Vernetzte Versorgung für ältere Menschen in Deutschland
International Journal of Integrated Care, 6 July 2005 - ISSN 1568-4156
Book review
Vernetzte Versorgung für ältere Menschen in Deutschland
Christopher Kofahl, Katharina Dahl, Hanneli Döhner
Gerontologie Band 8, Universität Hamburg, 2004, pp 119,
ISBN 3 8258 8195 4 (Only in German)
Susan Jedeloo, MSc, PhD, University of Professional Education Rotterdam, Expertise Centre Transition in Care, The Netherlands E-mail:
Integrated care for the elderly in Germany

How to translate “Vernetze Versorgung”? Does the term reflect the German vision on the organization of care? Finding the term that covers the essence often leads to confusion, both within countries and internationally. For instance, disease management, chain of care, care networks, case management and care management—each term brings about a specific aspect of all processes and initiatives to enhance continuity, quality and efficiency of care. In this journal (IJIC) the term “Integrated Care” is used.

The authors describe “Vernetzte Versorgung” as ‘the cooperation between those involved in the field by means of personal contacts or, at least, in an adequate written or oral way’. “Vernetzung”, aims at prohibiting mistakes in providing care or discontinuity in care caused by inadequate information. The main goal is to improve quality of medical and social care for those depending on the health care system. The authors underline that a standard interpretation of the concept “Vernetzung” does not exist. They define ‘coordination’ and ‘cooperation’ as basic essentials of the concept. The authors describe these difficult concepts and conclude that “Vernetzung” can be used when cooperation becomes normal routine.

This book is a synopsis of the “ProNETZ” project. The goal of this project was to research the many initiatives and projects on the integration of care for the elderly in Germany. Along with the book comes a CD-ROM, containing a digital version. The handy hyperlinks provided in the digital version partly make up for the lack of chapter and paragraph numbering, which makes finding your way through the book more difficult. A PowerPoint presentation on the project gives a concise insight into how it was organized.

An extended summary is provided as an opening chapter of the book, followed by the section “Problem description and background” (what is “Vernetzung” about?). In the “Material and Methods” section the selection process of the 58 projects involved in the synthesis is described. Criteria for inclusion of a project in the analysis regard general project information as well as elements of the target groups, case management and care management, structural innovation, quality assurance, results and experiences. The authors discuss methodological problems in revealing project information, e.g. problems due to accessibility, quality or availability of information, or due to nomenclature. Eventually, the projects are compared according to the type of integration (“community centered”, “institution centered” or “target group centered”). Case management and care management elements were scored and scientific monitoring was registered.

In the “Results” section the authors show the comparisons structured according to these and other predefined integrated care components. In addition, the CD-ROM provides a short description of each of the 58 projects.

Like in other western countries, in Germany, integration of institutions, services and professions is necessary to prevent breaks in the chain of care for people with different or multiple needs of care or who need to make a transition in care. The authors recognize that due to decentralization, increase of supply possibilities and increase in quality of care (demands), integration is becoming more important than a few decades ago. The German care system seems to lack a systematically organized coordination system enabling case management through the different parts of the chain (continuity of care). In the “Discussion” section initiatives to enhance integration are thoroughly discussed and the authors present and elaborate on a practical model for Integrated Consultation (“Integrierten Beratung”). The lack of evidence and the lack of a description of initiatives, their required conditions and their results seem as much a problem in Germany as abroad. The project findings invite for further research and will be used for policy making.

The purpose of this book is to inform field-workers and researchers and to pass on the experiences and efforts of those involved in care for the elderly. In revealing concepts and examples of good practice from the ProNetz project I believe the authors contribute to the integration of experiences and knowledge on integration of care. Unfortunately, the book is only accessible for those interested and proficient in German. This hampers an international sharing of the experiences. However, for those who are proficient in German, this book provides a good impression of experiences with integration of care for the elderly in Germany, comparable and recognizable for colleagues in other European countries.