[Development of the quality of surgical gynaecological care in the State of Hesse, Germany under external quality assurance].
BACKGROUND AND RESEARCH GOAL: All German hospitals have to participate by law in comparative performance assessment, so called external quality assurance (QA). However, there is only limited research showing a positive impact of such state- and nationwide QA programmes. This article analyses whether the quality of surgical gynaecological care in Hessian hospitals changed after receiving regular feedback on the quality of care between 1998 to 2002.


METHODS
Secondary data analysis of data from all hospitals with gynaecological services in Hesse (n = 84) was performed. The requirement of a constant caseload and continuous data supply reduced cases from 218,217 to 148,549. Considering twelve quality indicators we recalculated the performance of all Hessian hospitals for each quarter during 1998 and 2002. Changes over time were analysed by using rank correlation coefficients and considering multiple testing.


RESULTS
Two indicators (antibiotic prophylaxis in breast surgeries and hysterectomies) showed a significant quality improvement over time. Six indicators (post-operative infections, inappropriate removals of cyst of ovaries, hormone receptor analysis and x-ray of tumour in breast cancer, ovary-preserving procedures for benign tumours and heparin prophylaxis) demonstrated a slight quality improvement and another four indicators (unplanned revision of operation, organ injuries, adjuvant therapy and breast-preserving surgery in breast cancer) tended towards reduced quality.


CONCLUSIONS
During 1998-2002, we observed only marginal improvements in the quality of care. The expected significant improvement of all quality indicators, based on external QA and comparative performance reporting of all Hessian gynaecological hospitals did not eventuate.
Public Health Studiengang an der Heinrich-Heine-Universität Düsseldorf.
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D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology* / Q000601:surgery*; D005858:Germany; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards* / Q000639:trends*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome