Standardized and comparable outcome measures are needed
for the identification of quality problems and the management of
improvements. The German Inpatient Quality Indicators (G-IQI) [1] provide a tool to measure volumes,
medical outcome and other quality indicators in a comparable way
based on available administrative data. The use of data generated
in the DRG (Diagnosis Related Groups) billing process has important
advantages:
The reference to DRG billing data reduces the risk of manipulations.
Complications which are charged automatically become a subject of
quality control, which is intended and provides a crosscheck for
correctness of data.
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Cases cannot be omitted (unless
they are not charged). Therefore, with respect to the cases included,
the information is complete.
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The definition of indicators is standardized with respect
to the coded information controlled on different levels in the reimbursement
process.
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There is no additional effort for data collection.
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Results are available immediately after patient discharge.
The G-IQI system, which has been developed during the last ten
years, has largely been extended in the new version 3.1 released
in the year 2011. On the one hand indicators for some diseases and procedures,
which had already been covered before, have been refined and complemented
by adding new measures. On the other hand indicators for important
diseases and procedures, which have not been covered before, were
added.
Refinements include for example the share of ischemic stroke
patients receiving thrombolytic therapy and the respective mortality
of this subgroup. Furthermore the share of stroke patients receiving standardized
stroke unit treatment is indicated. In case of myocardial infarction,
the share of patients treated by a coronary catheter and/or
coronary surgery is indicated. Thus besides mortality numbers some
indicators have been added which inform about the use and/or
effective availability of specific services considered to be related
to better outcome.
New indicator groups cover, among others, the following diseases
and procedures: cardiac surgery, thoracic surgery, peripheral vascular
surgery, amputations, chronic obstructive pulmonary disease, geriatrics,
spine procedures, gastric resections, cystectomy, etc.
The indicators mostly refer to measures which have been used
in scientific investigations before (references are given in the
G-IQI definition manual). Unlike more general indicator approaches which
need more extensive risk adjustment, our indicators address specific
diseases and/or procedures, which are stratified by risk
groups. In case of peripheral artery procedures for example the
indicators are differentiated by Fontaine classes and additional
criteria. Besides providing more adequate outcome information such
differentiation improves acceptance by physicians.
The new G-IQI are the most extensive quality indicator system
based on available coded data. As these data are present in the
information systems of hospitals, insurance companies and on a national
level, the indicators can readily be applied. They enable hospitals
to set up a continuous quality management process and to identify
areas which might have quality problems. In conjunction with peer
review (audit) procedures targeting such weaknesses these outcome
oriented management processes have been shown to improve outcome
significantly, especially in hospitals starting from subpar results.
G-IQI is currently used by about a quarter of the German hospitals
on a voluntary basis for quality management. It has become the basis
of the Swiss and the Austrian indicator system as presented elsewhere
on this conference. G-IQI is necessarily (due to data availability)
restricted to single case data. In cooperation with the AOK indicator
systems have been developed which extend the scope beyond the single
case to long term measurements using insurance data. In future both
systems will be needed in parallel. Hospitals need G-IQI for rapid
analysis and quality management. Results of long term indicators,
which are available with delay only, will complement the short term
indicators with more standardized measures and additional information
on important issues of late outcome.
Autorenerklärung: Das Fachgebiet
Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen
ist eine Stiftungsprofessur der Helios Kliniken GmbH.
