QUALITY ASSESSMENT IN GYNECOLOGY AND OBSTETRICS PROJECTS AND EXPERIENCE IN SWITZERLAND

The first steps in quality assessment of results of performance in gyn ecology and obstetrics were taken by the Swiss Association of the OB/G YN Clinics of the Swiss Society of Obstetrics and Gynecology in the 19 80's. Currently, medical data of more than 800000 patients are availab le, allowing a good comparison of the quality of results. Concerned th at purchasing coverage for health services was made exclusively on the basis of cost, resulting in lower public health quality, the Swiss So ciety of OB/GYN set up a Board of Quality Assessment in 1995. Not only the quality of results, but also the quality of indications, structur es and processes are considered by using a modified Donabedian model. Moreover, standardized patient information forms have been worked out for 15 gynecological and five obstetrical operations. Since hysterecto my is the most common major gynecological operation in Switzerland, th e evaluation of the quality of the indications is of substantial inter est. Guided by the RAND Appropriateness Method, criteria for quality a ssessment with respect to appropriateness and necessity of hysterectom y have been drawn up. Swiss guidelines and 125 different clinical scen arios are defined by a panel of 22 OB/GYN experts. The aim of this pro ject is to offer an interactive second opinion system, called ''Swiss Guidelines for Hysterectomy'', and anonymous self-assessment of qualit y. Appropriateness and necessity of medical procedures have to be defi ned by medical professionals providing a proper balance between the pa tient's desires and financial demands. (C) 1998 Elsevier Science Irela nd Ltd.