Guideline for cross-institutional and cross-sector quality assurance
The Federal Joint Committee (G-BA) decided on the basis of Section 92, Paragraph 1, Clause 2, No. 13 SGB V in conjunction with Section 137, Paragraph 1, No. 1 of SGB V on December 2, 2010, a guideline on the establishment and Cross-sectoral quality assurance ( Qesü-RL ). It basically applies uniformly to all patients and initially only contains specifications for cross-facility and cross-sector quality assurance measures . These aim in particular to improve the quality of the results , to gain valid and comparable knowledge about the quality of care of the service providers and thus to strengthen the self-determination of the patients. A continuous quality development process is to be initiated through the cross-sectoral consideration.
The guideline applies in particular to approved hospitals and service providers approved for contract medical or contract dental care, approved medical care centers as well as authorized doctors , dentists, psychotherapists and authorized medical or dental-managed institutions.
scope
The scope includes all contracts of the fourth chapter of SGB V with service providers according to sentence 1 as well as based on the entitlement to benefits according to Section 116b SGB V and, if relevant, based on model projects according to Section 63 and Section 64 SGB V. The scope includes all of service providers according to sentence 1 services provided for patients, specified in the subject-specific provisions.
State working group
At the level of the federal states or across federal states, the respective Association of Statutory Health Insurance Physicians (KV), Association of Statutory Health Insurance Dentists (KZV), State Hospital Society (LKHG) and the associations of health insurance companies including substitute funds in the state form a state working group for cross-sector quality assurance (LAG). If there are several KVs or KZVs in a country, then these must be included.
The LAG makes its decisions through a steering committee . The named organizations are entitled to vote in the steering committee. The steering committee is made up of equal representation with representatives of the regional associations of health insurance funds and the substitute funds on the one hand and representatives of the mentioned organizations of the service providers on the other. The steering committee either alternates between its members and elects a chairperson or a chairperson or appoints an impartial chairperson. In the event of a tie, the chairperson has the casting vote. The steering committee is responsible to the G-BA for the proper implementation of the guidelines.
The Association of Private Health Insurance , the respective regional medical associations , as well as the organizations of the nursing professions at the state level are involved by the LAG. In addition, the state chambers of dentists and the state chambers of psychotherapists are involved , insofar as their concerns are thematically affected in quality assurance . The organizations at the federal level that are relevant to safeguarding the interests of patients and the self-help of chronically ill and handicapped people are given a right of opinion in the steering committee.
Tasks of the state working group
The LAG sets up an office and rules of procedure. The LAG has the following tasks:
- Commissioning the evaluation agencies
- Evaluation of statistical and documentation-related abnormalities
- Implementation of the quality improvement measures
- Creation and submission of quality assurance results reports
- Information and advice to service providers
- Promotion of the exchange between service providers
- Information of the public about the results of the quality assurance measures in a manner understandable to laypersons
To carry out the quality assurance measures, the LAG employs specialist commissions with sufficient expertise from the outpatient and inpatient areas.
Data collection points
The basis for the activities of the LAG are the evaluations of the data transmitted by the service providers (LKG, KV, KZV). The service providers (e.g. doctors) have to transmit their data to the following common data collection point:
- The responsible KV / KZV is the data accepting body for contract doctors working under collective agreements
- The data collection point for the hospitals is the State Office for Quality Assurance (LQS) or the State Hospital Society (LKG)
- The data collection point for physicians who are selectively contracted doctors and the MVZ is the trust center in accordance with Section 11, an organization that pseudonymizes the patient-identifying data that is collected as part of cross-sector quality assurance. The trust agency is advertised by the G-BA.
abnormalities
If the evaluations reveal anomalies with a service provider, he is first given the opportunity to comment. If the abnormalities cannot be sufficiently clarified in the structured dialogue, the responsible body decides on the need to initiate appropriate measures according to measure level 1, such as
- Participation in suitable training courses, technical discussions, colloquia,
- Participation in the quality circle ,
- Implementation of treatment pathways,
- Conduct of audits ,
- Implementation of peer reviews ,
- Implementation of recommendations for action based on guidelines .
If there is evidence of serious individual grievances, if a service provider refuses to conclude or fulfill an agreement, or if the status sought by the agreement is not achieved in the allotted time, the service provider concerned must be given the opportunity to comment before action level 2 begins. In addition, it can be used in the case of repeated or particularly serious abnormalities, in cases in which the service provider does not take part in the quality assurance measure or does not fully participate, or in other cases where there is an urgent need for action. Action level 2 includes
- the correction of the agreement or
- the information of the bodies responsible for payment deductions or the withdrawal of the billing option for the respective service with corresponding recommendations.
The implementation of these recommendations is carried out by the KVen / KZVen for contract doctors working under collective agreements, and by all other service providers within the framework of the respective contractual relationships.
Feedback
The service providers receive well-understandable feedback reports on the data they have transmitted, which contain information on completeness and the statistical representation of the data transmitted by the service provider and the comparison group. The feedback report does not contain an evaluation, which should be expressly pointed out.
Web links
- Annex to the Qesü-RL , G-BA. Retrieved October 27, 2015.
- Basic reasons for the decision of the Federal Joint Committee on cross-institutional and cross-sectoral quality assurance measures , G-BA. Retrieved October 27, 2015.
- Regina Klakow-Franck, goals and instruments of external quality assurance of the Federal Joint Committee - Present and Future , G-BA. Retrieved October 27, 2015.
