Overview of current projects

Scientific support for the hospital reform in Germany
Since the end of 2022, a reform of hospital structures has been actively pursued in Germany. The basis and inspiration for this is, among other things, the Swiss approach to hospital planning, which was developed in Zurich and has been used in more and more cantons since 2012. The German National Association of Statutory Health Insurance (GKV-SV) wants to participate in the current discussions on the design of hospital reform in a scientifically sound manner. To this end, this project consists of two essential parts: (1) Empirical analysis of the degree of differentiation and the centralization potential of the Zurich hospital planning system based on a grouping system from North Rhine-Westphalia on the German hospital landscape. The project aim is to derive recommendations for the German reform process, especially with regard to a service group system, financing of the provision of service structures ("Vorhaltefinanzierung"), and hospital service mandate planning.

EuroQol Seed Grant - Investigation potential of clinical dashboards incorporating patient-reported outcome measures
The project’s focus lies on clinical dashboards, which are data-driven clinical decision support tools capable of querying multiple databases and providing a visual representation of key performance indicators in a single report. Visualizing data on clinical dashboards has been shown to decrease time spent on data gathering and to improve situation awareness and compliance with evidence-based safety guidelines. The use of PROMs in clinical dashboards supports the clinician’s understanding of how treatments impact symptoms scores and it enables the identification of health-related quality of life (HRQoL) deterioration or improvement at an early stage. 
SLHS - Swiss Learning Health System
Health systems around the world are facing increasing challenges associated with changing clinical patterns of communicable and non-communicable diseases, demographic aging and increasing technological progress, as well as growing resource constraints.
The Swiss Learning Health System (SLHS) is a collaborative project of ten Swiss universities and universities of applied sciences to establish a long-term national platform for health systems and health care research, policy and practice.
DigitalRadar - digital maturity measure
The mission of the «DigitalRadar» is to evaluate the maturity level of hospitals with regard to digitization according to § 14b KHG. The maturity model enables a standardized and comprehensive evaluation of the degree of digitization of hospitals by means of conducting and evaluating a survey or self-assessment of the hospitals. The overall objective is to examine and evaluate the basic status of digitization in German hospitals, as well as the effects of funding with regard to the degree of digitization and the improvement of patient care and regional care structures..
COPdha - Uncovering the need for daily support of COPD patients for developing a digital health assistant
COPD (chronic obstructive pulmonary disease) is a chronic lung disease which - depending on its stage - severely restricts patients in their daily lives. With the help of a survey, we would like to find out in which areas there are difficulties in dealing with COPD and where possible care deficits can be identified. Depending on the feedback from the participants, a healthcare service will be developed to support patients in dealing with their disease. In order to find out whether and in what way such a health service is desired, a needs analysis in the form of this survey should provide clarity
Medical certificates in the area of conflict between different stakeholders
MEDAS in St. Gallen aims at ensuring high-quality medical certificates in eastern Switzerland. For this purpose, medical students should familiarise themselves with medical expert activities already during their education.
By funding a coordination and research position at the Chair, the organization of the course and the further content development is strengthened. It is noteworthy that the content of the course «Medical certificates in the area of conflict between different stakeholders» is be influenced by the funding party.
Preparation of the intercantonal hospital planning for acute somatic care SG-AR-AI 2023
The cantons of St.Gallen, Appenzell Ausserrhoden and Appenzell Innerrhoden develop a joint hospital capacity plan for acute somatic care in 2023 and will each issue independent hospital lists as of 1 January 2024. The project is being led by Roland Unternährer Appenzeller, Office for Health Care, Department of Health of the Canton of St.Gallen. The Chair of Health Care Management of the School of Medicine, University of St.Gallen, supports the Department during the hospital capacity planning process with their expertise.
Low Value Care - Study on financial incentives for the overutilization of healthcare services
Compulsory healthcare insurance in Switzerland entails a deductible system. The fact that the insuree pays only a small amount of health care expenses as soon as the deductible is reached, or none at all after the maximum co-payment, could create an incentive to use services that are not beneficial in the individual context and thus lead to unnecessary consumption of resources.
The objective of this research project is to identify and quantify the overuse of healthcare services by insurees who exceeded the annual deductible and completed their co-payment.  Additionally, we aim at exploring the extent to which such overuse of healthcare services is mediated by structures on the supply-side, e.g., as measured by physician density. 
Effectiveness of Swiss breast cancer prevention program "donna"
We aim to determine the number and types, stages, date of diagnosis of interval cancers in the mammography screening program "donna" since the start of the program, from 2010 to 2019 in the cantons St.Gallen and Graubünden, using combined date of the cancer registry of Eastern Switzerland and the mammography screening program "donna". The original screening mammographies of patients diagnosed later with an interval cancer will be reviewed by expert radiologists and AI diagnosis software. Goal of the project is quality control and improvement of the screeing program.


