title: Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned.
abstract: Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed.
authors: AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hanover Medical School, Carl-Neuberg-Straße 1, 30625 Hanover, Germany. Electronic address: Anke.Bramesfeld@Aqua-Institut.de.
authors: Anke
authors: A
authors: Bramesfeld
authors: AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.
authors: Jürgen
authors: J
authors: Pauletzki
authors: AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.
authors: Lars
authors: L
authors: Behrenz
authors: AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany; Department of General Practice and Health Services Research, Universitätsklinikum Heidelberg, Voßstraße 2, 69115 Heidelberg, Germany.
authors: Joachim
authors: J
authors: Szecsenyi
authors: AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.
authors: Gerald
authors: G
authors: Willms
authors: AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.
authors: Björn
authors: B
authors: Broge
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D002387:Cataract Extraction / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D004282:Documentation; D005858:Germany; D006801:Humans; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000458:organization & administration*
keywords: Health insurance data; Health policy; Health system; Quality assessment; Quality improvement; Quality in health care