IQI
The system of inpatient quality indicators ( English for quality indicators for hospital patients , IQI ) is used for the uniform measurement of the quality of care of inpatients in all hospitals. The measurement is made using quality indicators that are created on the basis of routine data from the hospitals. The aim is to identify abnormalities and possible weak points in treatment processes in hospitals in order to derive measures to improve quality accordingly. The system emerged in the United States in the 1990s. In Europe it is used in Germany, Austria and Switzerland.
United States
In the USA, the quality indicators were developed by the Agency for Healthcare Research and Quality (AHRQ) in the 1990s and first published in 2006. The indicators are based on data from state and private hospitals. Many states make the results of the surveys available to the public on the Internet.
Europe
In the German-speaking area, the IQI system is used by hospitals in Germany, Austria and Switzerland. The participants joined forces in the Quality Medicine Initiative (IQM), which was founded in Germany in 2008.
Germany
In Germany, the German Inpatient Quality Indicators (G-IQI) were made publicly available for the first time in 2008. In 2011 the second extended edition of the definition manual for the G-IQI appeared. Accordingly, as of March 18, 2011, ten percent of all German hospitals have voluntarily joined the system.
Austria
The nationwide introduction of the Austrian Inpatient Quality Indicator (A-IQI) in Austria was initiated by the Ministry of Health and decided in April 2011 by the Federal Health Commission (BGK). The BGK is composed of ministries (health, science, economy and finance), social security, federal states, patient advocates and the medical association. With the decision, in Austria - unlike in Germany - public hospitals are obliged to participate in the A-IQI.
After completion of the trial operation of A-IQI, trial peer reviews will be carried out on the key indicators of myocardial infarction , pneumonia and femoral neck fracture . At the beginning of 2014, the project is to be transferred to routine operation.
Creating focus indicators
The Austrian focus indicators are determined by a national steering group. This also decides where peer reviews will be carried out if necessary .
In Austria , anonymous routine hospital data collected from the DRG system , such as mortality, age and gender, diagnoses, benefits and length of stay are used in departments. Indicators are developed and statistically evaluated for individually selected clinical pictures and published in a definition manual.
Collection of abnormalities
In addition to the frequency of death ( mortality ), there are indicators from the areas of complications, frequency of intensive care, surgical techniques, care processes, amount and length of stay. Using the example of mortality, abnormalities are recorded by comparing the actual deaths with the statistically expected deaths. The mortality to be expected is that which would result if a sample with the same age and gender structure of the clinic in question were drawn from the entire Austrian stay data.
Peer reviews
In the second step, indicators that deviate significantly from the expected value are analyzed, with the affected hospitals or departments being encouraged to perform self-analysis. If the abnormalities in this step are not plausible, external analyzes are used. These peer reviews are carried out by external and specially trained peer reviewers, mostly primary physicians or senior physicians in a managerial position. Improvement measures are developed from the peer reviews.
Switzerland
In Switzerland, the system of the Swiss Inpatient Quality Indicator (CH-IQI) was introduced nationwide in early 2012.
Advantages and disadvantages
Those involved emphasize the advantage that the data is already available and therefore there is no additional effort. In addition, the data can be compared nationwide due to the uniform structure. Since it is health data, it is also more complete than reporting procedures.
It is seen as a disadvantage that the representation of the indicators is not a perfect representation of clinical reality and does not represent a scientific basis. In addition, a statistical abnormality does not have to mean that there is a quality deficiency in individual cases. Measures must also be taken to improve the quality of treatment; the presentation of the deficiency alone does not improve the quality.
Individual evidence
- ↑ IQI overview at AHRQ
- ↑ FAQ from IQM (PDF, 484 kB). Retrieved September 17, 2013.
- ↑ T. Mansky, U. Nimptsch, Winklmair, KC Vogel, F. Hellerhoff: G-IQI | German Inpatient Quality Indicators Version 3.1. University Press of the TU Berlin, 2011, ISBN 978-3-7983-2316-2 .
- ↑ Organization manual of the Federal Ministry of Health ( Memento from July 26, 2014 in the Internet Archive ) (PDF, 410 kB). Retrieved September 17, 2013.
- ^ F. Fuchs, M. Amon, U. Nimptsch, T. Mansky: A-IQI | Austrian Inpatient Quality Indicators, quality indicators of the Niederösterreichische Landeskliniken-Holding. Definition manual V. 1.0, data year 2010, St. Pölten / Berlin June 2010. Retrieved on September 17, 2013.
- ^ S. Türk, J. Schimmerl, F. Fuchs, B. Preining: Austria: Harter Boden der Politik. In: J. Martin, O. Rink, J. Zacher (Eds.): Yearbook Quality Medicine 2012. MWV Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin 2013, pp. 125–129.
- ↑ Quality indicators help hospitals to become even better. ( Memento of the original from February 11, 2017 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. Interview with Prof. Dr. med. Thomas Mansky, Technical University of Berlin. In: Social Security CHSS. 5/2012, p. 315ff. (PDF, 18 MB). Retrieved September 17, 2013.
- ↑ D. Zahnd, T. Mansky: The revised version of the quality indicators (CH-IQI version 3.1). In: Swiss Confederation, Federal Department of the Interior (FDHA), Federal Office of Public Health (FOPH): Quality indicators of Swiss acute hospitals 2008/2009. Bern 2012, p. 1. (PDF, 165 kB) Retrieved on September 17, 2013.
- ↑ T. Mansky, U. Nimptsch: Necessity of unhindered access to social and disease-related insurance data for the German Medical Association and other medical bodies as well as scientific specialist societies in order to optimize medical care. Expertise within the framework of the funding initiative for health services research of the German Medical Association. Technical University Berlin 2010. (PDF, 1 MB). Retrieved September 17, 2013.
