QUALITY IN-HOSPITAL TREATMENT - HOW IS IT ASSURED AND WHO PROVIDES THE GUIDELINES

Background: Internal quality control of medical performance in the int erest of patient safety is not a new idea. In fact it has been impleme nted in varying degrees since the beginnings of medicine. Actual Situa tion and Methods: Ever since hospitals are compelled by law to apply m ethods of quality assurance and external quality control, the question arises as to whether this law can achieve a concrete increase in qual ity of patient care or whether this law can achieve a concrete increas es in quality of patient care or whether it rather serves to support e conomically motivated goals of health care policies, in the sense of a n increase in efficiency of performance by physicians. Seen in the lig ht of the overall situation of hospital care, the attempt to create ma ndatory quality standards is problematical. A reduction of hospital be ds and a decrease in the average length of hospital stay contrasts the growing number of treated patients. This presents a problem which muc h be compensated for, despite cutbacks in budget and personell. Method s of quality analysis are of the implicite as well as of the explicite type. Implicite methods are based on retrospective data analysis lack ing previously set standards of comparison. These methods harbor the d anger of viewer-dependent subjectivity (restricted reliability). Expli cite methods are based upon comparison to previously defined standards . These methods are more objective, but often fail to give considerati on to individual situations (restricted validity). The infrastructure necessary in order to sensibly apply quality control in the hospitals is not yet present in Germany. The software required in order to recor d and analyse data is still in a stage of development in many places. Conclusion: It is of importance not to leave external quality control to politicians and economists unfamiliar with the subject matter, but rather that quality control is implemented by experts in the medical f ield.