Hanisch E, Weigel T F, Buia A, Bruch H-P
Asklepios Klinik Langen, Röntgenstr 20, 63225, Langen, Deutschland.
Heilig-Geist-Hospital Bingen, Bingen, Deutschland.
Chirurg. 2016 Jan;87(1):56-61. doi: 10.1007/s00104-015-0012-1.
The assessment of the quality of medical practice is a legitimate requirement by society. Reliable methods for measurement of the quality of performance are sought worldwide. Quality is often quantified by using administrative data and in Germany this method has been implemented by the health insurance company AOK.
(1) How is the AOK quality system rated by senior consultant surgeons? (2) How valid are quality statements derived from administrative data?
This article was compiled following the PRISMA (i.e. preferred reporting items for systematic reviews and meta-analyses) statement for qualitative systematic reviews. In order to answer the first question the Professional Association of German Surgeons (Berufsverband der Deutschen Chirurgen) initiated two surveys and to answer the second question a structured literature search following the PICO (i.e. patient problem or population, intervention, comparison control or comparator and outcomes) format was initiated. In addition numerous websites were contacted.
Of the responding senior consultant surgeons 95% considered that the AOK method of quality measurement by administrative data is not objective. One third was definitely wrongly classified. The literature search revealed that no validation data exist for the AOK indicators, including the Elixhauser comorbidity risk score. Altogether, the sensitivity of indicators is poor when good sensitivity is defined by the Institute for Applied Quality Improvement and Research in Health Care (AQUA Institute) as ≥ 80 < 90%.
Quality statements resulting from administrative data alone are unreliable.
对医疗实践质量进行评估是社会的合理要求。世界各地都在寻求可靠的医疗绩效质量衡量方法。质量通常通过行政数据进行量化，在德国，健康保险公司AOK已采用这种方法。
（1）高级外科顾问如何评价AOK质量体系？（2）从行政数据得出的质量声明有多有效？
本文是根据PRISMA（即系统评价和荟萃分析的首选报告项目）声明编写的定性系统评价。为回答第一个问题，德国外科医生专业协会发起了两项调查；为回答第二个问题，按照PICO（即患者问题或人群、干预措施、对照或比较组以及结果）格式进行了结构化文献检索。此外，还联系了众多网站。
在做出回应的高级外科顾问中，95%认为AOK通过行政数据进行质量衡量的方法不客观。三分之一的情况被明确错误分类。文献检索表明，包括埃利克斯豪泽共病风险评分在内的AOK指标没有验证数据。总体而言，当应用医疗质量改进与研究机构（AQUA机构）将良好敏感性定义为≥80＜90%时，指标的敏感性较差。
仅由行政数据得出的质量声明不可靠。
