Colorful circle

Bunter Kreis is the name of an integrated aftercare model between hospital and outpatient treatment for children and adolescents with cancer, chronically and seriously ill as well as their families. The aftercare services from nursing , social education , psychology , dietetics etc. should be centrally coordinated and evaluated in a case management .

The first "Bunte Kreis" was founded in 1992 in Augsburg . To date, over 90 aftercare facilities throughout Germany have joined forces in the Bundesverband Bunter Kreis eV (as of 2018).

The model

In 1990, the Bunte Kreis Augsburg began setting up aftercare for children and adolescents with cancer, chronic diseases and seriously ill, as well as their families. At the beginning, aftercare was primarily carried out by pediatric nurses; in 1996, the socio-pedagogical work was expanded through funding through the first level of assistance for the disabled , part of the open assistance for the disabled in Bavaria. In 1998 the first contract was signed with the regional health insurances, so that aftercare services for nursing, social education, psychology and dietetics could then be invoiced. The spread of the aftercare model Bunter Kreis in Germany required on the one hand to prove its effectiveness and efficiency and on the other hand to create a nationwide billing option for aftercare.

The beta Institut non-profit GmbH carried out the necessary studies on the effectiveness and efficiency of aftercare together with the Bunter Kreis, the University of Augsburg and the University Children's Hospital in Bonn and introduced the legal initiative on aftercare. In 2004, Section 43 (2) SGB ​​V Social Medical Follow-up Care was included in the Health Modernization Act (GMG) .

Follow-up care based on the Bunter Kreis model is ideally organized from a follow-up care center, which, as a kind of platform, can offer services in five areas.

1. Social medical follow-up care is a service provided by the statutory health insurance companies following an inpatient hospital stay. The aim is to shorten and avoid hospital stays, to ensure successful treatment and to integrate the sick child into their environment.
2. The first stage of assistance for the disabled is a service that has so far been provided in Bavaria as part of open work for the disabled . In the first level of assistance for the disabled, the focus is on psychosocial health. The objectives are to promote activities and integration into everyday and social life, as well as to ensure and promote the psychosocial health of the family members concerned.
3. Patient education / trainings are z. B. for children and adolescents with asthma, diabetes, neurodermatitis and obesity and can be billed through the statutory health insurances according to § 43 Abs. 1 Nr. 2 SGB V. In the training, knowledge is imparted, skills are trained and competencies are built up with the aim of ensuring and improving treatment success, supporting child development and increasing the quality of life for the entire family. In addition to the children / adolescents, the parents also take part in the training.
4. Optional offers are services that are only offered as part of aftercare if there is a regional need that is not already covered by other providers. These are services such as home nursing for children, psychotherapy , occupational therapy , speech therapy , physiotherapy , nutritional advice , interaction consultation , family relief service , animal-assisted therapy , social fund, etc.
5. Pastoral care is offered across all denominations and religions to support the family if the child is critically ill or has died.

Follow-up care based on the Bunter Kreis model has a preventive and rehabilitative character and follows established guiding principles:

• Orientation towards the needs of the individual and their living environment, that is, no blanket recipe is imposed.
• Holistic aspects, i.e. all relevant aspects of health, medical-functional, social, psychological and spiritual, are taken into account.
• Help for self-help, that is, those affected are made competent so that they can help themselves.
• Resource orientation, that is, what the family can do themselves and which helpers are available are taken into account.
• Family orientation, i.e. aftercare, takes into account the needs of the whole family, not just those of the patient.
• Effectiveness and efficiency, i.e. suitable methods are used professionally.
• Scientificity, i.e. the services are provided according to the current state of research.
• Quality assurance, i.e. ongoing documentation and optimization is carried out.

Case management action concept

The complex problems of the families concerned require a high level of expertise on the part of the aftercare staff. The case management concept forms the basis of the Bunter Kreis model. This is carried out on the case and system level.

