Abstract
BackgroundIn 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Since then, MVRQs were implemented for seven hospital procedures. This study evaluates the effect of a system-wide intermission of MVRQ for total knee arthroplasty (TKA), demanding 50 annual cases per hospital.MethodsAn uncontrolled before–after study based on federal-level data including the number of hospitals performing TKA, and TKA cases from the external hospital quality assurance programme in Germany (2004–2017). Bi- and multivariate analyses based on hospital-level secondary data of TKA cases and TKA quality indicators extracted from hospital quality reports in Germany (2006–2014).ResultsThe number of TKAs performed in Germany decreased by 11% after suspending the TKA-MVRQ in 2011, and rose by 13% after its reintroduction in 2015. The number of hospitals with less than 50 cases rose from 10 to 25% and their case share from 2 to 5.5% during suspension. Change in hospital volume after the suspension of TKA-MVRQ was not associated with hospital size, ownership, or region. All four evaluable quality indicators increased significantly in the year after their first public reporting. Compared to hospitals meeting the TKA-MVRQ, three indicators show slight but statistically significant better quality in hospitals below the TKA-MVRQ.ConclusionsIn Germany, TKA-MVRQs seem to induce in-hospital caseload adjustments rather than foster regional inter-hospital case transfers as intended.
Highlights
In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument
Our study design is an uncontrolled before–after study; the target population is all hospitals in Germany performing total knee arthroplasty (TKA)
It is most important to keep in mind that our analyses revealed no influence of hospital size, its type of ownership or the region within Germany on the adaption to the MVRQ
Summary
In 2004, the Federal Joint Committee, supreme decision-making body in German healthcare, introduced minimum volume requirements (MVRQs) as a quality instrument. Minimum volume requirements (MVRQs) are an internationally adopted quality instrument In his pioneering publication in 1979, Luft analysed “whether there is a relation between a hospital’s surgical volume and its surgical mortality” [1]. Minimum volume requirements for hospitals are installed to improve treatment results for patients and to redistribute hospital caseloads. These two steering effects of minimum volume requirements have been used either by authorities as a universal requirement in public or social security-based health care systems [3,4,5,6,7,8], or as initiatives in privately organized health care systems [9, 10]
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