Qualitätssicherung in der Intensivmedizin: Peer Reviews und Qualitätsindikatoren

Zusammenfassung

Für eine gute medizinische Behandlungsqualität ist ein zielorientiertes Qualitätsmanagement notwendig. Dadurch werden zentrale Aspekte des Behandlungsprozesses transparent, um Entwicklungspotenziale zu identifizieren und durch externe Qualitätssicherung vergleichbar zu sein. Dieser Beitrag stellt die hierfür wesentlichen Verfahren vor – mit dem Fokus auf Verfahren der formativen Evaluation (Peer Review) und prozessbasierten Qualitätsindikatoren.

Abstract

Goal-oriented quality management in health care is an essential tool to provide good medical practice and treatment. It aims at a patient-centred case management with high transparency of structural and clinical process aspects, as well as patient outcome. An objective and comprehensive description of clinical care includes the use of quality indicators. However, the appliance of those indicators falls short, when the evaluation of quality is not followed by recommendations for improvement.

As a highly specified area in health care provided in hospitals, intensive care medicine is characterized by complex interprofessional and multidisciplinary approaches. In addition, critical care units are an expensive resource. In order to provide an economic and yet high quality patient care, treatments should be evidence-based, and cost-drivers must be analysed for their effectiveness on patient-outcome.

Various methods of quality assurance allow for a formative evaluation of intensive care units by peer reviews, including the use of quality indicators. This article focuses on peer review systems currently applied in German hospitals, and particularly describes quality indicators that have been established by DIVI (German Interdisciplinary Society of Intensive Care and Emergency Medicine). It also addresses the need for a professional dialogue between equal partners. This has to accompany each peer review that aims at an improvement in quality of critical patient care.

Schlüsselwörter

Intensivmedizin - Qualitätssicherung - formative Evaluation - Peer Review - Qualitätsindikatoren

Key words

intensive care medicine - quality assurance - formative evaluation - peer review - quality indicators

• Literatur

• 1 Chop I. [The “Medical Peer Review” curriculum of the German Medical Association]. Z Evid Fortbild Qual Gesundhwes 2012; 106: 555-559 doi:10.1016/j.zefq.2012.08.001
• 2 Griem C, Kleudgen S, Diel F. Qualitätssicherung: Instrumente der kollegialen Qualitätsförderung. Dtsch Arztebl Int 2013; 110: 1310-1313
• 3 Bundesärztekammer. Leitfaden Ärztliches Peer Review. 2014 Im Internet (Stand: 16.10.2020): http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/Leitfaden_Aerztliches-Peer-Review_2014.pdf
• 4 Brenner T, Bingold T, Braun J. et al. Konzepte zur Qualitätssicherung in der Intensivmedizin – Ärztliches Peer-Review, Zertifizierungsverfahren & Benchmarking-Instrumente. Anästh Intensivmed 2019; 60: 209-222 doi:10.19224/ai2019.209
• 5 Krahwinkel W, Rink O, Liebetrau M. et al. [10 years of Peer Reviewing: improving treatment by quality indicators from administrative data]. Dtsch Med Wochenschr 2011; 136: 2083-2088 doi:10.1055/s-0031-1272577
• 6 Bingold T-M, Bickenbach J, Coburn M. Modulares Zertifikat Intensivmedizin der DGAI. Anästh Intensivmed 2014; 55: 316-329
• 7 Ivers N, Jamtvedt G, Flottorp S. et al. . Cochrane Database Syst Rev 2012; (06) CD000259 doi:10.1002/14651858.CD000259.pub3
• 8 OʼBrien MA, Rogers S, Jamtvedt G. et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007; (04) CD000409
• 9 Donabedian A. The quality of care. How can it be assessed?. JAMA 1988; 260: 1743-1748
• 10 Becker M, Breuing J, Nothacker M. et al. Guideline-based quality indicators – a systematic comparison of German and international clinical practice guidelines: protocol for a systematic review. Syst Rev 2018; 7: 5 doi:10.1186/s13643-017-0669-2
• 11 Blumenstock G. Zur Qualität von Qualitätsindikatoren. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2011; 54: 154-159 doi:10.1007/s00103-010-1209-6
• 12 Brinkmann A, Genz R, Köberer A. et al. Dialog auf Augenhöhe. f&w – Führen und Wirtschaften im Krankenhaus 2013; 30: 598-601
• 13 Braun JP, Mende H, Bause H. et al. Quality indicators in intensive care medicine: why? Use or burden for the intensivist. Ger Med Sci 2010; 8: Doc22 doi:10.3205/000111
• 14 Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI). Peer Review – Qualitätsindikatoren. Im Internet (Stand: 20.10.2020): http://www.divi.de/empfehlungen/qualitaetssicherung-intensivmedizin/peer-review/qualitaetsindikatoren
• 15 Kumpf O, Nothacker M, Braun J. et al. The future development of intensive care quality indicators – a methods paper. Ger Med Sci 2020; 18: Doc09 doi:10.3205/000285
• 16 Berenholtz SM, Dorman T, Ngo K. et al. Qualitative review of intensive care unit quality indicators. J Crit Care 2002; 17: 1-12
• 17 Needham DM, Davidson J, Cohen H. et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholdersʼ conference. Crit Care Med 2012; 40: 502-509 doi:10.1097/CCM.0b013e318232da75
• 18 Kumpf O. [Quality indicators in intensive care medicine: Background and practical use]. Med Klin Intensivmed Notfmed 2019;
• 19 Grol RP, Bosch MC, Hulscher ME. et al. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q 2007; 85: 93-138 doi:10.1111/j.1468-0009.2007.00478.x
• 20 Kumpf O, Bloos F, Bause H. et al. Voluntary peer review as innovative tool for quality improvement in the intensive care unit – a retrospective descriptive cohort study in German intensive care units. Ger Med Sci 2014; 12: Doc17 doi:10.3205/000202
• 21 Braun JP, Bause H, Bloos F. et al. Peer reviewing critical care: a pragmatic approach to quality management. Ger Med Sci 2010; 8: Doc23 doi:10.3205/000112
• 22 Greenhalgh T, Robert G, Macfarlane F. et al. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004; 82: 581-629 doi:10.1111/j.0887-378X.2004.00325.x
• 23 Grimshaw JM, Thomas RE, MacLennan G. et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004; 8: iii-iv doi:10.3310/hta8060 1–72