Structural characteristics and contractual terms of specialist palliative homecare in Germany
Authors: Jansky Maximiliane , Heyl Lia , Hach Michaela , Kranz Steven , Lehmann Thomas , Freytag Antje , Wedding Ulrich , Meißner Winfried , Krauss Sabine H. , Schneider Werner , Nauck Friedemann ,   for the SAVOIR Study Group, Bauer Anna , Ditscheid Bianka , Eichhorn Cornelia , Gaser Elke , Hammer Ulrike , Helbig Aicko , Hennig Beata , Kaufmann Michelle , Krause Markus , Kruschel Isabel , L’hoest Helmut , Maddela Srikanth , Marschall Ursula , Mboulla Martial , Melching Heiner , Mühler Florian , Nageler Cornelia , Parhizkari Sara , Rothaug Judith , Saam Joachim , Schulz Sven , Stichling Kathleen , Vollmar Horst C. , von Hayek Julia 
Published: October 2023

Abstract
Background
Multi-professional specialist palliative homecare (SPHC) teams care for palliative patients with complex symptoms. In Germany, the SPHC directive regulates care provision, but model contracts for each federal state are heterogeneous regarding staff requirements, cooperation with other healthcare providers, and financial reimbursement. The structural characteristics of SPHC teams also vary.

Aim
We provide a structured overview of the existing model contracts, as well as a nationwide assessment of SPHC teams and their structural characteristics. Furthermore, we explore whether these characteristics serve to find specifc patterns of SPHC team models, based on empirical data.

Methods
This study is part of the multi-methods research project “SAVOIR”, funded by the German Innovations Fund. Most model contracts are publicly available.
Structural characteristics (e.g. number, professions, and affiliations of team members, and external cooperation) were assessed via an online database (“Wegweiser Hospiz- und Palliativversorgung”) based on voluntary information obtained from SPHC teams. All the data were updated by phone during the assessment process.
Data were descriptively analysed regarding staff, cooperation requirements, and reimbursement schemes, while latent class analysis (LCA) was used to identify structural team models.

Results
Model contracts have heterogeneous contract partners and terms related to staff requirements (number and qualifications) and cooperation with other services. Fourteen reimbursement schemes were available, all combining different payment models. Of the 283 SPHC teams, 196 provided structural characteristics. Teams reported between one and 298 members (mean: 30.3, median: 18), mainly nurses and physicians, while 37.8% had a psychosocial professional as a team member. Most teams were composed of nurses and physicians employed in different settings; for example, staff was employed by the team, in private practices/nursing services, or in hospitals. Latent class analysis identified four structural team models, based on the team size, team members’ affiliation, and care organisation.

Conclusion
Both the contractual terms and teams’ structural characteristics vary substantially, and this must be considered when analysing patient data from SPHC. The identified patterns of team models can form a starting point from which to analyse different forms of care provision and their impact on care quality.