1. Measurement in Healthcare: the German Experience Burkhard Fischer, BQS, Düsseldorf, Germany 05.03.2009 Prague

2. M AIN PERFORMANCE AND QUALITY INDICATORS MEASURED 26 measurement areas, 194 evidence-based QI covering indication, process, and outcome per-case electronic data capture (self-reported) based on software specification (integrated into HIS) patients: 3.590.000 (96,6%) hospitals: 1.605 von 1.634 (98,2%) source data validation (random sample) individual comparative benchmarking reports BQS Outcome, BQS Quality Report, BQS for Patients Structured Dialogue, regional benchmarking

3. M AIN PERFORMANCE AND QUALITY INDICATORS MEASURED

5. BQS Quality Indicators 2007 regional benchmarking

6. K EY LESSONS LEARNED use evidence-based, risk-adjusted quality indicators mandate an independent leading organisation involve stakeholders incl. patients limit the data collection burden make measurement mandatory, remunerate providers use administrative routine data were available, suitable and valid (e.g. DRG, ICD-10, procedure codes) give timely feedback, work on the results (Str. Dialogue) check appropriateness for public disclosure (QUALIFY)! be aware of publication bias!

8. BQS Quality Indicators 2007 acceptable for public diclosure PneumoinieAortenklappenCholezystektomie Dekubitusprophylaxe Geburtshilfe Gynäkologische Op. HSM Aggregatwechsel HSM-Implantation Herztransplantation Hüft-TEP-ErstimplantationHüftgelenknahe FemurfakturKarotis-Rekonstruktion Knie-TEP-Erstimplantation Komb. Koron.- u. Aortenkl.Chir. Koronarchirurgie, isoliertLeberlebendspendeLebertransplantationMammachirurgieNierenlebendspendeNierentransplantation PCI Knie-TEP-WechselHüft-TEP-Wechsel HSM-Revision/-Explantation assessed by QUALIFY instrument with lay understandable texts

9. N EXT STEPS Quality Measurement along hole care healthcare provision process (out-patient / in-patient) increased use of administrative routine data (DRG, diagnoses and procedures) increased use area indicators inclusion of chronic diseases Quality Management peer review programmes expansion of public disclosure introduction of selective contracting pay for performance(?) Support patient’s choice results to be published by new national quality institute lay understandable language and presentation

10. Contact and Further Information Contact BQS Bundesgeschäftsstelle Qualitätssicherung (National Agency for Quality Measurement in Healthcare) Kanzlerstr. 4, D-40472 Düsseldorf, Germany info@bqs-online.deinfo@bqs-online.de - www.bqs-online.dewww.bqs-online.de Further information QUALIFY instrument http://www.bqs-qualify.com/?set_language=en&cl=enhttp://www.bqs-qualify.com/?set_language=en&cl=en BQS Indicators www.bqs-qualitaetsindikatoren.dewww.bqs-qualitaetsindikatoren.de BQS for Patients http://www.bqs-online.com/public/bqsfp/qifphttp://www.bqs-online.com/public/bqsfp/qifp Results www.bqs-outcome.dewww.bqs-outcome.de BQS Quality Reports www.bqs-qualitaetsreport.dewww.bqs-qualitaetsreport.de

11. www.bqs-online.de