Gehrig Stefan, Zander-Jentsch Britta, Gutzeit Maurilio, Klein Silvia, Rauh Johannes
Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Katharina-Heinroth-Ufer 1, Berlin, 10787, Germany.
IU International University of Applied Sciences, Juri-Gagarin-Ring 152, Erfurt, 99084, Germany.
BMC Health Serv Res. 2025 Jun 9;25(1):815. doi: 10.1186/s12913-025-12939-8.
Inpatient safety can benefit from effective policies for hospital quality assurance. Following legal reform to put quality of care more center stage in hospital capacity planning, a new quality assurance program was introduced in Germany in 2017. The program was based on pre-existing quality indicators and included new policy design components emphasizing hospital accountability. Learning if the policy was effective is important, but challenging in the observational setting.
We adapt a quasi-experimental difference-in-differences approach to estimate the causal effect of the program on quality of care in the 4 years after program onset. A control group of indicators from other clinical areas is carefully selected to compare trends in process quality.
Results show a relevant reduction in risk of adverse care events nationally in the affected patient population relative to a counterfactual scenario of no program adoption. The effect emerged over the first two program years before plateauing.
The study allows to learn about important design components in healthcare quality assurance. Among our discussed mechanisms for the documented improvement in process quality are the initial announcements of legal consequences and high public attention. These led hospitals to initiate quality improvement, to seek dialogue with state agencies, and to put more efforts into submitting correct quality data. Methodologically, we show how to adapt rigorous study designs to quality assurance evaluation, considering also their assumptions and limitations.
The online version contains supplementary material available at 10.1186/s12913-025-12939-8.
有效的医院质量保证政策有助于提高住院患者的安全性。在法律改革将医疗质量置于医院容量规划的更核心位置之后，德国于2017年引入了一项新的质量保证计划。该计划基于先前存在的质量指标，并纳入了强调医院问责制的新政策设计要素。了解该政策是否有效很重要，但在观察性环境中具有挑战性。
我们采用准实验性差异分析方法来估计该计划在实施后的4年里对医疗质量的因果效应。精心挑选来自其他临床领域的一组指标作为对照组，以比较过程质量的趋势。
结果显示，相对于未采用该计划的反事实情景，受影响患者群体中全国范围内不良护理事件的风险有显著降低。这种效果在计划实施的头两年出现，之后趋于平稳。
该研究有助于了解医疗质量保证中的重要设计要素。在我们讨论的过程质量改善的机制中，包括法律后果的初步宣布和公众的高度关注。这些促使医院启动质量改进，寻求与国家机构对话，并更加努力地提交正确的质量数据。在方法上，我们展示了如何使严谨的研究设计适用于质量保证评估，同时也考虑了它们的假设和局限性。
在线版本包含可在10.1186/s12913-025-12939-8获取的补充材料。
