Quality in Health Care

Britney AgustinCSULB

Kimberly De La CruzCSULB

Stephanie MoralesCSULBFelipe Weinberg M.D.

HAW

Thursday, June 26th, 2014

HAW Summerschool - The German Healthcare System -15/06/2014-28/06/2014

Prof. York ZöllnerProf. Christine FärberProf. Wolf PolenzClaudia Duwe MPHProf. Erlyana

Table of ContentsDefinition of Quality, how it is measured and why it is importantQuality in the hospital setting

United States Vs Germanycredentialcertificationpatient satisfactiontransparency

● What can be improved in Germany● What can be improved in U.S.● Final Conclusion● References

What is Quality in Health Care?

Healthcare quality is determined by the measurement of the value of the health care resources and its ability to provide medical resources of high quality to all who need them.

Quality assurance as defined by the German Social Code, Book V (SGB V) is not static, but rather is in constant flux, adapting to major trends and new evidence emerging on medical care. For example, the demand for more transparency in the quality of care keeps growing ever stronger. (AQUA Institut GmbH, 2014)

How do you measure quality and why is it important?

Measure Quality by:Quality IndicatorsChecklistsRandom Checks6 Dimensions of QualitySafetyEffectivenessPatient CenterednessTimelinessEfficiencyEquity

Important because:Show what areas are being sufficient

Show what changes need to be improved

Quality Assurance in USA

The Food and Drug Administration (FDA)National Institutes of Health (NIH)Centers for Disease Control and Prevention (CDC)Department of Health and Human Services (DHHS)Fed World - US Government InformationNational Center for Complementary and Alternative Medicine (NCCAM)National Center for Infectious Diseases (NCID)National Science Foundation (NSF)Office of Disease Prevention and Health Promotion (ODPHP)

Source: NCQA > HEDIS & Quality Measurement > Quality Measurement Products > Quality Compass [WWW Document], (accessed 6.25.14)

Quality Assurance in Germany Legislation: Gesundheitsstrukturgesetz (9. clause SGB V, §§135-139, 1993)Statutory provisions: Gemeinsamer Bundesausschuss - Federal Joint CommitteeNumerous institutions (Bundesärztekammer…)Realisation of quality assurance in medicine is the responsibility of the managementAQUA-Institut: independent analysis but based on hospital data, no functioning quality assureance in ambulatory careInstitut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG)

Independent Scientific Institute newly established within the context of the health care reform 2004

Publish evidence-based reports to guarantee quality and economic efficiency in health careEuropean Foundation for Quality Management (EFQM)Extra exceptional: blood transfusions (Transfusionsgesetz, 1998)Robert Koch Institute (1998), an agency for the control of infectious diseases and health

reporting.National Cancer Plan - in August 2012 plan nationwide standardized cancer registry in

2018 to improve the quality of cancer care.Sources: https://www.iqwig.de, Simon: Das Gesundheitssystem in Deutschland

Health Care Quality Indicators OECD

Source: OECD (2013), Health at a Glance 2013: OECD Indicators, OECD Publishing. doi: 10.1787/health_glance-2013-en

Primary CareAcute CareCancer CareMental CarePatient SafetyPatient Experience

Health Care Quality Indicators

Source: Oecd.org [homepage on the Internet]. Health status. OECD.StatExtracts 2014. Paris: Organisation for Economic Co-operation and Development; cited 2014 Jun 25 Available from: http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT (accessed 6.23.14)

Quality Assurance in Pharmaceutical Germany & USA

Source: Wissenschaftlicher Dienst des Bundestages, 2010

Source: NCQA

What can be improved in Germany?

More patient-centred health-care delivery. Effective and efficient guidelines.GPs as effective gatekeepers.Transparency in hospital healthcare and external reports.Management of information and the adoption of meaningful electronic assistance systems.National interconnected information systemImprove training and working condition of healthcare professionals.

Improvements for the USVariation in Services

There continues to be a pattern of wide variation in health care practice, including regional variations and small-area variations. This is a clear indicator that health care practice has not kept pace with the evolving science of health care to ensure evidence-based practice in the United States.

Underuse of ServicesMillions of people do not receive necessary care and suffer needless complications that add to costs and reduce

productivity Each year, an estimated 18,000 people die because they do not receive effective interventions.

Overuse of ServicesEach year, millions of Americans receive health care services that are unnecessary, increase costs, and may even

endanger their health. Research has shown that this occurs across all populations.

Improvements for the USMisuse of Services

Too many Americans are injured during the course of their treatment, and some die prematurely as a result.

Disparities on Quality Although quality problems affect all populations, they may be most marked for members of ethnic and racial minority

populations.

Conclusion Germany has many problems similar to those in the U.S. (e.g. aging population).The German healthcare system is characterized by the "three S's"- social solidarity, subsidiarity (decentralization to public and private organizations), and self- governance.In this sense, the delivery of healthcare in Germany is similar to that found in the United States. Limited internationally comparable data available on quality indicators, especially in areas involving medical care interventions.Quality assurance can only be successful when all stakeholders in the healthcare system pull together.High structural quality represents an important fundament to improve outcome and process measures

References AQUA Institut GmbH, 2014. German Hospital Quality Report 2012. AQUA – Institute for Applied Quality Improvement and Research in Health Care,, Göttingen,Germany.Improving Health Care Quality: Fact Sheet. September 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/errors-safety/improving-quality/index.html (accessed 6.23.14)Simon, Michael: Das Gesundheitssystem in Deutschland © 2005/2007 by Verlag Hans Huber, Hogrefe AG, Bern, ISBN 978-3-45684483-1U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives - The Commonwealth Fund [WWW Document], June 2010. URL http://www.commonwealthfund.org/publications/press-releases/2010/jun/us-ranks-last-among-seven-countries (accessed 6.23.14)NCQA > HEDIS & Quality Measurement > Quality Measurement Products > Quality Compass [WWW Document], n.d. URL http://www.ncqa.org/HEDISQualityMeasurement/QualityMeasurementProducts/QualityCompass.aspx (accessed 6.26.14)OECD (2013), Health at a Glance 2013: OECD Indicators, OECD Publishing. doi: 10.1787/health_glance-2013-enOecd.org [homepage on the Internet]. Health status. OECD.StatExtracts 2014. Paris: Organisation for Economic Co-operation and Development; cited 2014 Jun 25 Available from: http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT (accessed 6.23.14)Wissenschaftlicher Dienst des Deutschen Bundestages: Qualitätssicherung in der Arzneimittelversorgung, 2010, www.bundestag.de