title: [Evolutionary quality assurance. A new concept for improving process and outcome quality].
abstract: BACKGROUND
  The concept evolutionary quality assurance is a new, non-mandatory, open peer review process for in-patients settings.
  
  
  METHODS
  Ten medical charts (with radiographs) from participating hospitals were randomly chosen and assessed using a prespecified questionnaire (total 134). Individual inadequacies had to be justified on a case by case level. Reviewer and reviewee are known by names, allowing subsequent discussions on content between reviewer and reviewee prior to a final judgement. The final analysis was performed anonymously and communicated to the participants after completion of the process. Patients had to give their consent to the review process. The report, however, is not part of the medical patient file, so that access is not warranted. For the first cycle, all lung clinics and departments throughout Germany were asked to participate. 35 chest hospital (approximately 50%) agreed to participate.
  
  
  RESULTS
  Data analysis revealed that almost all detected inadequacies were apparent, i.e. discussions on the discordant interpretation of diagnostic and therapeutic strategies rarely occurred (0.25%). Final analysis of the evaluation performance of reviewers judged less than 5% and 14% judged more than 30% of all quality inadequacies.
  
  
  CONCLUSIONS
  The quality assurance process is comparably cheap and can be implemented without delay, because standards for reference values are not required. The structure allows adaptation in all areas of clinical medicine.
authors.affiliation: Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs-und Schlafmedizin, Schmallenberg.
authors.forename: D
authors.initials: D
authors.lastname: Köhler
authors.forename: G
authors.initials: G
authors.lastname: Goeckenjan
authors.forename: J
authors.initials: J
authors.lastname: Rünz
mesh_terms: D005858:Germany; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010380:Peer Review; D011785:Quality Assurance, Health Care