Gumpert Marcus, Reese Jens-Peter
Abteilung Qualitätssicherung und Qualitätsmanagement, Kassenärztliche Vereinigung Sachsen, Dresden, Deutschland.
Koordinierungszentrum für Klinische Studien, Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2018 Dec;139:28-36. doi: 10.1016/j.zefq.2018.10.005. Epub 2018 Nov 22.
According to Sect. 135a (2) of the Fifth Book of the German Social Code (SGB V), all physicians, psychotherapists and medical care centers are obliged to introduce an intra-institutional quality management system (QM system). The legislator instructed the Federal Joint Committee (G-BA) to develop basic requirements in a quality management guideline (QM-RL). Factor analysis was used to examine whether individual quality categories had a significant influence on the scores of QM systems.
The random sample was collected in Saxony and included a total of 24 medical practices because these practices were made available for analysis by the Saxon Association of Statutory Health Insurance Physicians. First, two primary units (family physicians/specialists) were established from the population. In the following step, one sample per QM system was drawn for each primary unit. In total, there were twelve family physicians and twelve specialists, or eight practices per QM system. The analysis was performed using three self-constructed questionnaires (physician, employee and patient). The individual items were developed independently of a QM system (26 quality categories with 40 questions per survey group). For the analysis, the arithmetic mean was calculated in the individual groups of questions. Factor analysis was used to investigate which quality categories per QM system had a significant influence on the evaluations. The Kaiser-Meyer test was used to measure the data's suitability for factor analysis, also Bartlett's test relating to significance and the cumulative percentage of total of variance were applied.
In the first step, the quality categories having a significant influence on the overall evaluation of the QM system are presented. Regarding the DIN EN ISO 9001, 18 quality categories have a significant influence on the overall result; in QEP and QisA, 17 quality categories each have a significant influence on the overall result. The quality categories 'continuous professional development and qualification', 'hygiene and cleaning', 'quality management system', 'quality objectives', and 'procurement and storage' do not define an influence on the overall rating in any of the QM systems. Finally, eleven relevant quality categories were discovered which have an influence on all the QM systems.
17 quality categories have a significant influence on the overall rating based on sample documents, flow charts, process flows, interview guidelines, maintenance protocols, or job advertisements. There are also eleven categories with a significant and pronounced effect on all three QM systems.
根据德国社会法典第五卷（SGB V）第135a条第（2）款，所有医生、心理治疗师和医疗保健中心都有义务引入机构内部质量管理体系（质量管理体系）。立法者指示联邦联合委员会（G-BA）在质量管理指南（QM-RL）中制定基本要求。使用因子分析来检验各个质量类别是否对质量管理体系的得分有显著影响。
随机样本取自萨克森州，共包括24个医疗执业机构，因为这些执业机构由萨克森法定医疗保险医生协会提供用于分析。首先，从总体中确定两个主要单元（家庭医生/专科医生）。接下来，为每个主要单元抽取每个质量管理体系的一个样本。总共，有12名家庭医生和12名专科医生，即每个质量管理体系有8个执业机构。分析使用三份自行编制的问卷（医生问卷、员工问卷和患者问卷）进行。各个项目的制定独立于质量管理体系（26个质量类别，每个调查组有40个问题）。为进行分析，计算各个问题组的算术平均值。使用因子分析来调查每个质量管理体系的哪些质量类别对评估有显著影响。使用凯泽-迈耶检验来衡量数据对因子分析的适用性，还应用了与显著性相关的巴特利特检验以及总方差的累积百分比。
第一步，呈现了对质量管理体系总体评估有显著影响的质量类别。对于DIN EN ISO 9001，18个质量类别对总体结果有显著影响；在QEP和QisA中，各有17个质量类别对总体结果有显著影响。质量类别“持续专业发展与资质”“卫生与清洁”“质量管理体系”“质量目标”以及“采购与储存”在任何质量管理体系中均未对总体评级产生影响。最后，发现了11个对所有质量管理体系都有影响的相关质量类别。
基于样本文件、流程图、流程、访谈指南、维护协议或招聘广告，17个质量类别对总体评级有显著影响。还有11个类别对所有三个质量管理体系都有显著且明显的影响。
