The Center for Evidence-Based Healthcare at Dresden University Medical Center has a very important special feature: The ZEGV is not simply seen as an add-on that simply conducts health services research, but is promoted as an integral component and cross-sectional area of the faculty and hospital, because it has been recognized that "a far greater impact is triggered when clinicians, patients and health services researchers are brought together."

>> The Center for Evidence-Based Health Care (ZEGV) at Dresden University Medical Center is one of the few German locations where the public health initiative, which received state funding in the 1990s, has not only survived but thrived, developing further into health services research as early as the 2000s. This is thanks to the support of the NBL funding initiative, but above all to Prof. Dr. Dr. Wilhelm Kirch, Dean (1997 to 1999) of the Faculty of Medicine, and Prof. Albrecht, Medical Director of the University Hospital, which proudly and confidently calls itself "Die Dresdener," and, of course, to Dr. Jochen Schmitt, who was appointed W2 Professor for Social Medicine and Health Services Research in 2011. He has been Director of the ZEGV since 2012 and Managing Director of the Health Economics Center (GÖZ) at TU Dresden since March 2016.
Perhaps unique, however, is that, unlike many other locations, the Center for Evidence-Based Healthcare is seen not only as an integral component, but also as a cross-sectional area of the faculty and hospital, which together form Dresden's university medical center. While university medical center primarily researches and treats oncological, metabolic, and neurological diseases, the Center for Evidence-Based Healthcare (ZEGV) focuses on translational research, not just from "bench to bedside" (T1 translation), but also from "bedside to practice" (T2 translation). "It has been recognized," Prof. Schmitt states, "that it is no longer sufficient to focus solely on increasing knowledge through basic research; rather, a far greater impact can be achieved by bringing clinicians, patients, and health care researchers together." Only this leads to what really advances care and is meant by the third translation step: "It is no longer necessarily about the so-called Pfaffian last mile, but about the question of how to move from clinical effectiveness to quality-assured implementation in the context of the health system." Only this truly final, third step from clinical to population-based application leads to real health improvement.
Here, the ZEGV primarily works in quality research. Among other things, the safety of service provision or complex interventions in the healthcare context is analyzed, which goes far beyond mere efficacy or effectiveness under routine conditions because it involves much broader contexts – starting with safety, the integration of different perspectives, and, of course, quality itself. Schmitt: "Ultimately, it's about using the methods of evidence-based medicine and those of health services research to evaluate and ultimately achieve the political goals of quality medicine."
What is not so easy at the political level is practiced in Dresden's university medicine. The Carl Gustav Carus University Hospital is the first hospital in Germany to create a joint quality research department, which structurally integrates the health services research of the ZEGV (German Association for the Advancement of Health Care Services) with questions of practical implementation by the Central Department of Quality and Medical Risk Management, headed by Prof. Maria Eberlein-Gonska*. Both departments work closely together, always with the goal of applying health services research methods to quality management. Schmitt illustrates how this can work using the example of pressure ulcers, which can actually be considered the only medical quality indicator in nursing. The ZEGV team evaluated the pressure ulcer documentation recorded in the hospital information system over a period of approximately four years. The results showed that the risk of pressure ulcers varies greatly between clinical areas, despite the fact that such cases naturally occur more frequently in geriatric medicine than in child and adolescent psychiatry. Based on the analysis, the results were discussed with the nursing management. Scenarios were developed, calculated, and critically examined by consensus to determine whether the 100 percent documentation underlying the analysis really makes sense. Where the risk of developing a pressure ulcer is less than 0.5 percent, general pressure ulcer documentation would probably not be very useful, but on the other hand, it would save documentation time and costs by minimizing the number of person-minutes. "To do this, however, it must be clear what risks are associated with less documentation and also how many cases could be missed by no longer performing general screening," explains Schmitt. This was described in various scenarios as part of health services research and presented to the board together with nursing management and quality management. As a result, the board decided that general pressure ulcer documentation would only be carried out in hospital areas with medium to high risk, but that this would be further evaluated. "That's the great thing about health services research in the clinical setting," Schmitt says happily, "because what we research always has the potential to be implemented quickly to improve care."
At least at the Dresden location, and only at the university hospital, but not in the many other hospitals in the state capital of the Free State of Saxony or even in the Free State itself. "Now we have to take the next step," Schmitt says, setting himself a task, because our experiences in Dresden could certainly be transferred to the state and federal levels.
The fact that translation works so well at the Carl Gustav Carus University Hospital in Dresden is not only due to the people involved, who get along well with one another, but also to the structure itself. Many different clinics and institutes of the "Dresden" group contributed to the founding of the ZEGV, not just ideologically, but also with equipment and, above all, personnel – it started with just four positions. After the founding phase, driven by the positive commitment of all involved, the ZEGV was also fortunate enough to have two major BMBF applications approved with partners from the fields of anesthesiology and neonatology. Schmitt: "This allowed us to launch two highly successful projects in the very first year; it was kind of like a fairytale." Today, just four years later, 28 employees – the majority of whom are funded by third-party funds – work at the ZEGV, reaching a critical threshold that raises not only structural and future questions, but also questions about the need for another professorship – but that will surely be another story.