Gumpert Marcus, Reese Jens-Peter
Kassenärztliche Vereinigung Sachsen, Abteilung Qualitätssicherung und Qualitätsmanagement, Dresden.
Philipps-Universität Marburg Fachbereich Medizin, Koordinierungszentrum für Klinische Studien, Marburg.
Gesundheitswesen. 2019 Dec;81(12):1037-1047. doi: 10.1055/a-0832-199. Epub 2019 Feb 26.
Since 1 January 2004, all physicians, psychotherapists and medical care centres on contracts with statutory healthcare in Germany are obliged according to § 135a section 2, no. 2 of the Fifth Social Security Statute Book to introduce and develop an intra-institutional quality management system. Thus, physicians are faced with the question of which quality management system is best suited to their own practice.
A total of 24 medical practices were chosen by random sampling. The sample was collected in Saxony because the Health Insurance Physicians Unification Saxony provided the necessary information. First, 2 primary units were determined from the basic population. In the following step, a sample was taken for each primary unit using 3 quality management systems. The analysis was carried out with the help of three specially developed questionnaires (physician, employee and patient). The individual questions were developed independently of a quality management system. The basis was formed by the guidelines of the Federal Joint Committee, which describes the concrete contents of the quality categories. A total of 26 quality categories with different questions were available in the 3 survey groups. For the analysis of the data, the arithmetic mean was formed in the individual question complexes. Subsequently, a variance analysis was used to test whether the systems differed statistically significantly on average. Taking into account the costs of the individual quality management systems and their introduction, the effect size was finally analyzed according to η2 and Cohen's d. Finally, a cost-benefit analysis was carried out by researching the direct/indirect costs of the various quality management systems through a literature study.
Based on model documents and process support, the "Quality and Development in Practices" had the highest score. Due to a specific family practitioner specialty, "Quality management systems in Saxony medical practices" had the next best scores. The individual quality categories such as the 'range of services' or 'treatment pathways and guidelines' indicate significant differences and sustained effect sizes between quality management systems.
The assessment of quality management systems shows significant differences. The specific differences between the systems can be explained by the differences in process tools.
自2004年1月1日起，根据《第五部社会法典》第135a条第2款第2项规定，德国所有与法定医疗保险机构签订合同的医生、心理治疗师及医疗保健中心均有义务引入并发展机构内部质量管理体系。因此，医生们面临着哪种质量管理体系最适合其自身诊所的问题。
通过随机抽样共选取了24家医疗诊所。样本采集于萨克森州，因为萨克森州医疗保险医生联合会提供了必要信息。首先，从基础人群中确定2个初级单位。在接下来的步骤中，针对每个初级单位采用3种质量管理体系抽取样本。借助三份专门设计的问卷（医生问卷、员工问卷和患者问卷）进行分析。各个问题的设计独立于质量管理体系。依据联邦联合委员会的指南确定基础内容，该指南描述了质量类别的具体内容。在3个调查小组中，共有26个包含不同问题的质量类别。对于数据分析，在各个问题组中计算算术平均值。随后，采用方差分析来检验这些体系在平均值上是否存在统计学显著差异。考虑到各个质量管理体系及其引入成本，最终根据η2和科恩d值分析效应大小。最后，通过文献研究对各种质量管理体系的直接/间接成本进行研究，从而进行成本效益分析。
基于模型文件和流程支持，“诊所中的质量与发展”得分最高。由于特定的家庭医生专业特点，“萨克森州医疗诊所质量管理体系”得分次之。诸如“服务范围”或“治疗路径与指南”等个别质量类别表明质量管理体系之间存在显著差异和持续的效应大小。
质量管理体系的评估显示出显著差异。这些体系之间的具体差异可以通过流程工具的差异来解释。
