[Experienced quality assurance in the IVOM structural contract of the AOK­BW : A practical example]. / Gelebte Qualitätssicherung im IVOM-Strukturvertrag der AOK­BW : Ein Praxisbeispiel.

BACKGROUND: According to § 73c of the Social Security Codebook V (SGB V), the AOK health insurance structural contract regulates the treatment of macular diseases by intravitreal drug administration (IVOM) in Baden-Württemberg (BW). Quality assurance is a central part of the agreement in order to ensure the high quality as well as effective and sufficient care of patients. MATERIAL AND METHODS: Every year at least 2% of the cases of the 254 currently participating surgeons are evaluated in a pseudonymized procedure by a panel of experts based on the billing data. Based on quality parameters, such as accuracy of diagnosis, quality and completeness of treatment documents and adherence to treatment pathways, the Medical Advisory Board recommends sanctions or facilitation of controls. The overall assessment of an expert opinion is based on a matrix of the evaluated quality parameters. The transmission of findings and expert opinions is digital and web based. Each surgeon has access to a comparative analysis of the quality data over time (benchmarking). RESULTS: In the first 11 quality assurance rounds, a total of 3639 expert opinions were made by a total of 20 reviewers. With respect to the quality parameter "diagnosis", the surgeon and the expert opinion differed in an average 7% of cases. Sanctions or facilitation of control by changing the sample were recommended 138 times for 80 surgeons in the first 10 quality assurance rounds. Financial sanctions or exclusion from contracts were each decided four times by the steering committee. DISCUSSION: The digital, web-based quality assurance system presented here within the framework of the IOVM structural contract of the AOK-BW should be perceived as an opportunity to classify and improve one's own quality level with respect to intravitreal treatment of retinal diseases. The current focus of quality assurance is on diagnosis and adherence to the disease-specific treatment recommendations of the professional societies. If the analysis of data could be extended to individual patient histories over time, quality assurance could be better used for questions of health services research.

Phytosociological contrast of ferns and lycophytes from forest fragments with different surroundings matrices in southern Brazil / Contraste fitossociológico de samambaias e licófitas de fragmentos florestais com diferentes matrizes de entorno no sul do Brasil

Abstract Forest edges typically exhibit higher luminosity and lower humidity than the forest interior, resulting in an abiotic gradient. However, the degree of abiotic difference can be affected from the type of the matrix, influencing the selection of species. We compared the floristic and phytosociological structure of understory communities of ferns and lycophytes of the edge and interior of three forest sites influenced by different types of surrounding matrices (natural field, Pinus plantation, and cultivation of crops). In the region of Araucaria Forest, in Rio Grande do Sul, Brazil, twelve 10 × 10 m plots were selected at the edge and interior of each site, totaling 72 plots and to evaluate the phytosociological contrast, using as a parameter coverage and species richness per plot to evaluate this contrast. We recorded a total of 38 species in the studied areas, distributed in 15 families. The results show that the edge effect acts at different intensities in the analyzed sites. In the site with unnatural matrix, the composition was more homogeneous both in the edges and in the interiors and presented lower richness, showing a more pronounced and deep impact. Already in the site with natural matrix surroundings, although the border also presents low richness, the interior was about 3x richer. Based on our results, we concluded that fern conservation efforts should focus on fragments of Araucaria Forest inserted in the natural field, because the conversion of natural field into Pinus planting and cultivation of crops decreases ferns species both in the edges and forest interiors of the studied fragments, besides altering the phytosociological structure leading the communities to simplification.

Resumo Bordas florestais tipicamente exibem maior luminosidade e menor umidade que o interior florestal, resultando em um gradiente abiótico. Entretanto, o grau de diferença abiótica pode ser afetado a partir do tipo da matriz, influenciando a seleção de espécies. Comparamos a composição florística e a estrutura fitossociológica das comunidades de samambaias e licófitas na borda e interior de três sítios influenciados por diferentes matrizes (campo natural, plantio de Pinus e cultivo de olerícolas). Na região de Floresta com Araucária no Rio Grande do Sul, Brasil, foram sorteadas doze parcelas de 10 × 10 m na borda e no interior de cada sítio, totalizando 72 parcelas para avaliar o contraste fitossociológico, utilizando como parâmetro cobertura e riqueza das espécies por parcela para avaliar esse contraste. Registramos um total de 38 espécies nas áreas estudadas, distribuídas em 15 famílias. Os resultados mostraram que o efeito de borda atua em intensidades distintas nos sítios analisados. Nos sítios com matriz antropizada, a composição foi mais homogênea tanto nas bordas, quanto nos interiores e apresentou menor riqueza, demonstrando impacto mais pronunciado e profundo. Já no sítio com matriz de entorno natural, apesar da borda também apresentar baixa riqueza, o interior foi cerca de 3x mais rico. Sugerimos que os esforços de conservação de samambaias e licófitas em fragmentos com araucária, devem se concentrar em sítios inseridos em campo natural, pois, a conversão destes em plantio de Pinus e cultivo de olerícolas, diminui a diversidade dessas plantas, tanto nas bordas quanto nos interiores da floresta, além de alterar a estrutura fitossociológica levando as comunidades à simplificação.

