[Data-based quality assurance in the context of the DeQS directive and clinical cancer registries in Germany - A...

In the German healthcare system, the legislator has established various concepts of data-based quality assurance. The Federal Joint Committee (G-BA) regulates external quality assurance procedures through the Directive on Data-Based Cross-Institutional Quality Assurance (DeQS-RL) to improve the quality of care and enable transparent, publicly accessible comparisons between providers. The nationwide implementation of clinical cancer registries (CCRs) was intended to strengthen, in particular, oncological quality assurance and reporting.

This article compares the quality assurance concepts of the DeQS-RL and CCRs regarding the consistency of data collection, data quality and analysis, the use of quality indicators, the handling of deviant quality results to address deficiencies, and the publication of outcomes.

Under the DeQS-RL, data collection, analysis, and the handling of results are standardized nationwide and mandatory for all providers. In case of deviant quality results, targeted improvement measures are initiated with providers to ensure minimum quality standards across all facilities. CCRs operate largely under state regulations and focus primarily on their respective catchment areas. The responsibility for addressing deviant quality results lies with individual facilities. Comparative results are published exclusively by the G-BA.

Unlike CCRs, the G-BA uses three data sources (quality assurance documentation, health insurance data, and patient surveys). Due to binding national specifications and data delivery deadlines, DeQS data demonstrate high completeness, comprehensiveness, and timeliness. Since medical providers do not always comply with their legal obligation to report to CCRs in a timely manner, case histories are often incomplete, impairing quality results and the depiction of care processes.

CCRs can make important contributions to oncological quality assurance; however, due to their organization under state law, limited binding nature, and lack of authority to enforce quality standards, they do not constitute an independent alternative to DeQS. Nevertheless, there are synergies between the two approaches, which will soon be utilized in an upcoming DeQS procedure of the G-BA.