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[Quality assurance in German hospitals - federal quality of care monitoring vs. evaluation of routine clinical data. A head-to-head comparison on the example of pressure ulcers].

Abstract

Quality assurance is a backbone for the provision of health care. This has lead to the introduction of systems to evaluate and improve patient care. Currently, a 29-category monitoring is mandatory for all German hospitals (EQS, Einrichtungsübergreifende Qualitätssicherung). Since 2007, the incidence rate of pressure ulcers as an indicator for quality of care has been incorporated. A concern associated with the EQS is the requirement for active data entry by doctors and nurses, whereas the US-based patient safety indicator "PSI 3 - pressure ulcer" relies on routine clinical data without the need for additional documentation. In this study, we perform a head-to-head comparison of the 2 methods and analyze the feasibility of implementing the PSI 3 system in German hospitals on the example of pressure ulcer incidence in a German academic hospital. Our analysis shows that the usage of the PSI 3 is feasible. In particular, all clinical data are readily available. Critical advantages of the PSI 3 include the low time consumption and the positive economic impact due to increased work-flow. A prerequisite for the accuracy of the PSI 3 is the careful distinction and documentation of whether a condition (in our case: pressure ulcers) is pre-existing or hospital-acquired. In this regard, the accurate documentation of admission diagnoses is a potential weakness because these are not essential for reimbursement from health insurances and thus tend to be less well documented. In the US and Australia this problem has been addressed by introducing "present on admission" tabs into patient records. In conclusion, our study demonstrates that the usage of a quality assurance system based on routinely acquired clinical data in German hospitals is feasible, and encourages further evaluation.

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  • Authors+Show Affiliations

    ,

    Universitätsklinikum Aachen, Aachen. stheisen@ukaachen.de

    , ,

    Source

    MeSH

    Adult
    Aged
    Female
    Germany
    Hospitalization
    Hospitals
    Humans
    Male
    Middle Aged
    Pressure Ulcer
    Prevalence
    Quality Assurance, Health Care
    Quality Indicators, Health Care
    Quality of Health Care

    Pub Type(s)

    Comparative Study
    English Abstract
    Journal Article

    Language

    ger

    PubMed ID

    20859847

    Citation

    Theisen, S, et al. "[Quality Assurance in German Hospitals - Federal Quality of Care Monitoring Vs. Evaluation of Routine Clinical Data. a Head-to-head Comparison On the Example of Pressure Ulcers]." Gesundheitswesen (Bundesverband Der Arzte Des Offentlichen Gesundheitsdienstes (Germany)), vol. 73, no. 12, 2011, pp. 803-9.
    Theisen S, Drabik A, Lüngen M, et al. [Quality assurance in German hospitals - federal quality of care monitoring vs. evaluation of routine clinical data. A head-to-head comparison on the example of pressure ulcers]. Gesundheitswesen. 2011;73(12):803-9.
    Theisen, S., Drabik, A., Lüngen, M., & Stock, S. (2011). [Quality assurance in German hospitals - federal quality of care monitoring vs. evaluation of routine clinical data. A head-to-head comparison on the example of pressure ulcers]. Gesundheitswesen (Bundesverband Der Arzte Des Offentlichen Gesundheitsdienstes (Germany)), 73(12), pp. 803-9. doi:10.1055/s-0030-1262865.
    Theisen S, et al. [Quality Assurance in German Hospitals - Federal Quality of Care Monitoring Vs. Evaluation of Routine Clinical Data. a Head-to-head Comparison On the Example of Pressure Ulcers]. Gesundheitswesen. 2011;73(12):803-9. PubMed PMID: 20859847.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Quality assurance in German hospitals - federal quality of care monitoring vs. evaluation of routine clinical data. A head-to-head comparison on the example of pressure ulcers]. AU - Theisen,S, AU - Drabik,A, AU - Lüngen,M, AU - Stock,S, Y1 - 2010/09/21/ PY - 2010/9/23/entrez PY - 2010/9/23/pubmed PY - 2012/4/26/medline SP - 803 EP - 9 JF - Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) JO - Gesundheitswesen VL - 73 IS - 12 N2 - Quality assurance is a backbone for the provision of health care. This has lead to the introduction of systems to evaluate and improve patient care. Currently, a 29-category monitoring is mandatory for all German hospitals (EQS, Einrichtungsübergreifende Qualitätssicherung). Since 2007, the incidence rate of pressure ulcers as an indicator for quality of care has been incorporated. A concern associated with the EQS is the requirement for active data entry by doctors and nurses, whereas the US-based patient safety indicator "PSI 3 - pressure ulcer" relies on routine clinical data without the need for additional documentation. In this study, we perform a head-to-head comparison of the 2 methods and analyze the feasibility of implementing the PSI 3 system in German hospitals on the example of pressure ulcer incidence in a German academic hospital. Our analysis shows that the usage of the PSI 3 is feasible. In particular, all clinical data are readily available. Critical advantages of the PSI 3 include the low time consumption and the positive economic impact due to increased work-flow. A prerequisite for the accuracy of the PSI 3 is the careful distinction and documentation of whether a condition (in our case: pressure ulcers) is pre-existing or hospital-acquired. In this regard, the accurate documentation of admission diagnoses is a potential weakness because these are not essential for reimbursement from health insurances and thus tend to be less well documented. In the US and Australia this problem has been addressed by introducing "present on admission" tabs into patient records. In conclusion, our study demonstrates that the usage of a quality assurance system based on routinely acquired clinical data in German hospitals is feasible, and encourages further evaluation. SN - 1439-4421 UR - https://www.unboundmedicine.com/medline/citation/20859847/abstract/Quality_Assurance_in_German_Hospitals___Federal_Quality_of_Care_Monitoring_vs__Evaluation_of_Routine_Clinical_Data__A_Head_to_Head_Comparison_on_the_Example_of_Pressure_Ulcers_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0030-1262865 DB - PRIME DP - Unbound Medicine ER -