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[Quality circles in expert assessment as an instrument in quality management]
1Landratsamt Erlangen-Höchstadt, Gesundheitsamt, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Insights
A quality management program for medical assessments in public health found that physician evaluations varied. The intercomparison program identified areas for improvement in quality assurance and continuing education.
Area of Science:
- Public Health
- Medical Quality Management
Background:
- An intercomparison program was implemented in Baden-Württemberg's public health service to manage the quality of medical assessments.
- Physicians performing medical assessments in January 1997 were invited to a voluntary participation program.
Observation:
- Participants received a case study of a disabled patient and were asked to determine permanent work incapacity.
- Assessments were reviewed against five criteria, with participants and reviewers remaining anonymous.
- 103 out of 246 eligible physicians (43%) returned assessments; 45 requested additional expert opinions.
Findings:
- The program evaluated five criteria: formal construction (100%), case description (84%), sociomedical diagnosis (65%), work ability description (53%), and response to the posed question (75%).
- The program required significant time for preparation, fieldwork, and evaluation.
Implications:
- The intercomparison program proved practicable and valuable for quality management in medical assessments.
- It can enhance motivation, ensure quality, identify deficits, and guide continuing education and quality control programs.
Abstract:
An intercomparison programme was carried out as part of the quality management of medical assessments in the public health service in Baden-Württemberg. All physicians who performed medical assessments in January 1997 were invited to participate. They received a case description adopted from medical records of a precedent case (56-year-old head of a department in an administrative authority, severely disabled after left-sided stroke with residual right-sided partial hemiparesis, reduced work performance), and were asked to assess whether the patient was permanently unable to work. Access to medical expert opinions was requested. Participation was voluntary. Assessments were reviewed twice as to whether five prospectively defined evaluation criteria were fully met, or only partially or not at all. Participants and reviewers remained unknown to each other. Among 246 eligible physicians, 103 returned an assessment (43%). Forty-five respondents had requested additional expert opinions. Anticipations for five criteria were met to their full extent with regard to: formal construction, all submissions; case description, 84%; sociomedical diagnosis, 65%; description of ability to work, 53%; and response to the question posed, 75% of submissions. The programme required considerable work time in its preparatory, field, and evaluation phases. The procedure was however found to be practicable, and a suitable element within a quality management programme can contribute towards motivation, quality assurance and the identification of possible deficits, and thus indicate possible topics and issues for continuing education and quality control programmes.