The MDK as an Institution for Quality Assurance in the German Health System: A Practice Report on Quality Audits Based on the Guideline on Minimally Invasive Heart Valve Interventions of the G-BA

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In 2015, the Federal Joint Committee (G-BA) adopted a guideline on minimally invasive heart valve interventions (MHI-RL). Every year, hospitals have to declare compliance with the quality requirements of the guideline in the form of checklists vis-à-vis the social service providers, who can have the data checked by the medical service of the health insurance (MDK) on site. Here we report on the experience with these tests in Hessian hospitals. At the MDK Hessen, after being commissioned by the social service providers and announcement to this effect, examinations are carried out by two specialist medical assessors as part of on-site inspections in the hospitals. Since the MHI-RL took effect, a total of 33 quality audits for transcatheter aortic valve implantations (TAVI) and/or transcatheter mitral valve repairs (TMVR/"MitraClip®") have been performed in 12 Hessian hospitals. As part of a first review, 87.5% of hospitals performing TAVI and TMVR and 50.0% of TMVR-only hospitals confirmed compliance with the checklists. Following the initial assessment, all hospitals that had not yet complied fulfilled the requirement within the period agreed upon with the social service providers. By the deadline of 21.03.2017, 11 of the 12 hospitals examined fulfilled the requirements of the MHI-RL and since March 2018, all 12 hospitals did so. Since the MHI-RL took effect, the MDK Hessen has been commissioned as an independent and impartial socio-medical expert institution within the statutory health insurance system. With the quality checks, it makes an important contribution to the quality assurance of specialized inpatient care in Hesse. This has led to fulfillment of the quality requirements of the MHI-RL throughout Hessen. Based on these experiences, the MDK Hessen is well prepared for the challenges of the future MDK quality control guideline/MDK-QK-RL.