Abstracts by keywords: quality of care
Analysis of the competency profile from the perspective of quality and risk management
02.04.2025
Practice networks can be defined as regional associations of medical service providers that aim to improve the care of a group of patients receiving shared care. The aim of this survey was to obtain and systematically present information on the organization of practice networks, their cooperation and communication, as well as established initiatives to improve the quality of care.
03.12.2024
Since 2003, hospital services have been reimbursed through the case-volume-dependent, flat-rate reimbursement system of the G-DRG (German Diagnosis Related Groups) (Section 17b (1) Sentence 1 KHG/Reimbursement Institute 2023). Diagnosis, severity of the illness, and the operations and procedures performed, along with other parameters if applicable, are entered into the patient classification system for grouping (Reimbursement Institute 2023). Although other countries, such as the United Kingdom, Finland, and the Netherlands, also use DRG systems, Germany has a strong performance and volume incentive compared to other countries1. Despite the additional refinancing of nursing care through the nursing budget introduced in 2020 (Reimbursement Institute 2023), there is no case-volume-independent refinancing of necessary provision (Federal Ministry of Health 2023).
04.12.2023
Health services research has gained in importance over the last decade because it is becoming increasingly clear that the majority of scientifically based decisions in health care are based on data that have been carried out under the ideal conditions of an experimental study. These ideal conditions make it possible to demonstrate 'efficacy', which means that an expected effect was very likely brought about by the intervention suspected of causing this effect. Under these ideal conditions, however, it is not possible to test whether the effect proven as efficacy can also be induced under everyday conditions (effectiveness) if the naturally occurring confounding factors (confounders) such as comorbidity or therapies for concomitant diseases cannot be ruled out. The differences in the methods for proving efficacy and effectiveness have been described (Porzsolt et al. 2015). In order to be able to make reliable care decisions, however, information on effects that occur under everyday conditions is required. The Lancet addressed the significant problem of overuse that will be with us in the next decade (Berwick 2017; Brownlee et al. 2017). This problem can neither be quantified nor solved without depicting the reality of care (under everyday conditions).
03.04.2017
Against the background of current social changes such as demographic change and the phenomenon of new morbidity (Thyen 2009: 14), the healthcare system in Germany is faced with new tasks. The term new morbidity describes a development from a focus on simple somatic diseases in the German population to an increase in complex chronic health disorders in the last decades. The development is always multifactorial. Due to the complex and long-term course of the disease, which usually includes somatic and psychological components, the therapy is demanding and can only be managed by cooperating care structures (Schlack 2009: 450). Both institutional framework conditions and therapeutic treatment programs must be tailored to the current care needs and needs of the population. Faced with this challenge, not only service providers (Schlack 2009: 450, German Medical Association 2010: 27, Ungewitter 2010: 112 ff.), but also science (Expert Council 2009: 430) and politics (BMG 2012:66) are calling for a more closely integrated care structure. Services should be provided at a low threshold and, if necessary, in an interdisciplinary manner (BMG 2011:10, 22, 32, 35).
03.04.2017
The aim of the study was to analyze DRG-attributable effects on the care process in and around the hospital. On the basis of 30 representatively selected hospitals in Lower Saxony and using a differentiated methodology, it was possible to show: 1. The quality of direct patient care in the hospital has largely not changed due to the introduction of the DRG. 2. There is no evidence for a targeted selection of lucrative treatment cases. 3. The phenomenon of a "bloody dismissal" cannot be proven. 4. An increase in unplanned readmissions ("revolving door effect") in the course of the introduction of the DRG cannot be proven. 5. The hospitals have created the essential prerequisites for the operational implementation of the DRG system; a future-oriented strategic alignment and a consistent process design has only been partially implemented. 6. The working conditions have changed in the course of the introduction of the DRG, with the documentation and coding effort being overestimated. 7. The medium-sized and large hospitals are largely economically successful even under DRG conditions because they can use the opportunities for strategic realignment, while this is much more difficult for the smaller hospitals.
01.04.2010
Direct contracts started out as discount contracts for pharmaceuticals. In the meantime, however, it is becoming apparent that they are covering more and more areas of care through general practitioner and specialist contracts. Everyone should benefit from these contracts: Health insurance companies have a better influence on the service, service providers receive better remuneration and patients better care. But it shouldn't cost more either. Whether this is successful can only be shown by means of health services research. It should also be noted that direct contracts must not put you in a worse position than standard care. This specification, which has received little attention in the previous discussion, is a steep template for health services research.
01.06.2009
There are a variety of treatment options available to treat psoriasis vulgaris. The S3 guideline of the AWMF defines the current standard of treatment. As early as 2005, a Germany-wide study pointed to an undersupply of psoriasis vulgaris. A variety of treatment options are available to treat psoriasis vulgaris. The S3 guideline of the AWMF defines the current standard of treatment. As early as 2005, a Germany-wide study pointed to an undersupply. In the present Germany-wide cross-sectional study, the care situation of patients with psoriasis in Germany was examined in 2007. The following characteristics, among others, were recorded in 142 dermatological practices and clinics: a) Doctor questionnaire: previous therapies and illnesses, clinical characteristics, severity level (PASI), b) Patient questionnaire: quality of life, patient-relevant therapy benefits, satisfaction with care. Eight indicators of the quality of care were developed in an expert consensus. 11.6 % of the 2,009 patients had severe (PASI>20) and 27.4 % had moderate psoriasis (PASI 10-20). The mean PASI was 10.1. 32.2 % of the patients indicated a severely impaired quality of life (DLQI>10), the mean DLQI was 7.5. Almost half (47.3 %) of the patients had already received systemic therapy, among those with severe psoriasis 62.1 %. 20.1 % of the patients had been treated as inpatients in the previous year. On average, the patients were unable to work for 3.4 days per year due to their psoriasis. An improvement in the quality of care compared to 2005 could be seen in all eight indicators. In the present Germany-wide cross-sectional study, the care situation of patients with psoriasis in Germany was examined in 2007. The following characteristics, among others, were recorded in 142 dermatological practices and clinics: a) Doctor questionnaire: previous therapies and illnesses, clinical characteristics, severity level (PASI), b) Patient questionnaire: quality of life, patient-relevant therapy benefits, satisfaction with care. Eight indicators of the quality of care were developed in an expert consensus. 11.6 % of the 2,009 patients had severe (PASI>20) and 27.4 % had moderate psoriasis (PASI 10-20). The mean PASI was 10.1. 32.2 % of the patients reported a severely impaired quality of life (DLQI>10), the mean DLQI was 7.5. Almost half (47.3 %) of the patients had already received systemic therapy, among those with severe psoriasis 62.1 %. 20.1 % of the patients had been treated as inpatients in the previous year. On average, the patients were unable to work for 3.4 days per year due to their psoriasis. An improvement in the quality of care compared to 2005 could be seen in all eight indicators.