Dimensions of Quality and Their Increasing Relevance for Visceral Medicine in Germany

Abstract

Background: ‘Quality in medicine' is a term used in a broad sense. In this work the definition and dimensions of quality in medicine and the implementation of a measurement and reporting system in Germany are discussed. Existing applications are described and possible future effects are pointed out. Methods: The ongoing process of implementing a quality reporting system into the German healthcare system is studied by publicly available legal texts, published reactions of stakeholders and publications of G-BA and IQTIG. Definitions of quality, dimensions of quality and quality measurement in medicine are studied by using textbooks as well as the world wide web and PubMed search. Results: Donabedian‘s ‘dimensions of quality' are fundamental in dealing with quality in medicine. Existing measurement and reporting systems have immanent strengths and weaknesses, as the definition of quality is affected by one‘s point of view. The legislator will have to decide which ‘dimension of quality' is mandatory and how to measure it. Conclusion: Quality has become a control instrument with unforeseeable consequences. A clear definition of the used quality concept is as essential as the use of feasible measurement and reporting systems. The use of routine data could be an interesting option.

Carbon footprinting for hospital care pathways based on routine diagnosis‐related group (DRG) accounting data in Germany: An application to acute decompensated heart failure

“…This might lead to the concern that inpatient care provided by a hospital could be changed in a way that improves carbon footprint but involves lower quality, for example, due to skimping on necessary care items. In Germany, an array of care quality assurance regulations and measures are in place at both the federal and state level (Blümel et al., 2014; Keßler & Heidecke, 2017), which may relieve this concern. This includes mandatory internal and external quality control measures, especially the strict minimum quantity regulation.…”

Criteria and Indicators of Dental Care Quality: State of Development and Usage

“…Так, наукові дані свідчать, що насамперед при розробці критеріїв і індикаторів якості бажано здійснити дезагрегацію поняття якості на окремі компоненти з метою можливості вимірів кожного з них та співвіднести їх з відомими складовими моделі управління якістю А. Донабедіана -структурою, процесом і результатом. Таким чином рекомендують формувати блоки критеріїв і індикаторів якості у систематизованому вигляді [8][9][10][11], чого не спостерігається у досліджуваних закладах.…”

Surveillance of surgical site infections: methodical comparison of the IQTIG and KISS strategies

“…At the beginning of 2017, the Institute for Quality Assurance and Transparency in Health Care (IQTIG) implemented the quality assurance procedure for “Prevention of nosocomial infections – surgical site infections” (QA-SSI). With the components of case- and institution-related QA documentation as well as subsequent linking to relevant social data, the procedure is intended to generate cross-sectoral surveillance of corresponding surgical patient cases in the outpatient and inpatient sectors https://iqtig.org/downloads/berichte/2016/IQTIG_Poster_ QS-WI_2017-09-28.pdf [ 8 ], [ 9 ]. Based on the service and routine data in accordance with § 21 KHEntgG (German Hospital Fee Act), algorithms and combinations of different codes are used to trigger a documentation obligation to assess potential surgical site infections [ 8 ], [ 9 ].…”

“…With the components of case- and institution-related QA documentation as well as subsequent linking to relevant social data, the procedure is intended to generate cross-sectoral surveillance of corresponding surgical patient cases in the outpatient and inpatient sectors https://iqtig.org/downloads/berichte/2016/IQTIG_Poster_ QS-WI_2017-09-28.pdf [ 8 ], [ 9 ]. Based on the service and routine data in accordance with § 21 KHEntgG (German Hospital Fee Act), algorithms and combinations of different codes are used to trigger a documentation obligation to assess potential surgical site infections [ 8 ], [ 9 ]. The staff of the medical department to which the patient belongs at the time of initiation is responsible for meeting this requirement [ 8 ].…”