Evaluation of Internal Quality Management in Hospitals and Ambulatory Health Care - An Analysis of the Status of Implementation and of Efficacy/Effectiveness and Benefit

Since 2004 it is mandatory by law for all hospitals, statutory health insurance physicians, psychological therapists and dentists in Germany to implement internal qualitymanagement systems (QM). Standards are defined in guidelines by the German Federal Joint Committee (G-BA). In the context of these guidelines, the G-BA determined an evaluation of QM in terms of implementation grade and efficacy/effectiveness and benefit. Available results of the implementation grade of QM in German ambulatory and dental health care will be presented and analyzed in terms of relevance and validity. To analyze aspects of efficacy/effectiveness and benefit of QM, the KCQ performed a systematic literature review based on national and international studies. In a combined analysis of the results of the evaluation of implementation depth and general aspects of efficiency and benefit we assess the results for the German health sector. The evaluations of KBV and KBZV suggest a high level of implementation of QM in Germany although methodological weaknesses of the survey must be considered. The literature review demonstrates only weak evidence for efficacy/effectiveness and benefit -especially under the aspect of patients' outcome. A final assessment of the implementation grade and efficacy/effectiveness and benefit of QM is not possible on the base of the available data. The presented data gaps -based on methodicalweaknesses - do not indicate the failure of QM. To achieve significant results, alternative forms of evaluation are needed to analyze the impact of QM.