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Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned.
Health Policy. 2015 Aug; 119(8):1017-22.HP

Abstract

Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed.

Authors+Show Affiliations

AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hanover Medical School, Carl-Neuberg-Straβe 1, 30625 Hanover, Germany. Electronic address: Anke.Bramesfeld@Aqua-Institut.de.AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany; Department of General Practice and Health Services Research, Universitätsklinikum Heidelberg, Voβstraβe 2, 69115 Heidelberg, Germany.AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25864387

Citation

Bramesfeld, Anke, et al. "Developing Cross-sectoral Quality Assurance for Cataract Surgery in the Statutory Quality Assurance Program of the German Health Care System: Experiences and Lessons Learned." Health Policy (Amsterdam, Netherlands), vol. 119, no. 8, 2015, pp. 1017-22.
Bramesfeld A, Pauletzki J, Behrenz L, et al. Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned. Health Policy. 2015;119(8):1017-22.
Bramesfeld, A., Pauletzki, J., Behrenz, L., Szecsenyi, J., Willms, G., & Broge, B. (2015). Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned. Health Policy (Amsterdam, Netherlands), 119(8), 1017-22. https://doi.org/10.1016/j.healthpol.2015.03.008
Bramesfeld A, et al. Developing Cross-sectoral Quality Assurance for Cataract Surgery in the Statutory Quality Assurance Program of the German Health Care System: Experiences and Lessons Learned. Health Policy. 2015;119(8):1017-22. PubMed PMID: 25864387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned. AU - Bramesfeld,Anke, AU - Pauletzki,Jürgen, AU - Behrenz,Lars, AU - Szecsenyi,Joachim, AU - Willms,Gerald, AU - Broge,Björn, Y1 - 2015/03/23/ PY - 2014/10/14/received PY - 2015/02/23/revised PY - 2015/03/15/accepted PY - 2015/4/14/entrez PY - 2015/4/14/pubmed PY - 2016/12/20/medline KW - Health insurance data KW - Health policy KW - Health system KW - Quality assessment KW - Quality improvement KW - Quality in health care SP - 1017 EP - 22 JF - Health policy (Amsterdam, Netherlands) JO - Health Policy VL - 119 IS - 8 N2 - Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed. SN - 1872-6054 UR - https://www.unboundmedicine.com/medline/citation/25864387/Developing_cross_sectoral_quality_assurance_for_cataract_surgery_in_the_statutory_quality_assurance_program_of_the_German_health_care_system:_Experiences_and_lessons_learned_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8510(15)00091-3 DB - PRIME DP - Unbound Medicine ER -