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[Quality Controls in Hospitals by MDK Hessen: A Practice Report of Experiences and Outlook]
Sebastian Ritter1, Frauke Lehr1, Thomas Gaertner2
1Team Consulting stationär, Geschäftsbereich Krankenhaus, Medizinischer Dienst der Krankenversicherung Hessen, Oberursel.
Introduction:
The Hospital Structure Act introduced § 275a SGB V into the German Social Code. It specifies and expands the legal requirements for future quality controls in hospitals performed by the Medical Review Board of the Statutory Health Insurance Funds (MDK). These controls are intended to ensure high-quality, patient-centered and needs-based medical care of the population. Based on 10 years of experience of the Hessian MDK, the practicability of the quality controls is to be demonstrated.
Methods:
The hospital quality controls carried out so far concern either the examination of the structural quality according to the regulations of the Federal Joint Committee (G-BA) for the quality assurance of special care complexes/procedures or the specifications of the German Institute of Medical Documentation and Information (DIMDI) for complex procedures. All quality controls in the Hessian hospitals are performed as on-site inspections by a specialized MDK-team of 2 medical examiners. The quality controls involve the responsible medical staff as well as members of the hospital management.
Results:
From 2006-2016 a total of 357 quality controls were carried out according to the regulations of the G-BA for 10 different special care complexes/procedures. In about 20% of cases, the requirements were not fulfilled. During the same period, 1624 quality controls were carried out according to the specifications of the DIMDI for 33 different complex procedures. In about 40% of cases the required standards were not fulfilled.
Conclusion:
The deficits revealed demonstrate the need for quality control by an independent and qualified body. The quality controls contribute to quality assurance and thus to the quality of structures, processes and outcomes in hospitals. The quality control practice established by the Hessian MDK is transferable to nationwide quality controls to be performed in future.
Insights
Hospital quality controls by the Medical Review Board of the Statutory Health Insurance Funds (MDK) reveal significant deficits, underscoring the need for independent oversight to ensure patient-centered care and improve hospital quality nationwide.
Area of Science:
- Health Services Research
- Quality Improvement in Healthcare
- Hospital Administration
Background:
- The German Hospital Structure Act introduced § 275a SGB V, mandating enhanced quality controls in hospitals by the Medical Review Board of the Statutory Health Insurance Funds (MDK).
- These controls aim to ensure high-quality, patient-centered, and needs-based medical care for the population.
- This study evaluates the practicability of these quality controls based on a decade of experience from the Hessian MDK.
Purpose of the Study:
- To demonstrate the practicability of hospital quality controls mandated by § 275a SGB V.
- To assess the effectiveness of quality control measures implemented by the Hessian MDK.
- To provide insights for nationwide implementation of future hospital quality controls.
Main Methods:
- Quality controls were conducted according to regulations from the Federal Joint Committee (G-BA) for special care and the German Institute of Medical Documentation and Information (DIMDI) for complex procedures.
- Inspections involved on-site evaluations by specialized MDK teams, engaging medical staff and hospital management.
- Data were collected over a 10-year period (2006-2016) in Hessian hospitals.
Main Results:
- 357 G-BA-related quality controls revealed unmet requirements in approximately 20% of cases.
- 1624 DIMDI-related quality controls showed unmet standards in about 40% of cases.
- Identified deficits highlight areas for improvement in hospital structural quality and procedural compliance.
Conclusions:
- The study confirms the necessity of quality control by an independent body to address identified deficits.
- These quality controls are crucial for assuring and enhancing the quality of hospital structures, processes, and patient outcomes.
- The established quality control practices in Hesse are transferable and applicable to nationwide quality assurance initiatives.