[Quality assurance in cardiology with routine data : Requirement and reality]

Routine data are very helpful as an instrument for health services research. In German hospitals the input data of the statutory quality assurance (in cardiology: left heart catheterization, cardiac implantable electronic devices and transcatheter aortic valve implantation, TAVI), the data according to § 21 of the Hospital Remuneration Act and mandatory quality assurance reports of hospitals are available. In addition, the health insurance companies also have social data at their disposal. The very restrictive interpretation of data safety in Germany as well as a partition of the data according to the private or statutory health insurance status, outpatient and inpatient forms of treatment and two different remuneration sources exacerbate in the current reality an effective central use of routine data, as is possible in other countries, e.g., Sweden. Routine data are a powerful tool for quality assurance in terms of critical self-reflection and as a basis for peer review by colleagues; however, public reporting of routine data (publication of the results of individual hospitals) is questionable due to methodological limitations, such as data quality and risk adjustment, as it puts hospitals in the pillory without any chance to critically reflect on the validity of the data. Consequently, risk-avoiding behavior in medical services could compromise patient care. The current development of healthcare policies with a structural reform of the hospital landscape and the recommendations of the government committee will increase the demands on the quality assessment based on routine data. Simplified data acquisition, methodological improvements as well as new aspects, such as the quality of indications, assessment of nursing services and patient orientation will be added. In future, a quality-oriented remuneration based on routine data is intended to help control the healthcare system.