德国膝关节置换术暂停最低手术量要求对医院的影响：一项非对照前后研究。

Impact of suspending minimum volume requirements for knee arthroplasty on hospitals in Germany: an uncontrolled before-after study.

作者信息

de Cruppé Werner, Ortwein Annette, Kraska Rike Antje, Geraedts Max

机构信息

Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany.

Institute for Health Systems Research, School of Medicin, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.

出版信息

BMC Health Serv Res. 2020 Dec 1;20(1):1109. doi: 10.1186/s12913-020-05957-1.

DOI:10.1186/s12913-020-05957-1

PMID:33261615

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7709412/

Abstract

BACKGROUND

In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Since then, MVRQs were implemented for seven hospital procedures. This study evaluates the effect of a system-wide intermission of MVRQ for total knee arthroplasty (TKA), demanding 50 annual cases per hospital.

METHODS

An uncontrolled before-after study based on federal-level data including the number of hospitals performing TKA, and TKA cases from the external hospital quality assurance programme in Germany (2004-2017). Bi- and multivariate analyses based on hospital-level secondary data of TKA cases and TKA quality indicators extracted from hospital quality reports in Germany (2006-2014).

RESULTS

The number of TKAs performed in Germany decreased by 11% after suspending the TKA-MVRQ in 2011, and rose by 13% after its reintroduction in 2015. The number of hospitals with less than 50 cases rose from 10 to 25% and their case share from 2 to 5.5% during suspension. Change in hospital volume after the suspension of TKA-MVRQ was not associated with hospital size, ownership, or region. All four evaluable quality indicators increased significantly in the year after their first public reporting. Compared to hospitals meeting the TKA-MVRQ, three indicators show slight but statistically significant better quality in hospitals below the TKA-MVRQ.

CONCLUSIONS

In Germany, TKA-MVRQs seem to induce in-hospital caseload adjustments rather than foster regional inter-hospital case transfers as intended.

摘要

背景

2004年，德国医疗保健领域的最高决策机构联邦联合委员会引入了最低手术量要求（MVRQs）作为一种质量控制手段。自那时起，MVRQs已在七种医院手术中实施。本研究评估了全膝关节置换术（TKA）的MVRQ在全系统暂停的影响，该要求每家医院每年进行50例手术。

方法

基于联邦层面数据进行的一项非对照前后研究，数据包括进行TKA的医院数量以及德国外部医院质量保证计划中的TKA病例（2004 - 2017年）。基于德国医院质量报告中提取的TKA病例的医院层面二级数据和TKA质量指标进行双变量和多变量分析（2006 - 2014年）。

结果

2011年暂停TKA - MVRQ后，德国进行的TKA手术数量下降了11%，2015年重新引入后上升了13%。手术量少于50例的医院数量在暂停期间从10%增至25%，其病例占比从2%增至5.5%。TKA - MVRQ暂停后医院手术量的变化与医院规模、所有权或地区无关。所有四个可评估的质量指标在首次公开报告后的年份均显著提高。与达到TKA - MVRQ的医院相比，低于TKA - MVRQ的医院中有三个指标显示质量略好但具有统计学意义。