Editorial Referateband 2020

Dear Colleagues,

I am extremely pleased to present the volume of papers for the 91^st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Which - quality makes the difference? The limitation of quality characteristics in the context of evaluating effectiveness of different areas of ENT medicine occupies a large space in the presentation of our discipline. This is not limited to the benefit assessment considerations of the G-BA (Gemeinsamer Bundesausschuss; governmental administration for payment regulation in medicine), or regulatory instruments for insurance companies, but extends via guidelines up to the sophisticated notion of evidence. In the definition of the term of “evidence”, the concept of quality touches much more, since from a medical point of view it depends on the structure of the service provision, the quality of training of the medical and specialist staff, the whole package of pre- and post-treatment and on the concept of interdisciplinarity, which is important in many treatment areas.

Andreas Dietz

The following definition of the quality concept was developed in 1990 by the Institute of Medicine of the National Academy of Sciences, USA: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” This definition is helpful for the patient because it is “patient-centered”. The focus is not placed on the outcome of medical treatment alone, but rather on the (ideally desired) result perceived by the patient (patient-reported outcome, PRO), on the basis of sound medical knowledge (guidelines, evidence). The use of the quality aspect is very popular, but also highly inflationary and not clear in its exact meaning, on advertising homepages of medical service providers, and it is also frequently used by cost bearers and the industry. This is also reflected by an increasing number of certificates and quality labels, which are often difficult to assess in terms of quality from the patients’ perspective.

The measurement and assessment of the quality of medical treatment is complex, methodologically not easy and prone to errors. Among other things, the IQWiG (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen; German Institute for Quality and Efficiency in Healthcare) has the statutory mandate to evaluate the advantages and disadvantages of medical procedures, for example to compare different drugs or, more recently, surgical procedures. The IQWiG uses the methods of evidence-based medicine to select and evaluate the studies. This international standard method allows estimating how reliable the existing knowledge actually is. However, considering the study situation alone, the aspects of the structural quality of the – generally very heterogenic – treatment centers participating in the studies are difficult to assess. Only recently, these aspects also started playing a major role in trials. For example, current publications on the quality of the outcome after head and neck cancer therapy show a significantly different overall survival depending on the structural quality of the treatment center after supposedly the same therapy.

The following presentations of 8 ENT-related topics and one journalist’s external view should help to create a critical assessment of the quality standards that are relevant from a medical point of view. I hope that these extremely extensive and highly detailed contributions will give many valuable impulses for our daily work and the continuous development of our interesting discipline.

Prof. Dr. med. Andreas Dietz
President German Society of Oto-Rhino-Laryngology,
Head and Neck Surgery 2019/2020