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Quality level in hospitals largely stable
The quality level in the German clinics is largely stable, according to the announcement by the Federal Joint Committee (G-BA), citing the 2013 quality report, the publication of which the G-BA decided on Thursday. "The report, which has been published for twelve years, offers a comprehensive overview of the nationwide quality of treatment and results for selected medical and nursing services in hospitals," reports the G-BA.
The previously announced results of the 2013 quality report show a "nationwide stable quality level" without major changes in most indicators, according to the G-BA. However, only a few improvements in performance were discernible, although a need for action was identified in some areas. The quality report was drawn up by the Göttingen Institute for Applied Quality Promotion and Research in Health Care GmbH (AQUA Institute) on behalf of the G-BA.
More than three million data sets evaluated To determine the quality level in the clinics, the experts analyzed "in the year of registration in 1,557 hospitals more than 3.2 million data sets for 434 quality indicators from 30 so-called service areas (eg gynecological operations), 403 of which enable a trend statement." The performance of the clinics has been assessed using this method for twelve years. The evaluation showed an improvement in 40 quality indicators (9.9 percent of the indicators) and deteriorations in 17 quality indicators (4.2 percent). The vast majority of indicators (85.9 percent) did not show any changes compared to the previous year, but rather a stable quality level across the board, according to the G-BA.
Potential for improvement in obstetrics Regina Klakow-Franck, impartial member of the G-BA and chair of the sub-committee quality assurance, that “the external stationary quality assurance is the flagshipunder the G-BA quality assurance measures ”. The process has been established for many years, creates transparency and forms the basis for improvements. For this reason, those performance areas and indicators whose quality improvement potential has not yet been exhausted are of particular interest. Here, for example, the expert refers to the obstetrics service area, in which there is a "special need for action" in relation to the "presence of a pediatrician in premature births".
Considerable range of clinic services assessed Although the quality report does not cover all service areas that are covered in the clinics, a considerable range of treatments was again evaluated for 2013. According to the G-BA, "among other things, the results of the care for the use of total hip and knee endoprostheses, organ transplants, gynecological operations, catheter-assisted interventions on coronary arteries and heart valves, as well as for the care of premature and mature babies (obstetrics and neonatology ) “Consideration. In addition, the present report contains results on pressure ulcer prophylaxis (pressure ulcer prophylaxis) and a chapter on so-called hospital infections (nosocomial infections), which were related to inpatient or outpatient treatment.
Potential for improvement in individual areas The quality report 2013 also shows indications for the area of breast surgery that further improvements would be desirable here. In the early stages of breast cancer there is too often a radical removal of the lymph nodes, reports the "Deutsche Ärzteblatt" of the results of the report. The specialist newspaper also points out that the chairwoman of the GKV umbrella association, Doris Pfeiffer, has identified potential for improvement in femoral neck fractures, as there are still waiting times of more than 48 hours for an operation, although this significantly worsens the treatment results. Overall, the stable quality level in the clinics is rated positively by most experts. Georg Baum, managing director of the German Hospital Society (DKG), told the “Deutschen Ärzteblatt” that “through targeted quality assurance measures, the high quality level from the previous year could be maintained or further improved in 96 percent of the cases”. At the same time, the proportion of documented data has now risen to more than 99 percent.
Further improvements to the quality report planned Overall, in spite of the extensive data evaluation, only a part of the services are evaluated in the quality report, which slightly relativizes the informative value of the report, reports the "Deutsche Ärzteblatt", citing Wolf-Dietrich Trenner, one of the patient representatives in the G- BA. Trenner also referred to high error rates in individual data collections. However, these error rates will be followed up. The G-BA is also in dialogue with eye-catching clinics. The G-BA reports, for example, that concrete target agreements to remedy qualitative deficiencies are an integral part of the process as part of the so-called structured dialogue. Furthermore, according to the experts, they always work on “the methodological development of inpatient quality assurance.” The focus is on the one hand on adjusting the risk of the indicators to enable valid and fair quality comparisons and on the other hand on reducing bureaucracy through the use of existing routine data Dr. Regina Klakow-Franck. (fp)
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