Kostensenkung und verbesserte Versorgungsqualität für multimorbide, schwer transportable Patient:innen durch Mobile Endoskopische Dysphagie-Diagnostik im ambulanten Setting

Abstract

Background: Instrumental diagnostic procedures such as the Fiber Endoscopic Evaluation of Swallowing (FEES) are recommended as gold standard by the German Society of Neurology (DGN) for the assessment of aspiration risk, extent of disturbance and therapy planning. However, clinical procedures are often used in clinical practice for reasons of costs and handling. Due to their insufficient sensitivity, specificity and rater-dependent variability, these alone are not sufficient to assess the pathomechanisms of a swallowing disorder. In addition, access to FEES is limited for multimorbid and intensive care patients due to transport limitations. The use of Mobile Endoscopic Dysphagia Diagnostics (MEDD) is discussed as a possible solution to the care problem. However, there is a lack of implementation possibilities for a standard deployment in Germany. The purpose of the study is to investigate the implementation requirements of MEDD. Method: Four experts were interviewed using semi-standardized guide interviews on the implementation requirements, optimization and positive and negative aspects of the MEDD. Results: According to experts, MEDD can help to reduce health care costs and increase swallowing-related daily participation among those affected. Moreover, the use of MEDD provides an increasing quality of life and care, as therapists are able to plan and evaluate their treatments in detail using imaging. The standard use of MEDD is mainly limited by unclear legal regulation and accounting aspects as well as an insufficient awareness and trivialization of the symptom complex »dysphagia« by health professionals in Germany. Basically, a health-policy-supported financing model and a revision of the training curricula for the medical profession, speech therapy and nursing profession are required. Conclusion: From the expert's point of view, MEDD can contribute significantly to saving healthcare costs and improving the swallowing-related quality of life of affected patients by differentiated, instrumental and mobile dysphagia diagnostics. For the standard use of MEDD, clear, health-policy-based regulations on delegation, hygiene, emergency management and compensation are necessary, as well as a revision of the training curricula in human medicine and the health professions. Key words: dysphagia, instrumental swallowing diagnostics, FEES, mobile endoscopic dysphagia diagnostics, MEDD