[Minimum case volume regulations of the Federal Joint Committee : Mode of function and application in practice]. / Mindestmengenregelungen des Gemeinsamen Bundesausschusses : Funktionsweise und Anwendung in der Praxis.

The minimum case volume regulations of the Federal Joint Committee determine the size of the respective annual minimum number for each site of a hospital, for selected scheduled inpatient services where the quality of the treatment results is dependent on the number of services carried out. In addition, further details on the elucidation of the prognosis are determined in the regulations. Due to the legally defined prognostic procedure as a prerequisite for a prospective justification for service provision, new or altered minimum case volumes come into effect even before the end of the validity period established on the justification for provision of services. The Federal Joint Committee established this basic principle also for the introduction procedure in a resolution from 16 December 2021. This article explains the background and should support the implementation.

[10 years of external quality assurance in dialysis in Germany: Results and future prospects]. / 10 Jahre Qualitätssicherung Dialyse in Deutschland ­ Bilanz und Ausblick.

BACKGROUND: In 2006, the Federal Joint Committee introduced a quality assurance programme for ambulatory dialysis treatment in Germany. Regarding the impact of chronic dialysis treatment on the quality of life of patients and on health care costs, quality assurance in dialysis is considered highly relevant. The directive on Quality Assurance in Dialysis (QSD-RL) established an external quality assurance programme on the basis of the assessment of certain quality parameters combined with an internal quality management system based on benchmarking parameters in all dialysis practices and centres. Data on quality parameters are collected and analysed quarterly. Regional associations of statutory health insurance physicians take responsibility for quality improvement measures and sanctions. This article aims to provide an overview of the development of quality parameters from 2008 to 2015. METHODS: We analysed the summarised annual quality reports published on the website of the Federal Joint Committee between 2009 and 2016. We present results on the so-called core quality parameters duration and frequency of dialysis sessions (both for haemodialysis patients), wKt/V for peritoneal dialysis patients, and percentage of haemodialysis patients with central venous catheters which has only been measured since 2014. RESULTS AND CONCLUSIONS: In 2015, 92,000 patients received outpatient dialysis. Between 2008 and 2015, the results for the core quality parameters duration and frequency of haemodialysis improved while the results for wKt/V seemingly show an unfavourable trend. The percentage of patients with central venous catheters appears to be quite high, and thus indicates that there is potential for quality improvement. FUTURE PERSPECTIVES: For the future, the Federal Joint Committee has resolved to merge the quality assurance programmes in dialysis and in kidney transplantation into a newly designed programme that has the potential to follow patients through all stages and kinds of renal replacement therapy and to focus on further aspects of treatment quality.

[Comparative assessment of rehabilitation centres]. / Einrichtungsvergleiche in der medizinischen Rehabilitation.

Comparative quality analyses of rehabilitation centres are required by the legislators and are the focus of the external Quality Assurance plans presently implemented. However, they are also highly relevant for internal Quality Management models (e.g. for the result criteria of the EFQM model). To control for confounders of rehabilitation success that cannot be influenced by the rehabilitation centre (e.g. age, co-morbidity), and thus to permit fair comparisons of clinics, regression analysis risk adjustment procedures are primarily used in the literature. The present paper explains the use of so-called Hierarchical Linear Models (HLMs) using example of data of N = 2.044 patients undergoing rehabilitation following hip and knee operations from the Quality Assurance programme of the statutory health insurance funds (QA-Reha-procedure). This procedure has the advantages of: a) taking into account the multi-level structure of the comparison problem; b) permitting the inclusion of predictors at the rehabilitation centre level; and c) permitting the modelling of variation in regression coefficients over the centres. The data presented show that the differences in achieved rehabilitation outcome among the rehabilitation centres - after control of the confounders by means of HLMs tend to be slight. In addition to patient-related predictors of rehabilitation outcome (baseline somatic, functional, psychosocial status, co-morbidity, rehabilitation motivation, gender, age), the mean functional disability of the patients in the centre is shown to be a confounder at the clinic level. In this respect, a centre that has little experience with severely affected rehabilitation patients achieves on average lesser effects on somatic, functional, and psychosocial levels.