Overview of completed projects

Low-Value Care (I)
Low-Value Care is defined as services that in an individual context (a) provide little or no benefit to patients, (b) potentially cause harm, (c) incur unnecessary costs, and/or (d) do not use scarce health care resources in a benefit-oriented manner compared to the use of alternative services or the use in an alternative patient group. The systematic identification and quantification of Low-Value Care is challenging. Insurance invoice data have not been used for this purpose so far. The study aims to examine parts of the care path of two exemplary service areas for Low-Value Care with the help of insurance data. 
Cesarean Section Rate in Switzerland - Differences between elective and medically indicated cesarean sections
In Switzerland, approximately every third child is born by cesarean section. In Germany, about 10% of all cesarean sections are classified as elective. In Switzerland, such data are currently lacking. The aim of this research project is to identify factors for the identification of elective cesarean sections and to analyze to what extent they differ from medically justified interventions.
What if gender can determine the outcome?
This research project deals with the influence of gender on the healing process using the examples of hip and knee prostheses. The questions are which variables (pre- but also post-operative, e.g. age, ASA score, etc.) have an influence on the total score as well as the subdimensions of PROMs (Patient-Reported Outcome Measures). Preliminary analyses have shown that male patients often have a better score for the same patient characteristics when compared to female patients. The data come from two hospitals in Germany.
Analysis and further development of Swiss hospital cost accounting: How can comparable and usable cost data be collected transparently?
The costs in the Swiss healthcare system are continuously rising. As a result, the pressure on healthcare providers to get the costs of inpatient treatments under control is increasing. In this context, the importance of correct costing at the case level is very high, be it for internal hospital management, for efficient hospital planning of a canton or for tariff structure development at the national level. In order to investigate the validity of cost data, a systematic analysis and review of further development possibilities of Swiss hospital cost accounting will be carried out in this project.
Hospital Planning – Experience from Switzerland (Canton Zurich)
Switzerland has a highly decentralized healthcare system. The responsibilities at the national and cantonal levels are strictly determined by the Federal Health Insurance Law (Krankenversicherungsgesetz KVG). This law requires the 26 Swiss cantons to plan and to coordinate hospital care in their respective cantons. In 2012, the service-based hospital planning approach was introduced by the cantonal health department of the Canton of Zurich. This approach was successful and all other cantons in Switzerland adopted and adjusted it according to their cantonal specifications. The purpose of this project is to introduce the hospital capacity planning model of the Canton of Zurich into the actual version of 2021.
The project further examines the possibilities for extensions of the model's evaluation criteria
Outcome transparency and its impact on quality of care in hospitals
Due to information asymmetries between patients and physicians, patients have little or no possibility to assess the treatment process and its chances of success a priori. In the past decade, it has been shown internationally that there is a strong quality variance between healthcare providers. This points to the need to make treatment quality transparent through measurement and publication, and to anchor it as a target variable in the healthcare system.