For a better assessment of the informative value of the quality indicators (quality characteristics) there are so-called confidence intervals. The confidence interval indicates how accurately the actual result value of the quality indicator can reflect reality. The confidence interval takes into account that not all influences on the treatment outcome can be measured or ascertained.
The main objective of data-supported quality assurance across institutions is to improve the quality of medical and nursing services in hospitals in Germany and to make them comparable. In no other country in the world is there currently a comparable national procedure for quality presentation that includes all hospitals and is geared to medical and nursing objectives.
The procedure is based on the following methodological principle: The treatment of all patients in a hospital is documented in selected service areas on the basis of previously defined quality indicators (quality features). These data are transmitted to the Institute for Quality Assurance and Transparency in Health Care (IQTIG) or the respective state office for quality assurance and evaluated there. The trustworthiness of the data is checked by means of a validation procedure.
The results of the evaluation are reflected back to the hospitals. This gives each hospital the opportunity to assess its own performance level in comparison to others and to develop concrete approaches for quality improvement. In addition, there are specialist groups in each federal state which also analyse the results and hold discussions with the hospitals in the event of conspicuous data (structured dialogue). If a deficit is identified, quality-improving measures are initiated.
Disease Management Programmes (DMP) are special structured treatment programmes for people with a chronic disease. They aim to improve the treatment procedures and the quality of care for the chronically ill. DMPs currently exist in Germany for the indications asthma, chronic obstructive pulmonary disease (COPD), breast cancer, diabetes (diabetes mellitus type 1 and diabetes mellitus type 2) and coronary heart disease. The hospitals participating in a DMP commit themselves to providing quality-assured care in accordance with the specifications of these programmes and must, for example, meet contractually agreed quality requirements.
The course of a patient's treatment and all measures taken (e.g. examinations, operations) must be recorded in writing. During and after the treatment of a patient in hospital, doctors and trained personnel therefore document the examinations (diagnostics) and treatments (therapies) as well as their results in the case-file. In addition, medical quality data is collected for clinical pictures or examinations defined at state and federal level and documented in the case file. These data form the basis for data-supported quality assurance across all institutions. Here, the data necessary for measuring the quality indicators (quality features) are recorded completely and uniformly in order to obtain comparable results.
The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) is the highest decision-making body of the joint self-administration of doctors, dentists, psychotherapists, hospitals and health insurance companies in Germany. Patient representatives actively participate in this decision-making body. Among other things, the Federal Joint Committee decides on quality assurance measures. For example, all hospitals are obliged to participate in procedures of data-supported quality assurance across institutions and to publish quality reports.
ICD (International Classification of Diseases) is the international classification of diseases and related health problems. The ICD code consists of letters and numbers. Hospitals are legally obliged to document diagnoses according to the ICD. Further information is available from the German Institute for Medical Documentation and Information (DIMDI).
Quality management instruments are continuously applied processes for measuring and improving quality. These include, for example, quality indicators, surveys, complaint management, error and risk management, orientation towards guidelines or standards, inter-professional conferences, information and education of patients.
Focal points of care describe the individual medical services on which a hospital concentrates to a particular extent. The information on the main areas of care refers to the departments.
The results of the quality assurance procedures may be available in the form of quality indicators (quality features) and key figures. The key figures provide additional information. Since they do not have a defined quality objective or reference range, no assessment of the quality of care is carried out.
A main department is a department in the hospital where patients are treated by ward physicians of the hospital.
It can happen that a patient has several diseases. The main diagnosis is the disease that has mainly required the patient's hospital stay.
The medical-nursing service offers focus on the non-medical services of a hospital, such as diet and nutrition advice, massages or social services.
On a legal basis, the Federal Joint Committee (G-BA) draws up a catalogue of plannable hospital services for which there is a correlation between the quantity of services provided and the quality of outcomes. For these services it determines minimum quantities on the basis of available scientific knowledge.
The Federal Joint Committee (G-BA) has set minimum quantities for the following eight services:
- Liver transplantation (including partial liver donation)
- Kidney transplantation (including living donation)
- complex interventions on the organ system oesophagus (esophagus)
- complex operations on the organ system pancreas (pancreas)
- Stem cell transplantation
- Total knee joint endoprostheses (knee TEP)
- coronary surgical interventions (currently without specification of a concrete minimum quantity)
- Care of premature and newborn babies with a birth weight of less than 1250 grams
Non-medical service offers refer to the equipment of patient rooms, the special equipment of a hospital, offers for school-age patients and individual help and service offers.
The number of cases is a measure of the size of a hospital. It reflects the number of patients (inpatient, day patient or outpatient) treated within a year. Each patient is counted once during a hospital stay.
The Operation and Procedure Code (OPS) is the official classification of operations, interventions and other (also diagnostic) procedures and examinations in Germany. Hospitals are legally obliged to document their services according to the OPS. You can obtain further information from the German Institute for Medical Documentation and Information (DIMDI).
An occupancy ward is a department in the hospital in which patients are treated by resident doctors (affiliated doctors).
Since 2005, the annual preparation of structured quality reports has been mandatory for hospitals. These reports are intended to make hospital services understandable for patients and the public. The aim of the reports is a clear and comparable publication on the quality and performance of hospitals.
Quality indicators (quality criterion) are used to measure the quality of treatment in a hospital. Each quality indicator has a treatment goal, a documentation and measurement procedure and an evaluation concept. They can relate to the structural, process and outcome quality of a service area. Several quality indicators can be defined for a service area. Based on the reference area, the indicator result for a hospital is evaluated as arithmetically conspicuous or unremarkable and published in the quality report.
Hospitals are required by law to implement an internal quality management system. Professional management, suitable structures, well-trained staff and improved procedures should contribute to high quality and patient satisfaction.
Quality objectives in hospitals make the quality claim comprehensible and transparent. Typical quality goals can refer to patient and employee satisfaction as well as quality indicators (quality features).
The reference range of a quality indicator (quality criterion) distinguishes statistically conspicuous from statistically unremarkable hospital outcomes. Results outside the reference range are conspicuous and should be analysed within the framework of a further assessment (structured dialogue or commenting procedure).
The "Medical expertise of the department" provides information about the existing specialist qualifications and additional training in the department of a hospital.
The Structured Dialogue is a central quality assurance procedure in which statistically conspicuous results for defined quality indicators (quality features) are examined in greater detail. In the procedure, experts from the bodies commissioned for this purpose clarify with the hospital whether statistically conspicuous results were caused by non-compliance with quality requirements or whether there were other reasons. If it is established in the structured dialogue that the medical quality of the treatment can be improved, the hospital concerned is supported in the continuous improvement of the processes with various measures.
The employers' liability insurance associations ("Berufsgenossenschaft"), as the institutions responsible for statutory accident insurance, are obliged to ensure that proper care is provided as quickly as possible in the event of accidents at work. For this purpose, they appoint so-called "doctors on call", who decide on the further course of treatment after a diagnosis has been made. In order to be approved, doctors of intermediate level must, among other things, demonstrate further training as surgeons or orthopaedic surgeons, comprehensive accident medical training and experience as well as special equipment. Participation in the transit physician procedure is an indication of special accident medical experience and the existence of certain medical-technical facilities in the hospital.