Dr. Christof Veit, Hamburg The Structured Dialog National Quality Benchmarking in Germany Bipartisan Congressional Health Policy Conference, Miami 2006

National Health Care Politics Laws for Social Wellfare Self Government Benchmarking by Self-government. Sickness funds Health Care Providers Patients Physicians Nurses Fed. Joint Committee State level The circles show the partners constituting the steering committees of quality management.

Benchmarking with all hospitals. Nat. Institute Experts 1,708 Hospitals in 16 States project offices

Benchmarking: Scope in quality indicators  88% risk adjusted or no risk adjustment necessary  61% outcome indicators 2,8 million cases 1,708 hospitals 96,7% completeness of data

Community acquired Pneumonia Blood gas analysis within 8 hours Hospital results in Hamburg 2005 % of patients Structured Dialogue Objective achieved Improvement expected, no dialogue Structured dialogue Evaluation % of patients Objective achieved Improvement expected Follow up next year Quality problem Statistical Results % of patients % of patients who get the necessary blood gas analysis, objective: 100% each column represents a Hamburg hospital

Hip Replacement Antibiotic Prophylaxis % of patients who get the necessary prophylaxis, objective: > 95% each column represents a Hamburg hospital Hamburg data hospitals % of patients 2005 Objective achieved Follow up next year Quality problem

Antibiotic Prophylaxis and Wound Infection in Hip-Replacement 2001 – 2004 Hamburg Hospitals, cases per year % % of patients receiving prophylaxis % of patients with wound infection

National Results: Achievement of Quality Objectives. 21% objectives highly achieved 63% objectives substantially achieved 10% results far from expected 6% no evaluation possible

Improvement. Antibiotic Prophylaxis in Hysterectomies 2004 – ,000 cases, 97% completeness of data, results by state © BQS gGmbH Diagrams show percentage of patients receiving prophylaxis per state. Objective: >= 90%

National Health Care Politics Next Steps Health Care Reform Plan 2008 new National Institute for benchmarking in hospital care, ambulatory care and rehabilitation

Features for success.  strength of consensus in self government  involvement of existing institutions  transparency and fairness  focus on improvement  resistance to secondary interests  multiple advantages of a national project with local structures

national data cited from the BQS National Report 2006