Weibler-Villalobos U, Röhrig B
Medizinischer Dienst der Krankenversicherung Rheinland-Pfalz, Alzey.
Gesundheitswesen. 2010 Nov;72(11):780-9. doi: 10.1055/s-0029-1242790. Epub 2010 Jan 4.
Since 2009 there is a legal obligation in Germany to provide quality reports for all nursing facilities.
Criteria for measuring and presenting the quality of care defined for health services are applied to the area of nursing care. The German Nursing-Transparency-Order for nursing homes has been compared with those attributes.
Prior to realisation of the concept of publishing quality reports of care facilities, the definition of high-quality care standards, an explicit objective for quality reporting and the definition of addressees are required. The quality indicators to be derived must be relevant from the user's point of view as well as from professional perspectives. Benefits and undesirable effects must be weighted out mutually. Relevant for the choice of quality indicators are the methodical attributes: strength of evidence, precision of definitions, ability of discrimination, reliability and validity. To make the results comparable between facilities, it is suggested to include an equally stratified random sampling of persons. An aggregation or summation of the results may basically only occur when the results have a common content coherence (correlation) and the same importance (weighting). Through explicit specifications for the assessment, for example, so-called knock-out criteria, it must be assured that in essential events like damages under non-expert care, there are no compensations by other results. The German Nursing-Transparency-Order for nursing homes fulfils only one part of the generally established methodical quality criteria.
The procedure for the choice of quality indicators must be made clear; the methodical quality must be tested and the test results must be published. Above all it must be proven with test results that the appraisal of experts and users agrees with the results of the nursing transparency (validity). An accompanying research is absolutely necessary.
自2009年起,德国法律规定所有护理机构都必须提供质量报告。
将为卫生服务定义的护理质量衡量和呈现标准应用于护理领域。将德国养老院护理透明度指令与这些属性进行了比较。
在实现护理机构质量报告发布概念之前,需要定义高质量护理标准、质量报告的明确目标以及受众定义。得出的质量指标必须从用户角度以及专业角度来看都具有相关性。必须相互权衡利弊和不良影响。质量指标的选择与方法学属性相关:证据强度、定义精度、区分能力、可靠性和有效性。为使各机构之间的结果具有可比性,建议纳入按同等分层的人员随机抽样。只有当结果具有共同的内容连贯性(相关性)和相同的重要性(权重)时,才基本上可以对结果进行汇总或求和。通过例如所谓的淘汰标准等明确的评估规范,必须确保在诸如非专业护理下的损害等重大事件中,不会因其他结果而得到补偿。德国养老院护理透明度指令仅满足了普遍确立的方法学质量标准的一部分。
必须明确质量指标的选择程序;必须测试方法学质量并公布测试结果。最重要的是,必须通过测试结果证明专家和用户的评估与护理透明度结果一致(有效性)。一项配套研究绝对必要。