The Federal Joint Committee (G-BA) and Quality Assurance in Health Care
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1 The Federal Joint Committee (G-BA) and Quality Assurance in Health Care HOPE Study Tour Berlin Quality assurance in German Hospital Care 30./31. October 2014 Markus Wörz Department of Quality Assurance in Healthcare and Cross-sectoral Health Services Federal Joint Committee (Healthcare), Staff Office Berlin, Germany 1
2 Outline I. G-BA: Composition and working methods II. Directives for quality assurance III. Directive for quality report of hospitals and external quality assurance 2
3 Members of the G-BA 3
4 The Federal Joint Committee (G-BA) Established 2004, but predecessor committees dating back to the 1920s Main decision-making body of the self-governing German health care system Charged with health policy-making and regulationmaking within a legal framework Commissioned by law to issue legally binding directives Service providers (physicians, dentists, hospitals), statutory health insurance funds, and patient representatives are members of the G-BA. 4
5 What does the G-BA do? The G-BA issues directives and thus determines the benefit package of the statutory health insurance covering about 70 million people: Ambulatory and hospital care Dental care, psychotherapy Diagnostic and therapeutic procedures and interventions Pharmaceuticals, vaccines and medical devices In addition, the G-BA has important responsibilities regarding quality assurance for in- and outpatient care and in developing disease management programs for chronic diseases. 5
6 Legal status of the G-BA legal status of its directives 6
7 Structure of the Plenum of the G-BA 7
8
9 G-BA and its subcommittees 9
10 Application of the quality assurance directives Binding directives that apply to all Physicians Dentists Hospitals for services in the Statutory Health Insurance 10
11 Outline I. G-BA: Composition and working methods II. Directives for quality assurance III. Directive for quality report of hospitals and external quality assurance 11
12 What does the G-BA do in quality assurance? Section 137 SGB V* External Quality Assurance Programme (outcomes) Quality Report (hospitals) Minimum Requirements for Structure and Process (in- and outpatient care) Continuous Medical Education (hospital doctors) Requirements for internal Quality Management Minimum Volume Requirements *: German Social Code Book V 12
13 Directives for Quality Assurance (1) 1. Paediatric cardiac surgery 2. Minimum volume requirements 3. Quality assessments magnetic resonance tomography (MRT) 4. Quality assessment radiology 5. Quality assessment arthroscopy 6. Quality management for hospitals 7. Quality management for medical practice (office-based doctors) 8. Quality management for dentists 9. Quality audits / inspections for medical practice (office-based doctors) 10. Chronic renal dialysis 13
14 Directives for Quality Assurance (2) 13. External Quality Assurance Programme in hospitals 14. Abdominal aortic aneurysm (structure/process) 15. Paediatric oncology/haematology (structure/process) 16. Positron Emission Tomography (PET) in Non-Small Cell Lung Cancer 17. Proton Therapy of Rectum/Rectal Carcinoma 18. Neonatal intensive care services 19. Hospital quality reports / public reporting 20. Continuing Medical Education (hospital doctors) 21. External, data-based follow-up quality assurance 22. Directive for spezialised outpatient services in hospitals 23. [Directives which regulate Disease Management Programs (Quality assurance indicators for disease management programs)] 14
15 Paediatric Cardiac Surgery Patients up to the age of 18 suffering from congenital or acquired cardiac diseases Requirements for hospitals such as Number and qualification of staff (e.g. physicians, nurses, other therapists) Infrastructure (e.g. Imaging, diagnostics, intensive care unit, ) Availability of services (e.g. daily, on weekdays) Frequency and tasks of team meetings and quality circles (e.g. patient information, recommendations for standard operating procedures, ) 15
16 Paediatric Oncology Patients up to the age of 18 suffering from paediatric-haemato-oncological diseases Requirements for hospitals such as Number and qualification of staff (e.g. physicians, nurses, other therapists) Organisation (interdisciplinary tumour conferences) Technical equipment and facilities (availability of laboratory, imaging diagnostics, pharmacy ) Participating in studies to optimize therapies 16
17 Minimum Volume Requirements Minimum volumes per year and hospital: Liver transplant: 20 Renal transplant: 25 Complex oesophageal surgery: 10 Complex pancreatic surgery: 10 Stem cell transplant: 25 Total knee replacement: 50 Non-applicable directives Coronary surgery: not yet Neonatal care for very low birth weight neonates (< 1250g): 15 Non-applicable directives Evaluation of the directive 17
