materials and methods: A systematic search and review on MTT studies including ‘metric’ or ‘interval scale’ was performed in the health and social sciences literature. The search was restricted to 2001–2005 and 2011–2015. A Text Mining algorithm was employed to operationalize the eligibility criteria and to explore the uses of ‘metric’. The paradigm of each included article (Rasch Measurement Theory (RMT), Item Response Theory (IRT) or both), as well as its type (Theoretical, Methodological, Teaching, Application, Miscellaneous) were determined. An inductive thematic analysis on the first three types was performed.
Results: 70.6% of the 1337 included articles were allocated to RMT, and 68.4% were application papers. Among the number of uses of ‘metric’, it was predominantly a synonym of ‘scale’; as adjective, it referred to measurement or quantification. Three incompatible themes ‘only RMT/all MTT/no MTT models can provide interval measures’ were identified, but ‘interval scale’ was considerably more mentioned in RMT than in IRT.
Conclusion: ‘Metric’ is used in many different ways, and there is no consensus on which MTT metric has interval scale properties. Nevertheless, when using the term ‘metric’, the authors should specify the level of the metric being used (ordinal, ordered, interval, ratio), and justify why according to them the metric is at that level.
Background: Patient reported outcome measures (PROMs) have been integrated in national quality registries or specific national monitoring initiatives to inform the improvement of quality of care on a national scale. However there are many unanswered questions, such as: how these systems are set up, whether they lead to improved quality of care, which stakeholders use the information once it is available. The aim of this study was to examine supporting and hindering factors relevant to integrating patient-reported outcome measures (PROMs) in selected health information systems (HIS) tailored toward improving quality of care across the entire health system.
Methods: First, a systematic search and review was conducted to outline previously identified factors relevant to the integration of PROMs in the selected HIS. A social network analysis was performed to identify networks of experts in these systems. Second, expert interviews were conducted to discuss and elaborate on the identified factors. Directive content analysis was applied using a HIS Evaluation Framework as the frame of reference. This framework is structured into four components: Organization, Human, Technology, and Net benefits.
Results: The literature review revealed 37 papers for the NHS PROMs Programme and 26 papers for the SHPR and SKAR: Five networks of researchers were identified for the NHS PROMs Programme and 1 for the SHPR and SKAR. Seven experts related to the NHS PROMs Programme and 3 experts related to the SKAR and SHPR participated in the study. The main themes which revealed in relation to Organization were Governance and Capacity building; to Human: Reporting and Stakeholder Engagement; to Technology: the Selection and Collection of PROMs and Data linkage. In relation to Net benefits, system-specific considerations are presented.
Conclusion: Both examples succeeded in integrating PROMs into HIS on a national scale. The lack of an established standard on what change PROMs should be achieved by an intervention limits their usefulness for monitoring quality of care. Whether the PROMs data collected within these systems can be used in routine clinical practice is considered a challenge in both countries.
Objective: To describe functioning in people living with spinal cord injuries (SCI) in Switzerland.
Design: Secondary analysis of cross-sectional survey data. Setting Community, Switzerland.
Participants: Individuals (N=1549) 16 years of age or older with a history of traumatic or nontraumatic SCI and permanently residing in Switzerland.
Interventions: Not applicable.
Main Outcome Measures: Functioning was operationalized through 4 domains: (1) impairments in body functions; (2) impairments in mental functions; (3) independence in performing activities; and (4) performance problems in participation.
Results: Univariate analysis indicated a high prevalence of problems in 5 areas: (1) housework; (2) climbing stairs; (3) tiredness; (4) spasticity; and (5) chronic pain. Graphical modeling showed a strong association among the four domains of functioning. Moreover, we found that the differences in the dependence structures were significant between the paraplegia SCI population and the tetraplegia SCI population.
Conclusions: This study is a first study in the epidemiology of functioning of people living with SCI in Switzerland. Using univariate and graphical modeling approaches, we proposed an empirical foundation for developing hypotheses on functioning in each domain and category that could inform health systems on people’s health needs.
The Impact of Missing Values and Single Imputation upon Rasch Analysis Outcomes: A Simulation Study
(2018)
Imputation becomes common practice through availability of easy-to-use algorithms and software. This study aims to determine if different imputation strategies are robust to the extent and type of missingness, local item dependencies (LID), differential item functioning (DIF), and misfit when doing a Rasch analysis. Four samples were simulated and represented a sample with good metric properties, a sample with LID, a sample with DIF, and a sample with LID and DIF. Missing values were generated with increasing proportion and were either missing at random or completely at random. Four imputation techniques were applied before Rasch analysis and deviation of the results and the quality of fit compared. Imputation strategies showed good performance with less than 15% of missingness. The analysis with missing values performed best in recovering statistical estimates. The best strategy, when doing a Rasch analysis, is the analysis with missing values. If for some reason imputation is necessary, we recommend using the expectation-maximization algorithm.
Der Beitrag stellt die bauordnungsrechtlichen Anforderungen an Unterdecken allgemein und speziell die brandschutztechnischen Anforderungen an Unterdecken für Rohdecken mit Unterdecken sowie an das Brandverhalten von Unterdecken ohne Feuerwiderstand z.B. in Versammlungsstätten dar. Zudem werden die Randbedingungen für die Nachweisführung mit nach EU-Bauproduktenverordnung CE-gekennzeichneten Bauprodukten und Bausätzen oder Bauarten nach nationalem Bauordnungsrecht dargelegt.