Phytosociological contrast of ferns and lycophytes from forest fragments with different surroundings matrices in southern Brazil.

Forest edges typically exhibit higher luminosity and lower humidity than the forest interior, resulting in an abiotic gradient. However, the degree of abiotic difference can be affected from the type of the matrix, influencing the selection of species. We compared the floristic and phytosociological structure of understory communities of ferns and lycophytes of the edge and interior of three forest sites influenced by different types of surrounding matrices (natural field, Pinus plantation, and cultivation of crops). In the region of Araucaria Forest, in Rio Grande do Sul, Brazil, twelve 10 × 10 m plots were selected at the edge and interior of each site, totaling 72 plots and to evaluate the phytosociological contrast, using as a parameter coverage and species richness per plot to evaluate this contrast. We recorded a total of 38 species in the studied areas, distributed in 15 families. The results show that the edge effect acts at different intensities in the analyzed sites. In the site with unnatural matrix, the composition was more homogeneous both in the edges and in the interiors and presented lower richness, showing a more pronounced and deep impact. Already in the site with natural matrix surroundings, although the border also presents low richness, the interior was about 3x richer. Based on our results, we concluded that fern conservation efforts should focus on fragments of Araucaria Forest inserted in the natural field, because the conversion of natural field into Pinus planting and cultivation of crops decreases ferns species both in the edges and forest interiors of the studied fragments, besides altering the phytosociological structure leading the communities to simplification.

Phytosociological contrast of ferns and lycophytes from forest fragments with different surroundings matrices in southern Brazil

Abstract Forest edges typically exhibit higher luminosity and lower humidity than the forest interior, resulting in an abiotic gradient. However, the degree of abiotic difference can be affected from the type of the matrix, influencing the selection of species. We compared the floristic and phytosociological structure of understory communities of ferns and lycophytes of the edge and interior of three forest sites influenced by different types of surrounding matrices (natural field, Pinus plantation, and cultivation of crops). In the region of Araucaria Forest, in Rio Grande do Sul, Brazil, twelve 10 × 10 m plots were selected at the edge and interior of each site, totaling 72 plots and to evaluate the phytosociological contrast, using as a parameter coverage and species richness per plot to evaluate this contrast. We recorded a total of 38 species in the studied areas, distributed in 15 families. The results show that the edge effect acts at different intensities in the analyzed sites. In the site with unnatural matrix, the composition was more homogeneous both in the edges and in the interiors and presented lower richness, showing a more pronounced and deep impact. Already in the site with natural matrix surroundings, although the border also presents low richness, the interior was about 3x richer. Based on our results, we concluded that fern conservation efforts should focus on fragments of Araucaria Forest inserted in the natural field, because the conversion of natural field into Pinus planting and cultivation of crops decreases ferns species both in the edges and forest interiors of the studied fragments, besides altering the phytosociological structure leading the communities to simplification.

Resumo Bordas florestais tipicamente exibem maior luminosidade e menor umidade que o interior florestal, resultando em um gradiente abiótico. Entretanto, o grau de diferença abiótica pode ser afetado a partir do tipo da matriz, influenciando a seleção de espécies. Comparamos a composição florística e a estrutura fitossociológica das comunidades de samambaias e licófitas na borda e interior de três sítios influenciados por diferentes matrizes (campo natural, plantio de Pinus e cultivo de olerícolas). Na região de Floresta com Araucária no Rio Grande do Sul, Brasil, foram sorteadas doze parcelas de 10 × 10 m na borda e no interior de cada sítio, totalizando 72 parcelas para avaliar o contraste fitossociológico, utilizando como parâmetro cobertura e riqueza das espécies por parcela para avaliar esse contraste. Registramos um total de 38 espécies nas áreas estudadas, distribuídas em 15 famílias. Os resultados mostraram que o efeito de borda atua em intensidades distintas nos sítios analisados. Nos sítios com matriz antropizada, a composição foi mais homogênea tanto nas bordas, quanto nos interiores e apresentou menor riqueza, demonstrando impacto mais pronunciado e profundo. Já no sítio com matriz de entorno natural, apesar da borda também apresentar baixa riqueza, o interior foi cerca de 3x mais rico. Sugerimos que os esforços de conservação de samambaias e licófitas em fragmentos com araucária, devem se concentrar em sítios inseridos em campo natural, pois, a conversão destes em plantio de Pinus e cultivo de olerícolas, diminui a diversidade dessas plantas, tanto nas bordas quanto nos interiores da floresta, além de alterar a estrutura fitossociológica levando as comunidades à simplificação.