Khan Carmen, Ollenschläger Günter
Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland.
Institut für Gesundheitsökonomie und Klinische Epidemiologie der Uniklinik Köln (IGKE), Köln, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2014;108(10):576-86. doi: 10.1016/j.zefq.2014.10.013. Epub 2014 Nov 20.
Over the past decades, a large number of measures for quality management and quality assurance (QM/QA) of healthcare were established in the German healthcare system. Considering the resources required, it has been repeatedly demanded that such quality programmes be checked for their effectiveness. In this context, the present paper describes the results of a systematic literature review to evaluate German QM/QA programmes in the inpatient sector.
A systematic literature search was conducted in the electronic databases Medline, Cochrane Library and topic-related institution websites. In addition, hand searches were conducted, and the search engine Google Scholar was used. For Germany, no time limit was placed on the literature search. Evaluation studies were only selected if they included a comparison group without or at the beginning of a QM/QA programme and measured the effects on outcomes, process or structure of inpatient care. The methodological quality of the eligible studies was assessed and summarised.
Out of 3,065 hits, 18 publications were included in the literature review. In Germany, no causal relationships between QM/QA programmes and a relevant benefit for improved quality of care for patients in the hospital sector could be detected in any study. Results were inconsistent or insufficiently reliable without demonstrating a clear positive or negative impact of the analysed programmes on the quality of care. Overall, the quality of the included studies was low.
No acceptable scientific studies for the German healthcare system could be detected that provided proof for a patient-related effectiveness or ineffectiveness of the established quality programmes. Due to the insufficient evidence and despite the challenges faced when conducting convincing evaluation studies in the field of QM/QA, established methods of the evaluation research should be applied and extended.
在过去几十年里，德国医疗体系建立了大量医疗质量管理与质量保证（QM/QA）措施。鉴于所需资源，人们不断要求对这类质量项目的有效性进行检查。在此背景下，本文描述了一项系统文献综述的结果，以评估德国住院部门的QM/QA项目。
在电子数据库Medline、Cochrane图书馆及相关主题机构网站上进行了系统文献检索。此外，还进行了手工检索，并使用了搜索引擎谷歌学术。对于德国的文献检索，未设置时间限制。仅选择那些包含无QM/QA项目组或处于QM/QA项目起始阶段的对照组，并测量对住院护理结果、过程或结构影响的评估研究。对符合条件的研究的方法学质量进行了评估和总结。
在3065条检索结果中，18篇出版物被纳入文献综述。在德国，任何研究均未发现QM/QA项目与改善医院部门患者护理质量的相关益处之间存在因果关系。结果不一致或可靠性不足，未表明所分析项目对护理质量有明显的正面或负面影响。总体而言，纳入研究的质量较低。
未发现德国医疗体系中有可接受的科学研究能证明既定质量项目对患者相关的有效性或无效性。由于证据不足，尽管在QM/QA领域进行有说服力的评估研究面临挑战，但仍应应用和扩展评估研究的既定方法。
