[Effectiveness of structural quality in quality assurance--a review]

Minimum standards as a part of structural quality are often discussed for the sake of improving the quality of medical care. Before implementing obligatory standards, however, the effectiveness of the demands made should be evaluated.

Our method was a systematrix review (with an eye to structural quality indicators) of literature found by searching Medline; the structural quality indicators taken into account were special forms of medical care, hospital characteristics, certification, internal quality management, internal peer-reviewing, telemedicine, continuing medical education, the use of guidelines, and the caseloads of physicians and hospitals?

A minimum caseload, the use of guidelines and continuing medical education show positive effects on the outcome of care. The other items show mixed study results or are not measurable in a sense that would make their results of use for quality improvement. Without evidence of effectiveness, minimum standards should not be introduced. Despite the inhomogeneity of the methods used by the studies, minimum caseloads for some diagnoses, the use of guidelines and well-organised continuing medical education are to be recommended.