Feasibility of 48 quality indicators in ambulatory care in Germany: a cross-sectional observational study.

BACKGROUND: The National Association of Statutory Health Insurance Physicians develops quality indicators (QIs) for ambulatory care in Germany. This study explores the feasibility of a total of 48 QIs. METHODS: Cross-sectional observational study with primary data collection in writing from medical practices in 10 specialist fields of outpatient care. "Feasibility" covers 7 criteria for indicator assessment and data collection: applicability, availability, retrievability, complexity, relevance, reliability, and acceptance. A questionnaire consisting of 10 questions was used to evaluate these feasibility criteria for each indicator. Survey results were subjected to descriptive analysis. RESULTS: The analyzed sample comprises 103 participants who have been working as practice-based physicians for an average of 13 years. 40% only keep electronic medical records and 2% only paper records, and the rest uses both. The rating of QIs in the field-specific QI sets shows the following mean values: 67% of the participants consider the QIs assigned to them as corresponding to their practice care mandate. Data on these QIs deemed to be applicable are collected by 94% of respondents, documented by 91%, and by 51% electronically. 58% of the data required for the denominator, and 38% for the numerator are retrievable from the practice management system. The time required to access data on a QI is more than 30minutes for 84% of respondents, and 67% consider the effort involved as unacceptable. The rating received was 61% for the relevance of QIs to the assessment of a practitioner's own quality of health care, 69% for the estimated reliability of data collection, and 58% for the acceptance of being evaluated via QIs. CONCLUSIONS: In order to improve the feasibility of QI-based practice assessments it will be necessary to a) fine-tune the selection of QIs for the respective groups of specialist, b) to promote the use of computerized practice management systems, and c) integrate effective and user-friendly retrieval functions in the software. Another aspect to be explored is how the acceptance of QI-based practice evaluations can be improved in individual specialist fields.

[AQUIK®: starter set of ambulatory quality indicators developed by the German National Association of Statutory Health Insurance Physicians]. / KBV entwickelt Starter-Set ambulanter Qualitätsindikatoren - AQUIK®-Set.

AIM: Development of a starter set of quality indicators for application by general practitioners and specialists in the outpatient care sector. METHODOLOGY: The results of a systematic search for national and international quality indicators relevant to the outpatient care sector in Germany provided the basis for the indicator selection process. Outpatient care doctors rated the relevance and feasibility of the indicators according to the RAND/UCLA method. In a further step the indicators were tested in medical practices, focussing on data availability and accessibility. RESULTS: As a result, we established a set of 48 reliable, structurally developed and patient-oriented quality indicators which can be used for quality improvement in the outpatient care setting, both by specialists and general practitioners. DISCUSSION: The project provides important information with regard to the future development and use of quality indicators. Depending on the potential fields of application, the development of new indicators as well as a corresponding IT infrastructure is of high priority. Possible unintended effects of indicators will have to be considered.

[Method report 2007 of the Programme for National Disease Management Guidelines--background and content]. / Der Methodenreport 2007 des Nationalen Programms für VersorgungsLeitlinien - Hintergrund und Inhalt.

The Programme for National Disease Management Guidelines (German DM-CPG Programme) was established in 2002 by the German Medical Association (umbrella organisation of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF)--umbrella organisation of more than 150 professional societies--and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The programme provides a conceptual basis for disease management, focussing on high priority healthcare topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organised by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network G-I-N. The main objective of the German DM-CPG Programme is to establish consensus among the medical professions on evidence-based key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year DM-CPGs have been published for asthma, COPD, type 2 diabetes and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for healthcare providers. The article describes background, methods and tools of the DM-CPG programme using the DM-CPG Method Report 2007.