title: Mandatory national quality improvement systems using indicators: An initial assessment in Europe and Israel.
abstract: BACKGROUND
  Quality improvement systems (QIS) that are based on empirical performance assessment have increasingly been implemented as a mandatory part of health systems across countries. This study aims to describe national mandatory QIS in Europe in 2014.
  
  
  METHODS
  Relevant national agencies for national mandatory QIS in Europe were identified through online searches and key informants. A questionnaire was compiled during a workshop with these agencies and filled out by representatives from these particular agencies.
  
  
  RESULTS
  Agencies in charge of national mandatory QIS in seven countries (Denmark, France, Germany, Israel, Scotland, Sweden and Switzerland) were included in the study. An analysis of QIS revealed similarities, such as the use of routine data for performance assessment and the aim to hold healthcare providers accountable. Differences relate to the different forms of feedback systems and improvement mechanisms used. Trends include the development towards greater implementation of QIS within health systems, the inclusion of the patient's perspective in performance assessment, and experiments with pay for performance-related measures.
  
  
  CONCLUSIONS
  On a country level, for health systems striving for newly implementing QIS it is recommended to start where routine data is available, add qualitative methodologies once the QIS is getting more complex, report performance data back to service providers and be patient centred. On the inter-country level exchange of information between agencies commissioned with implementing national QIS is very much needed for.
authors: AQUA-Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8, 37073 Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany. Electronic address: bramesfeld.anke@mh-hannover.de.
authors: Anke
authors: A
authors: Bramesfeld
authors: Radboud University Medical Centre, Radboud Institute of Health Sciences, Geert Grooteplein 21, 6500 HB Nijmegen, The Netherlands.
authors: Michel
authors: M
authors: Wensing
authors: The Danish Clinical Registries-A National Quality Improvement Programme, Olof Palmes Allé 15, 8200 Aarhus, Denmark.
authors: Paul
authors: P
authors: Bartels
authors: AQUA-Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8, 37073 Göttingen, Germany.
authors: Henning
authors: H
authors: Bobzin
authors: Direction de l'Amélioration de la Qualité & de la Sécurité des Soins, Haute Autorité de Santé, 2, Avenue du Stade de France, 93218 Saint Denis La Plaine Cedex, France.
authors: Catherine
authors: C
authors: Grenier
authors: National Board of Health and Welfare, Rålambsvägen 3, SE 10630 Stockholm, Sweden.
authors: Mona
authors: M
authors: Heugren
authors: Braun School of Public Health & Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel; Kantar Health, Health Outcomes Practice, Jerusalem, Israel.
authors: Dena Jaffe
authors: DJ
authors: Hirschfield
authors: Bundesamt für Gesundheit BAG, Direktionsbereich Kranken- und Unfallversicherung, Schwarzenburgerstr. 175, 3003 Bern, Switzerland.
authors: Manfred
authors: M
authors: Langenegger
authors: National Board of Health and Welfare, Rålambsvägen 3, SE 10630 Stockholm, Sweden.
authors: Birgitta
authors: B
authors: Lindelius
authors: Direction de l'Amélioration de la Qualité & de la Sécurité des Soins, Haute Autorité de Santé, 2, Avenue du Stade de France, 93218 Saint Denis La Plaine Cedex, France.
authors: Bruno
authors: B
authors: Lucet
authors: Direction de l'Amélioration de la Qualité & de la Sécurité des Soins, Haute Autorité de Santé, 2, Avenue du Stade de France, 93218 Saint Denis La Plaine Cedex, France.
authors: Orly
authors: O
authors: Manor
authors: Bundesamt für Gesundheit BAG, Direktionsbereich Kranken- und Unfallversicherung, Schwarzenburgerstr. 175, 3003 Bern, Switzerland.
authors: Theres
authors: T
authors: Schneider
authors: Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, United Kingdom.
authors: Fiona
authors: F
authors: Wardell
authors: Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, United Kingdom; Department of General Practice and Health Services Research, Heidelberg University Hospital, Voßstr. 2, D-69115 Heidelberg, Germany.
authors: Joachim
authors: J
authors: Szecsenyi
mesh_terms: D003625:Data Collection; D003695:Delivery of Health Care; D005060:Europe; D006302:Health Services Research; D006801:Humans; D020407:Internet; D007557:Israel; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Health care; Health care systems; Health services research; Quality assurance; Quality indicators; Quality of health care