PARALLELSESSION III. Follert, P. & Doebler, K. Use of administrative data from health insurances for mandatory nationwide performance measurement in Germany Peter Follert Dipl.-Psych. MBA Head of Division Quality Assurance Department Medicine GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) Berlin Germany 21 st EUMASS congress, in 2016 in Ljubljana

Outline/Overview administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 2  Short: The system of quality assurance in Germany  Concept: Use of administrative data performance measurement  Implementation and next steps

Statutory health insurance: covers 91% of German population National Association of Statutory Health Insurance Funds We negotiate the framework for quality assurance administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 3 spitzenverband.de/english/statutory_h ealth_insurance/statutory_health_insur ance.jsp

administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 4  The legal basis for regulations concerning statutory health care insurance: is the German Social Code, Book Five (SGB V)  Mandate: self-governing German healthcare system  directives define details of statutory regulations  Mandatory regulations concerning quality assurance for  165,000 physicians and psychotherapists  2,000 hospitals

The Federal Joint Committee (G-BA) is a public legal entity comprising the four leading umbrella organizations of the self-governing German healthcare system topics/quality/

administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 6  Hospitals in Germany are required by law to track the quality of their treatments and results in certain areas  Directives by “G-BA”  Indicators for 30 selected clinical areas  provide information for – benchmarking and internal quality improvement – public reporting – nationwide comparison  Current data base: self reported clinical data based on nationwide standardized specifications  comparisons provided to hospital search engines via WWW

administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 7  30 clinical areas like heart surgery, organ transplantation, hip and knee arthroplasty, breast cancer …  464 quality indicators  Approx. 4 millions datesets: Time for documentation leads to complaints about bureaucracy  Data Validity partially questionable  validation procedures necessary

Nutzungsmöglichkeiten administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 8

Transparency: Comparable quality results administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 9

administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite : Concept for performance measurement  new law regulation Data Base: documentation by hospitals what happens afterwards? discharge

administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 11 Percutaneous coronary intervention (PCI) ~800,000 interventions p.a. Start: coronary angiography by indikation PCI (up to 18h until discharge Major Adverse Cardiac and Cerebrovascular Events (MACCE) i.e. myocardial infarction, apoplexia emergency coronary artery bypass coronary revasculari -zation mortality rate (30T/1J) Remuneration: DRG ICD+Procedurecodes Basic data Data from health insurance funds

simplified scheme administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 12 Data of 118 statutory health insurance funds Trustcenter: Pseudonymisation of patient identifying data § Institute for Quality Assurance (IQTIG*): junction, analysis and reporting * (379) ~800,000 interventions

Next projects administrative data for mandatory nationwide performance measurement  Seite 13  Measurement of wound infections for defined tracer procedures Starting 2017  4,3 Mio. operations p.a.  hospitals and ca doctors/ physicians  Coverage of mortality rates and severe complications for other clinical areas Starting 2018?  Kidney failure: dialysis and kidney transplantat  Psychiatry: schizophrenia  ……. EUMASS 2016

Data sources for mandatory nationwide performance measurement Patient reports Hospitals and doctors Statutory health insurance funds administrative data for mandatory nationwide performance measurement  Seite 14EUMASS 2016 New since 2016 New in 2018

Merci beaucoup! Thank you for your attention! Mille Grazie! Gracias por su atención спаси́бо! administrative data for mandatory nationwide performance measurement EUMASS 2016  Seite 15