Evaluating compulsory minimum volume standards in Germany: how many hospitals were compliant in 2004?

BACKGROUND: Minimum hospital procedure volumes are discussed as an instrument for quality assurance. In 2004 Germany introduced such annual minimum volumes nationwide on five surgical procedures: kidney, liver, stem cell transplantation, complex oesophageal, and pancreatic interventions. The present investigation is the first part of a study evaluating the effects of these minimum volumes on health care provision. Research questions address how many hospitals and cases were affected by minimum volume regulations in 2004, how affected hospitals were distributed according to minimum volumes, and how many hospitals within the 16 German states complied with the standards set for 2004. METHODS: The evaluation is based on the mandatory hospital quality reports for 2004. In the reports, all hospitals are statutorily obliged to state the number of procedures performed for each minimum volume. The data were analyzed descriptively. RESULTS: In 2004, 485 out of 1710 German hospitals providing acute care and approximately 0.14% of all hospital cases were affected by minimum volume regulations. Liver, kidney, and stem cell transplantation affected from 23 to hospitals; complex oesophageal and pancreatic interventions affected from 297 to 455 hospitals. The inter-state comparison of the average hospital care area demonstrates large differences between city states and large area states and the eastern and western German states ranging from a minimum 51 km2 up to a maximum 23.200 km2, varying according to each procedure. A range of 9% - 16% of the transplantation hospitals did not comply with the standards affecting 1% - 2% of the patients whereas 29% and 18% of the hospitals treating complex oesophageal and pancreatic interventions failed the standards affecting 2% - 5% of the prevailing cases. CONCLUSION: In 2004, the newly introduced minimum volume regulations affected only up to a quarter of German acute care hospitals and few cases. However, excluding the hospitals not meeting the minimum volume standards from providing the respective procedures deserves considering two aspects: the hospital health care provision concepts by the German states as being responsible and from a patient perspective the geographically equal access to hospital care.

Transplant rejections? Tighter organ-transplant restrictions from the CMS could lead to fewer programs; some are leery of changes based on outcomes.

At least 10 organ transplant centers are expected to lose their Medicare-approved status next year under new regulations meant to tighten standards and increase survival rates, according to Barry Straube, the CMS' chief medical officer. The updated rules worry providers, who say that the number of transplants doesn't accurately indicate quality, but neither does it automatically point to waste or fraud.

[Demands of private gastroenterologists for collaborative treatment concepts with clinics. Results of a Germany-wide survey]. / Welche Anforderungen stellen niedergelassene Gastroenterologen an integrierte Versorgungskonzepte mit Kliniken? Ergebnisse einer deutschlandweiten Umfrage.

BACKGROUND: New demands and possibilities of collaboration between hospitals and private practices in Germany have appeared, now that the way has been opened legally. A poll was conducted to analyse the current status of collaboration between outpatient gastroenterologists and hospital surgical departments and to identify possible future collaborations. MATERIALS AND METHODS: One thousand twenty-six private practices specialising in endoscopy were found by contacting the Association of Statutory Health Insurance Physicians and additional internet research. Of these, 50% were randomly selected (513 private practices) and contacted by mail with anonymous questionnaires about cooperation with their clinical partners. Two hundred three (39.6%) practices responded, of which 200 could be analysed. RESULTS: Of all practices reached, 75% considered the cooperation with clinics very valuable or even exceptional. Still, almost half (46%) suggested necessary improvements in these collaborations. Around a third of all contacted colleagues were already involved in projects following integrated care models. In about 80% of all participants, the main interest in integrated models was specified to be common therapy planning. CONCLUSION: The data analysis of this study shows a substantial interest of private-practice gastroenterologists in close collaboration with hospitals. It is now up to the hospitals to open contracts with their medical outpatient partners.

Duke Surgery Research Central: an open-source Web application for the improvement of compliance with research regulation.

BACKGROUND: Although regulatory compliance in academic research is enforced by law to ensure high quality and safety to participants, its implementation is frequently hindered by cost and logistical barriers. In order to decrease these barriers, we have developed a Web-based application, Duke Surgery Research Central (DSRC), to monitor and streamline the regulatory research process. RESULTS: The main objective of DSRC is to streamline regulatory research processes. The application was built using a combination of paper prototyping for system requirements and Java as the primary language for the application, in conjunction with the Model-View-Controller design model. The researcher interface was designed for simplicity so that it could be used by individuals with different computer literacy levels. Analogously, the administrator interface was designed with functionality as its primary goal. DSRC facilitates the exchange of regulatory documents between researchers and research administrators, allowing for tasks to be tracked and documents to be stored in a Web environment accessible from an Intranet. Usability was evaluated using formal usability tests and field observations. Formal usability results demonstrated that DSRC presented good speed, was easy to learn and use, had a functionality that was easily understandable, and a navigation that was intuitive. Additional features implemented upon request by initial users included: extensive variable categorization (in contrast with data capture using free text), searching capabilities to improve how research administrators could search an extensive number of researcher names, warning messages before critical tasks were performed (such as deleting a task), and confirmatory e-mails for critical tasks (such as completing a regulatory task). CONCLUSION: The current version of DSRC was shown to have excellent overall usability properties in handling research regulatory issues. It is hoped that its release as an open-source application will promote improved and streamlined regulatory processes for individual academic centers as well as larger research networks.

