Hamburg hospital mirror
The Hamburger Krankenhausspiegel is an Internet platform on which the quality of medical results from 27 Hamburg hospitals is presented in a manner understandable to laypeople using texts and graphics.
basis
Data is published that hospitals report on the legal basis of the fifth book of the Social Security Code (§§ 135 and 137) to the institute in accordance with § 135 SGB V or the regional office for External Quality Assurance Hamburg (EQS). These data contain results from performance areas and quality indicators that are intended to provide information about the quality of medical care. Service areas (modules) include breast cancer operations or cardiac catheter applications; Quality indicators for example the frequency of complications or the duration of fluoroscopy with X-rays. The Hamburg Hospital Review currently shows 12 modules with 5 to 12 quality indicators each. Participation in quality assurance is mandatory by law, whereas participation in the hospital mirror is voluntary (more under organizational form).
Content
Quality results from the modules breast cancer operations, bypass operations, gallbladder operations, obstetrics, gynecological operations, cardiac catheter applications, use of pacemakers, hip replacement, knee replacement, pneumonia, femoral neck hernia and reconstruction of the carotid artery are presented. Each service area is structured identically: All clinics involved are listed on an overview page, along with the number of cases and documentation rates. For each indicator there is a page on which the EQS / BQS results are presented in a graph and explained in a text that is understandable for laypeople; a traffic light system symbolizes the results (more under procedure). The results can be traced back to the year 2005 via an annual comparison. In addition to the quality assurance data, brief profiles of the hospitals and statutory quality reports are published. The hospital mirror is under development and updated annually. From the original 19 clinics involved at the beginning of 2007, the number has risen to 27. The clinics represented in the hospital mirror cover more than 95 percent of inpatient health care in the Hanseatic city. The service areas are also constantly being expanded; In 2010, at least two new modules are planned to be added.
Procedure
The collection of quality data is carried out uniformly nationwide. For every gallbladder or hip operation, the medical staff in all clinics in Germany must fill out the same forms and answer the same questions. This documentation is sent to the relevant regional BQS offices. The specialist committees pay particular attention to hospitals with results that deviate from the reference range. The experts then ask the hospitals concerned for a written statement. This process is called “structured dialogue”. The results can be conspicuous if a hospital treats a particularly large number of seriously ill patients. These patients often have a greater risk of suffering complicated disease courses than those for whom the operation could be planned long in advance in otherwise good health. For this reason, statistical treatment results often appear worse without the quality of medical care actually being limited. However, an explanation for statistical deviations can also be documentation problems, for example if the BQS data sets were inadvertently filled out incorrectly or incompletely. Deviating results can therefore arise even with good patient care. In the structured dialogue between EQS and the Hamburg hospitals, it is clarified for each anomaly which causes the deviations were based. Only then is it classified as “qualitatively inconspicuous” (green traffic light in the hospital mirror), “qualitatively inconspicuous with control in the following year” (yellow traffic light) or “qualitatively inconspicuous” (red traffic light). If there is a red light in the hospital mirror, the respective clinic has the opportunity to provide a brief explanation.
Organizational form
The clinics involved have committed to voluntarily disclosing quality data in a letter of intent signed by all. The hospital mirror is controlled by a steering group in which the hospitals are represented by HKG Health Services GmbH, a subsidiary of Hamburgische Krankenhausgesellschaft eV (HKG). Technically, the project will be implemented by an agency. Outwardly, a spokesman represents the Hamburg hospital mirror.
presentation
The slogan of the Hamburger Krankenhausspiegel is "Quality, Openness, Trust". In terms of transparency and patient orientation, the project can be seen as a nationwide reference project, as the publication of the data in a way that is understandable for laypeople goes far beyond the legal requirements. In the mandatory quality reports, the results of only about three indicators per module have to be published, in the voluntary hospital index, however, the results of all indicators are fully disclosed. This is unique in Germany when compared to similar regional or national internet portals. A clinic ranking is deliberately not included in the presentation with a traffic light system and diagrams in the hospital mirror. Rather, by jointly disclosing the results, the Hamburg clinics enable all patients to make a comparison and at the same time strive to further improve their own performance. In the four years of the presentation (2005–2008), almost all hospitals improved their results in most of the indicators, some significantly; the number of red lights for qualitative abnormalities has continuously decreased in the individual modules. In 2008, the hospital mirror was recognized by the Financial Times Deutschland as the “Prize Winner of the Health Economy Ideas Park”.
Limits
Responded patients would like results on the quality of treatment for other diseases. However, statutory quality assurance only covers around 20 percent of inpatient treatment cases, so that many service areas cannot currently be shown in the hospital index.
outlook
Analogous to the Hamburg hospital mirror, the Hannover hospital mirror was created in 2008, the Bremen hospital mirror in 2010 and the Thuringian hospital mirror in 2014; further regional portals based on the hospital mirror are under development.