US Healthcare Delivery SystemsQuality Outcome MeasuresDonna .docx
Germany Presentation on Quality
1. Quality in Health Care
Britney Agustin
CSULB
Kimberly De La Cruz
CSULB
Stephanie Morales
CSULB
HAW Summerschool - The German Healthcare System -
15/06/2014-28/06/2014
Prof. York Zöllner
Prof. Christine Färber
Prof. Wolf Polenz
Claudia Duwe MPH
Prof. Erlyana
2. Table of Contents
Definition of Quality, how it is measured and why it is important
Quality in the hospital setting
United States Vs Germany
credential
certification
patient satisfaction
transparency
● What can be improved in Germany
● What can be improved in U.S.
● Final Conclusion
● References
3. What is Quality in Health Care?
Healthcare quality is determined by the measurement of the value of the health
care resources and its ability to provide medical resources of high quality to all
who need them.
Quality assurance as defined by the German Social Code, Book V (SGB V) is not
static, but rather is in constant flux, adapting to major trends and new evidence
emerging on medical care.
For example, the demand for more transparency in the quality of care keeps
growing ever stronger. (AQUA Institut GmbH, 2014)
4. How do you measure quality and why is it important?
Measure Quality by:
Quality Indicators
Checklists
Random Checks
6 Dimensions of Quality
Safety
Effectiveness
Patient Centeredness
Timeliness
Efficiency
Equity
Important because:
Show what areas are
being sufficient
Show what changes
need to be
improved
5.
6. Quality Assurance in USA
The Food and Drug Administration (FDA)
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
Department of Health and Human Services (DHHS)
Fed World - US Government Information
National Center for Complementary and Alternative Medicine (NCCAM)
National Center for Infectious Diseases (NCID)
National Science Foundation (NSF)
Office of Disease Prevention and Health Promotion (ODPHP)
Source: NCQA > HEDIS & Quality Measurement > Quality Measurement Products > Quality Compass [WWW Document], (accessed 6.25.14)
7. Quality Assurance in Germany
Legislation: Gesundheitsstrukturgesetz (9. clause SGB V, §§135-139, 1993)
Statutory provisions: Gemeinsamer Bundesausschuss - Federal Joint Committee
Numerous institutions (Bundesärztekammer…)
Realisation of quality assurance in medicine is the responsibility of the management
AQUA-Institut: independent analysis but based on hospital data, no functioning quality assureance in
ambulatory care
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG)
Independent Scientific Institute newly established within the context of the health care reform 2004
Publish evidence-based reports to guarantee quality and economic efficiency in health care
European Foundation for Quality Management (EFQM)
Extra exceptional: blood transfusions (Transfusionsgesetz, 1998)
Robert Koch Institute (1998), an agency for the control of infectious diseases and health reporting.
National Cancer Plan - in August 2012 plan nationwide standardized cancer registry in 2018 to improve the
quality of cancer care.
Sources: https://www.iqwig.de, Simon: Das Gesundheitssystem in Deutschland
8. Health Care Quality Indicators OECD
Source: OECD (2013), Health at a Glance 2013: OECD Indicators, OECD Publishing. doi: 10.1787/health_glance-2013-en
Primary Care
Acute Care
Cancer Care
Mental Care
Patient Safety
Patient Experience
9. Health Care Quality Indicators
Source: Oecd.org [homepage on the Internet]. Health status. OECD.StatExtracts 2014. Paris: Organisation for Economic Co-operation and Development; cited 2014 Jun 25 Available from:
http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT (accessed 6.23.14)
10. Quality Assurance in Pharmaceutical Germany & USA
Source: Wissenschaftlicher Dienst des Bundestages, 2010
Source: NCQA
11. What can be improved in Germany?
More patient-centred health-care delivery.
Effective and efficient guidelines.
GPs as effective gatekeepers.
Transparency in hospital healthcare and external reports.
Management of information and the adoption of
meaningful electronic assistance systems.
National interconnected information system
Improve training and working condition of healthcare
professionals.
12. Improvements for the US
Variation in Services
There continues to be a pattern of wide variation in health care practice, including regional variations and small-area
variations. This is a clear indicator that health care practice has not kept pace with the evolving science of health
care to ensure evidence-based practice in the United States.
Underuse of Services
Millions of people do not receive necessary care and suffer needless complications that add to costs and reduce
productivity
Each year, an estimated 18,000 people die because they do not receive effective interventions.
Overuse of Services
Each year, millions of Americans receive health care services that are unnecessary, increase costs, and may even
endanger their health. Research has shown that this occurs across all populations.
13. Improvements for the US
Misuse of Services
Too many Americans are injured during the course of their treatment, and some die prematurely as a result.
Disparities on Quality
Although quality problems affect all populations, they may be most marked for members of ethnic and racial minority
populations.
14. Conclusion
Germany has many problems similar to those in the U.S. (e.g. aging population).
The German healthcare system is characterized by the "three S's"- social solidarity,
subsidiarity (decentralization to public and private organizations), and self-
governance.
In this sense, the delivery of healthcare in Germany is similar to that found in the
United States.
Limited internationally comparable data available on quality indicators, especially
in areas involving medical care interventions.
Quality assurance can only be successful when all stakeholders in the healthcare
system pull together.
High structural quality represents an important fundament to improve outcome
and process measures
AQUA Institut GmbH, 2014. German Hospital Quality Report 2012. AQUA – Institute for Applied Quality Improvement and Research in Health Care,, Göttingen,Germany.
Gesundheitsstrukturgesetz. ley estructural
Gemeinsamer Bundesausschuss: gremio de decisiones de los medios y profesionales medicos
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen , instituto para la calidad y rentabilidad en el sistema de salud
a few of them i couldn’t find statistics for the same recent year for both germany and america for me to compare. we can discuss in the am and i will reinsert the revised one
http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG)
Bundesministerium für Gesundheit
Arzneimittelkommission der deutschen Ärzteschaft: comision farmeceutica medicos alemanes
Bundesinstitut für Arzneimittel und Medizinprodukte
Several types of quality problems in health care have been documented through peer-reviewed research.
Underuse of services.
For example, a study of Medicare patients who had suffered heart attacks found that only 21 percent of eligible patients received beta blockers. The mortality rate among patients who received beta blockers was 43 percent lower than it was among nonrecipients.
Overuse of services.
For example, an analysis of hysterectomies performed on women in seven health plans found that one in six operations was inappropriate. A study examining the use of antibiotics for treating ear infections in children on Medicaid found that expensive antibiotics were used far more often than indicated.
Misuse of services. For example, a study of injuries to patients treated in hospitals in New York State found that 3.7 percent experienced adverse events; 13.6 percent of these events led to death, and 2.6 percent led to permanent disability. About one-fourth of these adverse events resulted from negligence.
Disparities in quality. Researchers at the University of Alabama at Birmingham examined the use of thrombolysis ("clot busters") for patients who had experienced a heart attack and found that while this evidence-based life-saving treatment was underused for all, black Medicare beneficiaries were significantly less likely than whites to receive this treatment.
