title: Feasibility of 48 quality indicators in ambulatory care in Germany: a cross-sectional observational study.
abstract: BACKGROUND
  The National Association of Statutory Health Insurance Physicians develops quality indicators (QIs) for ambulatory care in Germany. This study explores the feasibility of a total of 48 QIs.
  
  
  METHODS
  Cross-sectional observational study with primary data collection in writing from medical practices in 10 specialist fields of outpatient care. "Feasibility" covers 7 criteria for indicator assessment and data collection: applicability, availability, retrievability, complexity, relevance, reliability, and acceptance. A questionnaire consisting of 10 questions was used to evaluate these feasibility criteria for each indicator. Survey results were subjected to descriptive analysis.
  
  
  RESULTS
  The analyzed sample comprises 103 participants who have been working as practice-based physicians for an average of 13 years. 40% only keep electronic medical records and 2% only paper records, and the rest uses both. The rating of QIs in the field-specific QI sets shows the following mean values: 67% of the participants consider the QIs assigned to them as corresponding to their practice care mandate. Data on these QIs deemed to be applicable are collected by 94% of respondents, documented by 91%, and by 51% electronically. 58% of the data required for the denominator, and 38% for the numerator are retrievable from the practice management system. The time required to access data on a QI is more than 30minutes for 84% of respondents, and 67% consider the effort involved as unacceptable. The rating received was 61% for the relevance of QIs to the assessment of a practitioner's own quality of health care, 69% for the estimated reliability of data collection, and 58% for the acceptance of being evaluated via QIs.
  
  
  CONCLUSIONS
  In order to improve the feasibility of QI-based practice assessments it will be necessary to a) fine-tune the selection of QIs for the respective groups of specialist, b) to promote the use of computerized practice management systems, and c) integrate effective and user-friendly retrieval functions in the software. Another aspect to be explored is how the acceptance of QI-based practice evaluations can be improved in individual specialist fields.
authors.affiliation: Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. Electronic address: Werner.deCruppe@uni-wh.de.
authors.forename: Werner
authors.initials: W
authors.lastname: de Cruppé
authors.affiliation: National Association of Statutory Health Insurance Physicians, Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kleudgen
authors.affiliation: National Association of Statutory Health Insurance Physicians, Berlin, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Diel
authors.affiliation: National Association of Statutory Health Insurance Physicians, Berlin, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Burgdorf
authors.affiliation: Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Geraedts
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards*; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D058006:General Practice / Q000458:organization & administration / Q000706:statistics & numerical data; D005858:Germany; D006302:Health Services Research / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008511:Medicine / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration* / Q000592:standards*; D011216:Practice Management, Medical / Q000458:organization & administration / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000458:organization & administration* / Q000592:standards*
keywords: Deutschland; Feasibility; Germany; Leistungsmessung; Machbarkeit; Qualitätsindikator; ambulante Gesundheitsversorgung; ambulatory care; performance measurement; quality indicator