Many studies show that the process of patient treatment
is not always ideal which may considerably affect outcome [1]
[2]
[3]
. Vice versa, quality management
may considerably contribute to further improve medical outcome [4]
[5]
[6]
. However, a precondition is a
reliable method to measure outcome in order to recognize and address
possible problems. New forms of managed care also require empirical
verification if they are to improve quality. Furthermore, for the establishment
of pay for performance systems better methods to measure outcome
are needed. Last but not least the public demands better information
about provider quality.
All these approaches need reliable methods for measuring outcome
which are applicable with a reasonable consumption of resources.
Meanwhile the use of medical data gathered for administrative purposes
is an accepted approach. The question is no longer if but how such
data can be used and developed for example by refining the classification
systems where necessary. For a continuous measurement of long-term
results outside clinical studies, the use of longitudinally linked
administrative data may be the only applicable method. A nationwide,
sufficiently complete follow-up of an increasing number of defined
diseases and/or procedures using other methods based on
separate data collections would cause so much effort that it would
hardly be feasible and also not be accepted by professionals who
would have to deliver the additional information.
The QMR conference 2011 presents the current state of using administrative
data for quality measurement. The latest developments in the US Agency
for Healthcare Research and Quality, the strategies of Switzerland
and Austria which use indicators derived from German Inpatient Quality
Indicators [7], as well as developments
in Germany for inpatient, outpatient and integrated, cross-sectoral
measurements are presented by developers and managers first hand.
The discussion of methods and strategies is complemented by the
parallel presentation of quality management schemes as well as peer
review or audit procedures which – based on the measurement of
results – are targeted to improve daily clinical practice.
New forms of managed care and disease management require continuous
monitoring with regard to their effects on treatment quality. Indicators
based on administrative data are used for this purpose, too, which
is why we include this issue in our conference for the first time.
The use of long-term insurance data for outcome measurement (QSR) [8] as established by the largest
German statutory health insurance fund, the AOK, shows that quality
measurement is no longer only an internal matter for providers but
increasingly performed and further developed externally, for example
by health insurance funds.
With its multi-institutional approach, our conference aims at
bridging the gap between providers and payers as well as between
scientists and management, supporting the exchange of views and
thus contributing to a further improvement of quality measurement
instruments and most of all medical outcomes.
