title: A strategy for the implementation of a quality indicator system in German primary care.
abstract: BACKGROUND
  The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started.
  
  
  OBJECTIVE
  To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care.
  
  
  METHODS
  Literature review with a focus on the QOF and German quality indicator literature.
  
  
  RESULTS
  There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes.
  
  
  CONCLUSIONS
  For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.
authors.affiliation: Medical Centre Guetersloh, Nordrhein-Westfalen, Germany. rickvandenheuvel@doctors.org.uk
authors.forename: Henricus
authors.initials: H
authors.lastname: van den Heuvel
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D002908:Chronic Disease; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D019468:Disease Management; D005858:Germany; D006760:Hospitalization; D006801:Humans; D008505:Medical Staff, Hospital; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D006113:United Kingdom; D000078329:Workforce