Qualität der BQS-Dokumentation

[Effects of statutory quality assurance in acute inpatient care]

BACKGROUND

Statutory quality assurance (QA) serves to ensure and further develop the quality of service provision. Particularly prominent in Germany's acute inpatient care are mandatory quality reports (QRs) and participation in external quality assessments (eQAs). Their effects have not yet been comprehensively evaluated.

OBJECTIVES

What are the effects of eQAs and QRs on the quality of care?

MATERIALS AND METHODS

Based on a selective literature review, international evidence on the effects of QA was compiled. This was supplemented by analyses of the quality reports of the Federal Office for Quality Assurance (BQS), the Institute for Applied Quality Improvement and Research in Health Care (AQUA), and the Institute for Quality Assurance and Transparency in Healthcare (IQTIG), which have been responsible for eQAs since 2001.

RESULTS

According to international literature, at most weak effects of these measures can be expected, especially on process quality. Studies from Germany mostly observe only uncontrolled temporal trends and partly show improved quality indicators. Only one controlled study each was able to show weak positive effects on outcome and process quality for eQAs and QRs, respectively.

CONCLUSIONS

There are no convincing evaluation results for either the QRs or the eQAs. Deficiencies in the addressee-oriented design of the QRs and the reported indicator results in terms of their validity, risk adjustment, and temporal availability can be cited as potential causes. Statutory QA should be revised by paying more attention to the prerequisites for successful performance feedback and by again creating room for an intrinsically motivated assessment of one's own quality of care.

Quality assurance in primary total hip arthroplasty

OBJECTIVE

To compare two different methods of clinical outcomes documentation and investigate the potential impact of a quality assurance program.

METHODS

Data on primary hip arthroplasties conducted between 2004 and 2014 were prospectively collected and analyzed.

RESULTS

A total of 262/3395 patients suffered a postoperative complication. A reduction of complication rate was observed between 2010 and 2014. A significant difference between the two documentation methods was found in: "cardiovascular complications", "hematoma and postoperative hemorrhage" and "reintervention". Finally, the "normalized length of hospital stay" predicted the occurrence of complications.

CONCLUSION

Reduction of the incidence of complications through time may be attributed to accumulated surgical experience.

[Quality of documentation of intraoperative and postoperative complications : improvement of documentation for a nationwide quality assurance program and comparison with routine data]

INTRODUCTION

Complications after cholecystectomy are continuously documented in a nationwide database in Germany. Recent studies demonstrated a lack of reliability of these data. The aim of the study was to evaluate the impact of a control algorithm on documentation quality and the use of routine diagnosis coding as an additional validation instrument.

METHODS

Completeness and correctness of the documentation of complications after cholecystectomy was compared over a time interval of 12 months before and after implementation of an algorithm for faster and more accurate documentation. Furthermore, the coding of all diagnoses was screened to identify intraoperative and postoperative complications.

RESULTS AND DISCUSSION

The sensitivity of the documentation for complications improved from 46 % to 70 % (p = 0.05, specificity 98 % in both time intervals). A prolonged time interval of more than 6 weeks between patient discharge and documentation was associated with inferior data quality (incorrect documentation in 1.5 % versus 15 %, p < 0.05). The rate of case documentation within the 6 weeks after hospital discharge was clearly improved after implementation of the control algorithm. Sensitivity and specificity of screening for complications by evaluating routine diagnoses coding were 70 % and 85 %, respectively. The quality of documentation was improved by implementation of a simple memory algorithm.

[Quality assurance using routine data. Is outcome quality now measurable?]

Health service quality in Germany can be shown by the data from the external quality assurance program (BQS) but as these records are limited to the period of in-hospital stay no information about outcome after discharge from hospital can be obtained. Secondary routine administrative data contain information about long-term outcome, such as mortality, subsequent revision and the need for care following surgical treatment due to a hip fracture.Experiences in the use of secondary data dealing with treatment of hip fractures from the BQS are available in our department. In addition we analyzed routine administrative data from the health insurance companies Knappschaft Bahn-See and AOK in a cooperative study with the WidO (scientific institute of the AOK). These routine data clearly show a bias because of poor quality in coding as well as broad interpretation possibilities of some of the ICD-10 codes used.Consequently quality assurance using routine data is less valid than register-based conclusions. Nevertheless medical expertise is necessary to avoid misinterpretation of routine administrative data.