Quality in German clinics stable

Quality level in the hospitals largely stable

08/22/2014

The quality level in German clinics is largely stable, according to the Joint Federal Committee (G-BA), citing the 2013 quality report, which was approved by the G-BA on Thursday. „The report, which has now been published for twelve years, provides a comprehensive overview of the nationwide quality of treatment and results on selected medical and nursing services in hospitals“, reports the G-BA.

The results of the quality report 2013 announced in advance show „nationwide stable quality level“ Without significant changes in most indicators, the G-BA Communication. However, only a few improvements in performance were discernible, although in some areas there was a need for action. The quality report was prepared by the Göttingen Institute for Applied Quality Promotion and Research in Health Care (AQUA Institute) on behalf of the G-BA.

More than three million records evaluated
To determine the quality level in the clinics, the experts analyzed „in the year of data collection in 1,557 hospitals, more than 3.2 million records were added to 434 quality indicators from 30 so-called performance areas (e.g., gynecological operations), of which 403 provide a trend statement.“ For twelve years, the performance of the clinics has been evaluated using this method. The evaluation showed improvements for 40 quality indicators (9.9 percent of the indicators) and 17 for quality indicators (4.2 percent). By contrast, the vast majority of indicators (85.9 per cent) showed no changes compared to the previous year, but a quality level that remained stable throughout the country, according to the G-BA.

Potential for improvement in obstetrics
To the results of the quality report 2013 Regina Klakow-Franck, a non-partisan member of the G-BA and chairwoman of the quality assurance subcommittee that „the external stationary quality assurance the flagshipunder the G-BA quality assurance measures“ performing. The process has been established for many years, creates transparency and forms the basis for improvements. For this reason, those service areas and indicators of particular interest whose quality improvement potential has not yet been exhausted are of particular interest this year. Here, for example, the expert refers to the range of services obstetrics, in which a „special need for action“ in terms of the „Presence of a pediatrician in premature birth“ determine.

Considerable range of clinic services evaluated
Although the quality report does not cover all areas of care covered by the clinics, a considerable range of treatments was again evaluated in 2013. According to the information provided by the G-BA „among other things, the results of care in the use of hip and knee endoprostheses, in organ transplants, gynecological operations, catheter-supported surgery on coronary vessels and heart valves and in the care of premature and neonatal infants (obstetrics and neonatology)“ Consideration. In addition, the present report contains results on decubitus prophylaxis (pressure ulcer prophylaxis) and a chapter on the so-called hospital infections (nosocomial infections), which were related to inpatient or outpatient treatment.

Potential for improvement in individual areas
The 2013 quality report also shows indications for the area of ​​breast surgery that further improvements would be desirable. In the early stages of breast cancer too often a radical removal of the lymph nodes, the reports „German Medical Journal“ from the results of the report. The trade paper also points out that the CEO of the GKV-Spitzenverband, Doris Pfeiffer, has identified room for improvement in femoral neck fractures, as there are still waiting times of more than 48 hours for surgery, although this significantly worsens treatment outcomes. Overall, however, the stable quality level in the clinics is rated positively by most experts. Georg Baum, Chief Executive of the German Hospital Association (DKG), told the „German Medical Journal“, that „By means of targeted quality assurance measures, the high quality level from the previous year is maintained or even improved in 96 percent of the cases“ could. At the same time, the proportion of documented data has risen to more than 99 percent.

Further improvements to the quality report planned
Overall, in the quality report, despite the extensive data analysis, only a part of the services evaluated, which slightly relativizes the validity of the report, reports „German Medical Journal“ citing Wolf-Dietrich Trenner, one of the patient representatives in the G-BA. Trenner also pointed to high error rates for individual data acquisitions. However, these error rates will be investigated. Also, the G-BA is in dialogue with conspicuous clinics. As an integral part of the procedure in the framework of the so-called structured dialogue, for example, concrete target agreements for remedying qualitative deficiencies are concluded, reports the G-BA. Furthermore, the experts always work according to their own information „the methodological development of inpatient quality assurance.“ On the one hand, the focus is on the risk adjustment of the indicators in order to enable valid and fair quality comparisons and, on the other hand, on reducing bureaucracy by using existing routine data. Regina Klakow-Franck. (Fp)