18 Neonatal Intensive Care Services Neonatal Intensive Care Levels Level 1: birth weight <1,250 g or/and gestational age < 29+0 weeks Level 2: birth weight 1,250 1,499 g or/and gestational age 29+0 to 32+0 weeks Level 3: birth weight >1,500 g and/or gestational age 32+1 to 36+0 weeks Level 4: obstetric clinics for neonates with gestational age > 36+0 weeks and without risks Defines quality requirements concerning: Staff qualification Admission criteria (e.g. birth weight, diseases in the mother or congenital malformations) Technical equipment (e.g. respirator, cerebral function monitor, laboratory) Facilities (e.g. distance to operation theatre, neonatal intensive care unit and maternity ward) Publication of results (e.g. survival rate),... 18
19 Chronic Renal Dialysis Objectives: Transparency and evaluation of quality assurance data in institutions for chronic dialysis treatment Benchmarking Quality assurance and control Defines: Evaluation criteria for dialysis treatment Sampling (documentation, data security, analysis and evaluation) Duty to participate in a quality assurance programme (benchmarking) 19
20 Abdominal Aortic Aneurysm Requirements for hospitals, e.g.: Rules for admission/transfer Number, qualification and availability of staff (doctors, nurses, other therapists) Technical equipment Facilities (operation theatre, distance between intensive care unit and operation theatre, laboratory, imaging procedures) Duty to enable continuing medical education Declaration of compliance 20
21 Continuing Medical Education for Hospital Doctors and Psychotherapists Defines the requirements for continuing medical education e.g.: Scope and time frame (250 points within 5 years (thereof at least 150 points in areas specific to actual patient care) Certificates Duties of hospital administration (documentation and reporting) 21
22 Quality assurance across health care institutions and cross-sector Defines the requirements for measuring quality using quality indicators followed by a peer review process and the various steps in the process Following patients over space and time : quality data from all treatment episodes and all service providers regarding the specified quality assurance programme Working on: Cataract surgery, Percutaneous coronary intervention Colorectal carcinoma 22
23 Outline I. G-BA: Composition and working methods II. Directives for quality assurance III. Directive for quality report of hospitals and external quality assurance 23
24 Quality report of hospitals (Public Reporting) Information on services and outcome data of hospitals: Since 2005 all hospitals in Germany have been required by law to publish a quality report every two years. Aims of these reports are e.g.: to inform patients and doctors about hospital specialties and capabilities, to present hospital performance and quality data to the public, to provide a basis for benchmarking, The directive defines: the procedure of report preparing and publishing the content, scope and data format of these quality reports (e.g. kind and number of medical services provided, continued medical education, ) 24
25 External quality assurance programme in hospitals Measuring quality using quality indicators followed by a peer review process for 30 services/diseases [ Leistungsbereiche ], e.g.: Pneumonia Aortic valve surgery Cholecystectomy Obstetrics Gynaecological operations Implantation of pacemakers Heart transplants Hip replacements Carotid artery reconstruction Breast cancer surgery Liver transplants Renal transplants Combined heart- and lung transplants Neonatal care Overall: 434 quality indicators relating to these 30 services/diseases in
26 Collaboration through a contract The G-BA commissions the AQUA-Institute: AQUA-Institut (AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH Development of Quality Indicators, Instruments and Documentation Execution of the External quality assurance programme in hospitals and Quality assurance across health care institutions and cross-sector In 2013: 434 quality indicators (167 of them risk adjusted] 26
27 External quality assurance programme in hospitals Hospital 1 Hospital 2 Hospital 3 Standardized mandatory Documentation 20% 18% Wundinfektion/Abszessbildung 16% 14% 12% 10% 8% 6% 4% 2% 0% Institution according to 137a SGB V (AQUA-Institute) Krankenhäuser Comparative statistical Analysis (Feedback-, Benchmark-report) 27 Dr. B. Pietsch, modified R. Höchstetter, Wörz
28 External quality assurance programme in hospitals (Liver transplantation) Quality-Indicator: 1-year survival (with known status) 28
29 Thank you! Dr. Markus Wörz, M.A. (Desk Officer) Department of Quality Assurance in Healthcare and Cross-sectoral Health Services Federal Joint Committee Wegelystr Berlin markus.woerz@g-ba.de Internet: 29
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