Quality Controls in Hospitals by MDK Hessen: A Practice Report of Experiences and Outlook

Abstract

The Hospital Structure Act introduced § 275a SGB V into the German Social Code. It specifies and expands the legal requirements for future quality controls in hospitals performed by the Medical Review Board of the Statutory Health Insurance Funds (MDK). These controls are intended to ensure high-quality, patient-centered and needs-based medical care of the population. Based on 10 years of experience of the Hessian MDK, the practicability of the quality controls is to be demonstrated. The hospital quality controls carried out so far concern either the examination of the structural quality according to the regulations of the Federal Joint Committee (G-BA) for the quality assurance of special care complexes/procedures or the specifications of the German Institute of Medical Documentation and Information (DIMDI) for complex procedures. All quality controls in the Hessian hospitals are performed as on-site inspections by a specialized MDK-team of 2 medical examiners. The quality controls involve the responsible medical staff as well as members of the hospital management. From 2006-2016 a total of 357 quality controls were carried out according to the regulations of the G-BA for 10 different special care complexes/procedures. In about 20% of cases, the requirements were not fulfilled. During the same period, 1624 quality controls were carried out according to the specifications of the DIMDI for 33 different complex procedures. In about 40% of cases the required standards were not fulfilled. The deficits revealed demonstrate the need for quality control by an independent and qualified body. The quality controls contribute to quality assurance and thus to the quality of structures, processes and outcomes in hospitals. The quality control practice established by the Hessian MDK is transferable to nationwide quality controls to be performed in future.