title: [Impact of quality measurement, transparency and peer review on in-hospital mortality - retrospective before-after study with 63 hospitals].
abstract: BACKGROUND
  In 2008 the 'Initiative Qualitätsmedizin' (initiative for quality in medical care, IQM) was established as a voluntary non-profit association of hospital providers of all kinds of ownership. Currently, about 350 hospitals from Germany and Switzerland participate in IQM. Member hospitals are committed to a quality strategy based on measuring outcome indicators using administrative data, peer review procedures to improve medical quality, and transparency by public reporting. This study aims to investigate whether voluntary implementation of this approach is associated with improvements in medical outcome.
  
  
  METHODS
  Within a retrospective before-after study 63 hospitals, which started to participate in IQM between 2009 and 2011, were monitored. In-hospital mortality in these hospitals was studied for 14 selected inpatient services in comparison to the German national average. The analyses examine whether in-hospital mortality declined after participation of the studied hospitals in IQM, independently of secular trends or deviations in case mix when compared to the national average, and whether such findings were associated with initial hospital performance or peer review procedures.
  
  
  RESULTS
  Declining in-hospital mortality was observed in hospitals with initially subpar performance. These declines were statistically significant for treatment of myocardial infarction, heart failure, pneumonia, and septicemia. Similar, but statistically non-significant trends were observed for nine further treatments. Following peer-review procedures significant declines in in-hospital mortality were observed for treatments of myocardial infarction, heart failure, and pneumonia. Mortality declines after peer reviews regarding stroke, hip fracture and colorectal resection were not significant, and after peer reviews regarding mechanically ventilated patients no changes were observed.
  
  
  CONCLUSIONS
  The results point to a positive impact of the quality approach applied by IQM on clinical outcomes. A more targeted selection of hospitals to be peer-reviewed might further enhance the impact of this approach.
authors.affiliation: Technische Universität Berlin, Fachgebiet Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Berlin, Deutschland. Electronic address: ulrike.nimptsch@tu-berlin.de.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nimptsch
authors.affiliation: Universität Bremen, Institut für Public Health und Pflegeforschung (IPP), Bremen, Deutschland.
authors.forename: Dirk
authors.initials: D
authors.lastname: Peschke
authors.affiliation: Technische Universität Berlin, Fachgebiet Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Berlin, Deutschland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mansky
mesh_terms: D065187:Controlled Before-After Studies; D005858:Germany; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D010380:Peer Review; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013557:Switzerland
keywords: Ergebnisqualität; German Inpatient Quality Indicators (G-IQI); Krankenhaus; Peer Review; Qualitätsmessung; Routinedaten; administrative data; hospital; outcome; peer review; quality measurement