Patients in Germany are free to seek care from any office-based physician and can always ask for multiple opinions on a diagnosis or treatment. The high density of physicians and the freedom to choose among them without referrals have led to a need for better coordination between the multiple health professionals treating any given patient. The objectives of this study are to (1) identify informal networks of physicians who treat the same patient population, (2) provide these physicians with feedback on their network and patients, using routine data and (3) give the physicians the opportunity to meet one another in facilitated network meetings. The Accountable Care Deutschland (ACD) study is a prospective, non-blinded, cluster-randomised trial comprising a process and economic evaluation of informal networks among 12,525 GPs and office-based specialists and their 1.9 million patients. The units of allocation are the informal networks, which will be randomised either to the intervention (feedback and facilitated meetings) or control group (usual care). The informal networks will be generated by identifying connections between office-based physicians using complete datasets from the Regional Associations of Statutory Health Insurance (SHI) Physicians in Hamburg, Schleswig Holstein, North Rhine and Westphalia Lip, as well as data from three large statutory health insurers in Germany. The physicians will (a) receive feedback on selected indicators of their own treatment activity and that of the colleagues in their network and (b) will be invited to voluntary, facilitated network meetings by their Regional Association of SHI physicians. The primary outcome will be ambulatory-care-sensitive hospitalisations at baseline, at the end of the 2-year intervention period, and at six months and at 12 months after the end of the intervention period. Data will be analysed using the intention-to-treat principle. A pilot study preceded the ACD study. Cochrane reviews show that feedback can improve everyday medical practice by shedding light on previously unknown relationships. Providing physicians with information on how they are connected with their colleagues and what the outcomes are of care delivered within their informal networks can help them make these improvements, as well as strengthen their awareness of possible discontinuities in the care they provide. German Clinical Trials Register DRKS00020884 . Registered on 25 March 2020—retrospectively registered.

中文翻译：

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通过反馈和促进对话改善门诊护理的连续性和协调性——用于评估 ACD 研究的整群随机试验的研究方案（德国的问责制）

德国的患者可以自由地向任何办公室医生寻求护理，并且可以随时就诊断或治疗征求多种意见。医生的高密度以及无需转诊即可在其中进行选择的自由导致需要在治疗任何特定患者的多个卫生专业人员之间进行更好的协调。本研究的目的是 (1) 确定治疗同一患者群体的医生的非正式网络，(2) 使用常规数据向这些医生提供有关其网络和患者的反馈，以及 (3) 让医生有机会见面在便利的网络会议中相互交流。德国责任医疗 (ACD) 研究是一项前瞻性、非盲法、整群随机试验，包括对 12 名非正式网络的过程和经济评估，525 名全科医生和办公室专家以及他们的 190 万名患者。分配单位是非正式网络，将随机分配到干预组（反馈和促进会议）或对照组（常规护理）。非正式网络将通过使用来自汉堡、石勒苏益格荷尔斯泰因、北莱茵河和威斯特法伦州利普地区法定健康保险 (SHI) 医师区域协会的完整数据集以及来自三个大型法定健康保险的数据来确定办公室医师之间的联系来生成。德国的保险公司。医生将 (a) 收到有关他们自己及其网络中同事的治疗活动的选定指标的反馈，以及 (b) 将被邀请参加由其区域 SHI 医师协会发起的自愿、协助的网络会议。主要结局将是基线、2 年干预期结束时以及干预期结束后 6 个月和 12 个月时对门诊护理敏感的住院情况。将使用意向性治疗原则分析数据。在 ACD 研究之前进行了一项试点研究。Cochrane 评论表明，反馈可以通过揭示以前未知的关系来改善日常医疗实践。向医生提供有关他们如何与同事联系以及在他们的非正式网络中提供的护理结果如何的信息，可以帮助他们进行这些改进，并增强他们对所提供的护理中可能存在的不连续性的认识。德国临床试验注册 DRKS00020884。2020 年 3 月 25 日注册——追溯注册。