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IndiQ – Developing measurable indicators to investigate low value health care (indication quality) in German routine data and identifying needs for action



A suitable choice for an indication, meaning the right decision when, if and how a treatment is appropriate and brings benefits to the patients, is necessary to prevent and encompass overuse, underuse and misuse. Indication quality is a prerequisite for ensuring the best possible quality of care and avoiding overdiagnosis and associated overuse. Previous approaches to quality measurement in the German health care system have primarily focused on outcome quality.


The project aims to develop indicators to assess the appropriateness of indication using statutory health insurance (SHI) routine data. The developed indicators can be used to show the extent, trends and regional differences in the quality of indications.

Methods and content

Within the project, a mixed-methods approach consisting of a systematic review of indicators for measuring indication quality, DELPHI panels with clinical experts and documentation experts as well as routine data analyses and regional analyses will be used. Data basis are cross-sectoral SHI routine data of the ‘Techniker Krankenkasse’ as well as nationwide outpatient SHI-physicians claims and drug prescription data from the 17 regional ASHIPs.The analysis includes all insured persons, who were treated in the outpatient or inpatient sector during the reviewed period. Systematic monitoring of the appropriateness of indications will help to identify concrete need for action with regards to the improvement of the quality of care. Recommendations for the measurement and further improvement of process quality and efficiency of care will be formulated based on expert discussions with the main actors in the German health care system. This could lead to a higher acceptance within the service providers responsible for the indication in the first place. 

Project partners

Our consortium partners are the Techniker Krankenkasse (TK) and the Central Research Institute for Ambulatory Health Care in the Federal Republic of Germany (Zi). In addition, the project is supported by the Association of the Scientific Medical Societies in Germany (AWMF) and represented by the Institute for Medical Knowledge Management (IMWi) and the Working Group on the Collection and Use of Routine Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP) and the German Society for Epidemiology (DGEpi).

Website for further information is in progress and will follow soon.

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