title: [Perinatal centres in the state of Baden-Württemberg: effects of minimum volume standards and quality assessments by the Medical Service of Statutory Health Insurance (MDK)].
abstract: BACKGROUND
  In the year 2009 the Federal Joint Committee (G-BA) obliged neonatal units in Germany to publish yearly data on the number of preterm infants treated and their outcome in the internet. At the same time annual minimum volumes were introduced for each level of perinatal care. The exact numbers of compulsory minimum volumes are heavily discussed both scientifically and politically.
  
  
  METHODS
  28 perinatal centres (PNC) in the state of Baden-Württemberg published data on mortality and short-term morbidity of preterm infants with a birth weight (BW) <1,500 g admitted in the year 2008 (n=1,141). These data were analysed on the background of quality assessments of structures and processes in all hospitals performed by the Medical Service of Statutory Health Insurance (MDK).
  
  
  RESULTS
  By the end of 2008, 8 PNC had fulfilled the quality criteria of the G-BA nearly completely and reached a numerical benchmarking value of more than 300 of 465 maximally achievable points. Introducing annual minimum volumes of 36 preterm infants with a BW <1,250 g would lead to a concentration of perinatal care in 7 PNC and minimum volumes of 50 preterm infants with a BW <1,500 g per year in 8 such centres.
  
  
  CONCLUSIONS
  Further centralisation of clinical care for low birth-weight preterm infants in a limited number of PNC in the state of Baden-Württemberg would be economically reasonable and could be achieved either by the introduction of higher minimum volume standards or a stringent interpretation of quality criteria of the G-BA. Based on self-reported data of the PNC currently available in the Internet it is not possible to predict the effect of such a centralisation process on patient outcome.
authors: Medizinischer Dienst der Krankenversicherung Baden-Württemberg (Leitender Arzt: Privatdozent Dr. med. habil. Matthias Mohrmann), Karlsruhe. thomas.boehler@mdkbw.de
authors: T
authors: T
authors: Böhler
authors: B
authors: B
authors: Schaeff
authors: B
authors: B
authors: Waibel
authors: M
authors: M
authors: Mohrmann
mesh_terms: D019985:Benchmarking / Q000592:standards; D002497:Centralized Hospital Services / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality* / Q000517:prevention & control*; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data*; D020407:Internet; D008297:Male; D009313:National Health Programs / Q000592:standards*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000592:standards*; D014600:Utilization Review / Q000706:statistics & numerical data