[Health policy guidelines for ambulatory and brief inpatient surgery. Backgrounds, facts and possible future solutions]. / Gesundheitspolitischer Rahmen für die ambulante und kurzzeitstationäre Chirurgie. Hintergründe, Fakten und zukünftige Lösungsansätze.

Ambulatory and short-stay surgery in Germany are regulated by two different political committees with different members. Currently, hospitals are permitted to practice ambulatory surgery on the basis of a mere notification sent to the health insurance companies. The details for access, reimbursement, and quality assurance are negotiated between the hospitals' association, the health insurance companies, and the association of the physicians. Compared to other fields of ambulatory care, the legislation for ambulatory surgery is rather loose concerning hospitals' access to this field of health care provision. Short-stay surgery is designated under inpatient care. With the introduction of so-called diagnosis-related groups (DRG) in 2003, a steep decline in length of stay is expected. Further efforts of the government and health insurance companies to extend ambulatory surgery to further indications are expected, too. However, the hurdle of transferring services from the inpatient sector to the ambulatory sector is a major challenge in Germany. We recommend lowering the legislative hurdle hindering hospitals and physicians from entering the area of ambulatory surgery for specific diagnoses. Same-day treatment should also be encouraged.

The legal and risk management conundrum of telemedicine.

A store-and-forward teledermatology service was established between two general practices and the department of plastic surgery at Derriford Hospital in Plymouth. An academic lawyer and an expert in risk management made an assessment of the service. They looked at the following issues: medicolegal problems; security; confidentiality; and risk. None of them was considered insoluble and there is no reason why such issues should prevent the National Health Service from developing telemedicine services. All organizations considering telemedicine need to ensure that the proposed telemedicine service satisfies the issues raised in this study.

[Cost analysis of thyroid gland surgery in a university surgical clinic]. / Kostenanalyse der Schilddrüsenchirurgie in einer chirurgischen Universitätsklinik.

On 1 January 1996, the implementation of the new recompense system, the Bundespflegesatzverordnung (BPflV), at the Medical University Halle replaced the former German hospital financing system based on clinic-dependent individual prices. This was the beginning of a new price-performance system of the German hospital market. Since then, for all surgical procedures (catalogue section 301 SGB V ICPM 5061-5064) for benign and malignant thyroid diseases a detailed cost analysis has been performed. Our personnel and material inputs were documented on-line in the operating theatre on a special designed cost-analysis record. The cost analysis was based on 14 cases of lobectomy (average operative costs DM 1886.82), and 20 each of bilateral subtotal thyroidectomy (average DM 1970.48), unilateral subtotal thyroidectomy with contralateral lobectomy (average DM 2164.26) and total thyroidectomy (average DM 2396.70) respectively. In 12 cases the costs of total thyroidectomy with cervical and transthoracal lymphadenectomy have been analyzed (average DM 4664.48).

[New classification of practical surgical performance]. / Neuklassifizierung der praktischen chirurgischen Arbeit.

The commission was founded in April 1990 by the Professional Association of German Surgeons to devise a new evaluation of surgical practice, especially operative procedures. The catalogue uses time as its first approach, but also gives other qualities for surgical work. The given time values for some standard operations are backed up by statistical calculation of well-documented times in three different surgical units.

Impacto de la atención de enfermería que recibieron los pacientes hospitalizados en el servicio de Cirugía durante el pre y post-operatoria, Hospital Docente Latacunga 1992 / Impact of the infirmary attention that received the patients hospitalized in the service of Surgery during pre and postoperative, Educational Hospital Latacunga 1992

El presente trabajo pretende aportar al contexto general, como impacta la atención de enfermeríal al paciente en el período pre y pos-operatorio. En efecto cada vez se define en forma mas clara el área de actuación de la enfermera, centrada en la atención de las necesidades del individuo, diferenciada de la que cumplen los otros miembros del equipo de salud, pero con igual o quizá mayor valor ya que constituye un accionar directo y una estrecha relación con el paciente...