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Introduction: Reliable surveillance systems to monitor trends of COVID-19 case numbers and the associated healthcare burden play a central role in efficient pandemic management. In Germany, the federal government agency Robert-Koch-Institute uses an ICD-code-based inpatient surveillance system, ICOSARI, to assess temporal trends of severe acute respiratory infection (SARI) and COVID-19 hospitalization numbers. In a similar approach, we present a large-scale analysis covering four pandemic waves derived from the Initiative of Quality Medicine (IQM), a German-wide network of acute care hospitals. Methods: Routine data from 421 hospitals for the years 2019-2021 with a "pre-pandemic" period (01-01-2019 to 03-03-2020) and a "pandemic" period (04-03-2020 to 31-12-2021) was analysed. SARI cases were defined by ICD-codes J09-J22 and COVID-19 by ICD-codes U07.1 and U07.2. The following outcomes were analysed: intensive care treatment, mechanical ventilation, in-hospital mortality. Results: Over 1.1 million cases of SARI and COVID-19 were identified. Patients with COVID-19 and additional codes for SARI were at higher risk for adverse outcomes when compared to non-COVID SARI and COVID-19 without any coding for SARI. During the pandemic period, non-COVID SARI cases were associated with 28%, 23% and 27% higher odds for intensive care treatment, mechanical ventilation and in-hospital mortality, respectively, compared to pre-pandemic SARI. Conclusion: The nationwide IQM network could serve as an excellent data source to enhance COVID-19 and SARI surveillance in view of the ongoing pandemic. Future developments of COVID-19/SARI case numbers and associated outcomes should be closely monitored to identify specific trends, especially considering novel virus variants.
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OBJECTIVE: Peer review focuses on critical self-reflection, especially of physicians in direct contact and dialogue with other disciplines and professional groups. The main purpose of the peer review is the principle of self-determination, the intention to learn from each other more effectively, and a commitment to quality improvement. During the past five years the Quality in Medicine Initiative (IQM) has successfully promotes peer reviewing in German-speaking areas. The aim of this study is to investigate all records of IQM peer reviews and to outline the results in the course of development. The major focuses include medical aspects for improvement, information concerning organizational processes and the satisfaction of the visited hospitals. METHOD: A systematic descriptive analysis of all records as well as feedback sheets was conducted between 2010 and 2014. RESULTS: 294 of 304 planned peer reviews were considered, involving among different hospital owners and different clinical conditions. The identified potential for improvement of the peer team was higher than that of the physicians of the hospitals visited. The assessment of the medical review criteria illustrates the following different trends: a positive development occurred concerning the appropriate and timely diagnostic and treatment; a clear potential for improvement could be established concerning a complete and conclusive documentation. Regarding the clinical conditions, anomalies were identified which are important for all IQM hospitals. As regards sustainability, first results from so-called re-reviews were available and provided important information pointing in the direction of structure and process improvement. The satisfaction of the visited physicians increased continuously within these five years. CONCLUSION: In the light of all data records and satisfaction sheets, the IQM peer review has become well-established over the last five years. Possible reasons are a well-defined framework, clear structures and different kinds of support. The success of the cooperation of the German Medical Association and IQM is illustrated by the development of the curriculum peer review. Re-reviews provide impulses for sustainability. At any rate, there is a need for scientific evaluation of the peer review method in order to generate evidence for this important tool of quality improvement.