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Measuring, Monitoring, And Managing Quality In Germany's Hospitals

Reinhard Busse, Ulrike Nimptsch, Thomas Mansky
Health Affairs 28, no. 2 (2009): w294–w304



The development of quality measurement, monitoring, and management has made great progress in the German hospital sector, writes Reinhard Busse, professor and director of the Department of Health Care Management at the Technische Universitaet in Berlin, and his coauthors. Germany's external quality assurance system was developed and made mandatory already in the 1990s; by 2007, the Federal Office for Quality Assurance collected quality information from all acute care hospitals for 26 procedures and diseases, involving 194 separate indicators on 3.6 million patients. In 2003 Germany introduced a reimbursement system based on diagnosis-related groups (DRGs) for all acute care inpatient services except psychiatry. This was accompanied by strict coding guidelines, which greatly improved the quality of data available in administrative information systems and facilitated the development of two additional quality assessment approaches: a "second generation" system of quality measurement using hospital-level administrative data, which is voluntary, and a "third generation" of long-term performance measurements using administrative data at the payer level, which is still in the developmental stage. According to Busse and his colleagues, this third-generation system "may help establish a new type of quality assessment, in both Germany and the United States," particularly if it is enriched by information previously confined to the first-generation quality assessment system run by the Federal Office for Quality Assurance.

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