[Quality assurance in cardiology: Germany].

Quality assurance is a touchy subject: difficult to implement, time-demanding and expensive. The goal of quality assurance is to assist both the patients and the physicians. In addition to legal requirements, quality assurance is necessary for medical as well as economical reasons. It makes sense that the license to practice medicine does not automatically entail the right to perform all medical procedures; the development of new methods and the insights won from important scientific studies necessitates constant training. Furthermore, the decreasing allocation of funds for medical care combined with increased demand effected by new treatment methods and longer life expectancy force the development of instruments for specific and reasonable budgeting of medical expenditures. The primary goal of quality management in respect to economical regards must be the avoidance of unnecessary hospital admissions. But the patient must retain the right to choose the physician he prefers. The organization of the supervising structures in Germany is inconsistent: in 1995, a new Zentralstelle der Deutschen Arzteschaft zur Qualitätssicherung in der Medizin (German Physicians Headquarters for Quality Assurance in Medicine) was founded; it is proportionally staffed by representatives of the Bundesärztekammer (BAK, Federal Board of Physicians) and the Kassenärztliche Bundesvereinigung (KBV, Federal Commission of Panel Physicians). Furthermore, there is the Arbeitsgemeinschaft zur Förderung der Qualitätssicherung in der Medizin (Working Group for the Advancement of Quality Assurance in Medicine), in which the Bundesministerium für Gesundheit (Federal Ministry of Health) and the Kassenärztliche Vereinigung (KV, Public Health Insurance Providers) are represented. The KV is already seeing to it that stricter regulations govern physicians with private practice than those governing hospital physicians. There are three data banks existing on a voluntary basis for invasive diagnostic and therapy: a general, annual survey with baseline data from all German cardiac catheter laboratories; a data bank for storing records of PTCA's performed primarily in non-university-affiliated cardiac catheter labs (ALKK); and a data bank for recording diagnostic cardiac catheterization and PTCA's performed by physicians with private practice (BNK). In 1994, 15% of the diagnostic catheterizations and 16% of the coronary interventions were performed by physicians with private practice. Our survey shows that only 58% of German institutions record the data with a computer, 60% use their own developments; thus, the majority of groups in Germany are not linked to a central data bank. The least requirement for quality assurance should be the recording of major and minor complications as well as a comparison of one's own data with those of a central data bank.