At the case level, the focus is on the patient and their caregivers. The case manager records the individual problem situation, taking into account the respective needs, before a help plan is drawn up together with the family, which is then implemented. Follow-up measures are repeatedly checked to ensure that the assistance plan is up-to-date and adjusted if necessary. At the end of a measure, the performance is evaluated in terms of quality and reflected on by the employee in order to ensure continuous quality improvement.

At the system level, case managers promote cooperation between the institutions that are relevant for seriously and chronically ill children and adolescents, regardless of whether they work on an outpatient or inpatient basis. Systemic case management work includes analyzing the offers of help in a region as well as establishing contact and cooperation with children's or rehabilitation clinics, doctors, support and advice centers, therapists, health insurance companies, authorities, self-help groups and other relevant aid institutions and service providers. The focus here is not on the competition, but on the networking of the institutions.

financing

The work of an aftercare center based on the Bunter Kreis model is made possible by seven financial pillars:

• Health insurance benefits
• First stage of handicapped work, open handicapped work (Bavaria)
• Membership fees
• Donations, sponsoring , corporate citizenship
• Fines
• Foundations
• church

The use of these funding sources differs depending on the aftercare center. It is determined by the connection of the respective center to a children's clinic, a foundation, an association, a charity or a practice.

Colorful circles in Germany

The Bunter Kreis association was founded in November 2002 because a joint forum seemed sensible for the increasing number of aftercare facilities in Germany. In 2010 it was transferred to an independent non-profit association, the "Bundesverband Bunter Kreis". The head office is in Augsburg. Currently (as of January 2018) the association has 91 member institutions.

The core objectives of the association are:

• Establishment and expansion of comprehensive aftercare in Germany so that aftercare is available to all sick children, even in rural areas
• Increase in the number of diseases treated (premature babies, chronic and rare diseases)
• Ensuring quality according to the Bunter Kreis model through nationwide evaluation and regular quality audits
• Sustainability through adequate financing of the health insurance companies and health policy bases and framework conditions

Scientific background

A socio-scientific and economic evaluation of the aftercare services of the Bunte Kreis was able to demonstrate savings effects through the reduction of lying times for premature and risk-born babies. The study also shows that parents are significantly more satisfied with aftercare than without.

The “Prospective, randomized implementation of the Augsburg model project” (PRIMA study) is a second study project on follow-up care. In terms of health services research, the study shows that family-oriented aftercare improves family skills.

The implementation of the quality standards by the quality association is the basis for further multicenter scientific studies in order to check the quality of the results of the follow-up care and to transfer the findings from pediatric follow-up care to other areas of the health system and disability care.

The Case Management approach has already been successfully applied to breast cancer in the Augsburg model region (mammaNetz) and has also been scientifically evaluated.

literature

• Andreas Podeswik, Eva Kanth, Beate Schreiber-Gollwitzer, Hildegard Labouvie, Waltraud Baur, Antje Otto & Michael Kusch (2007): Praxishandbuch Pädiatric Nachsorge Modell Bunter Kreis. beta Institutsverlag, Augsburg.
• Tanja Wiedemann (2005): Economic efficiency and effectiveness of improved outpatient-inpatient integration through case management. A case-control study of the care of premature and risk-born babies by the “Bunte Kreis”. Peter Lang, Frankfurt a. M.
• vdak 2005a: Association of Salaried Health Insurance Funds eV (vdak) 2005. Framework agreement of the central associations in accordance with Section 43 (2) SGB V. (January 5, 2006)
• vdak 2005b: Association of Salaried Health Insurance Funds eV (vdak) 2005. Recommendations of the central associations according to § 132c SGB V. (January 5, 2006)
• WHO ICF 2006: International Classification of Functioning, Disability and Health (ICF). www.dimdi.de/statc/deklassi/ICF/index.htm (January 5, 2006).

Web links

Website Bundesverband Bunter Kreis