[The German Agency for Quality in Medicine (ÄZQ) 1995-2010: 15 years promotion of evidence-based medicine, patient orientation and patient safety]. / Das Ärztliche Zentrum für Qualität in der Medizin 1995-2010: 15 Jahre Förderung von Evidenzbasierter Medizin, Patientenorientierung und Patientensicherheit.

The German Agency for Quality in Medicine (ÄZQ) was established as a joint institution of the German Medical Association (BÄK) and the National Association of Statutory Health Insurance Physicians (KBV) in 1995. Starting as a small quality assurance co-ordination unit of the German physicians' national self-governmental bodies, ÄZQ has been developed during the last decade into a centre of excellence for clinical practice guidelines, patient information, patient safety, evidence-based medicine, and knowledge management. The article summarises the institution's acitivities over the period of 15 years with respect to its national projects and international collaboration, being a founding member of the Guidelines International Network. In the future ÄZQ's programme priorities will be in the fields of knowledge transfer and implementation of medical decision aids into the daily work of health-care providers.

[Glossary on patient safety -- a contribution to on-target-definition and to appreciate the subjects of "patient safety"]. / Das Glossar Patientensicherheit -- Ein Beitrag zur Definitionsbestimmung und zum Verständnis der Thematik "Patientensicherheit" und "Fehler in der Medizin".

Since the release of the report "To Err is Human" by the American Institute of Medicine (IOM) the subject "Medical Risks, Errors and Patient Safety" has gained increasing interest in literature. In Germany, neither extensive statistics nor generally significant epidemiological studies regarding common errors associated with damages caused to patients' health exist. In recent years the subject has become increasingly interesting both in specialist discussion and it the lay press; it has become evident that the different use of terms, especially those originating from the Anglo-Saxon language, can lead to misunderstandings. Hence, as one of the first steps of its action programme, the expert panel "Patient Safety" of the German Agency for Quality in Medicine has compiled a glossary of technical terms to provide adequate support to the discussion this important subject of nomenclature.

[The German Quality Management System for Outpatient Care (Q-M-A) Checklist--an instrument for assessing quality management systems in outpatient care]. / Die Checkliste Q-M-A--ein Instrument zur Bewertung von Qualitätsmanagementsystemen in der ambulanten Versorgung.

Quality management systems had originally been designed for industrial purposes and were hardly applicable for small enterprises, there have been adjustments to the two main applications EFQM and ISO enabling utilisation also in ambulatory care. There are also different approaches like the Dutch Visitatiae concept which reflects the needs of GP's and is based on peer exchange. The presented paper gives an overview of existing quality management and certification systems and presents an instrument for evaluation. This checklist was developed by an interdisciplinary expert panel of the Agency for Quality in Medicine and serves as an aid for users and graders of quality management systems with regard to the feasibility of these systems.

Error prevention and error management in medicine--adopting strategies from other professions.

The report of the Institute of Medicine (IOM) 'To Err Is Human' received public interest. The simple term 'medical error' as it has been used in public so far does not describe the complex setting in medicine. The development of error management in industry (e.g. aviation) with an emphasis on human factors, communication, and systematic error is demonstrated in order to design similar approaches for medicine. Recommendations are based on the principles for designing safety systems in health care organisations published in the IOM report.

[Current initiatives in Germany for translating national guidelines into reality - a survey]. / Aktuelle Initiativen zur Realisierung nationaler Leitlinien in Deutschland - eine Ubersicht.

The role of practice guidelines as a tool for quality management in health care is now widely accepted in Germany- not only by health professionals, but also in politics. The physicians' professional associations as well as health care authorities (physicians' self-governmental bodies) and parliament introduced several incentives and regulations, aiming at a regular use of guidelines in health care. Among these the German guideline clearinghouse with the systematic approach towards identification, dissemination, and implementation of best available evidence-based guidelines, as well as the country-wide implementation of disease management guidelines seem to be effective and efficient in quality management as well as in patient care management in the German health care system. The article gives an overview on background, procedures and barriers to country-wide implementation of clinical practice guidelines within a social security health care system.

[Guidelines and evidence-based medicine in Germany]. / Leitlinien und Evidenz-basierte Medizin in Deutschland.

Clinical Practice Guidelines (CPGs) are increasingly common in the German health care system. The German physicians' self-governmental body's position regarding CPGs as a tool of Evidence-based medicine (EBM) was described in a joint policy paper concerning quality in health care in late 1998. The German Medical Association (GMA) and the National Association for Statutory Health Insurance Physicians (NASHIP) stated that "the principles of EBM should be implemented into the German Health Care System" by the following means: to assess systematically and appraise critically the evidence in health care to develop evidence-based consensus CPGs for priority problems in health care to implement CPGs using graduate, post-graduate, and continuing medical education, as well as audits and CPG-based information management to evaluate quality in health care against the background of CPGs. The following paper will discuss the aims and scopes and the limits of this concept.

[The guideline clearing programme of the self-governmental bodies in the German health care system--a project to promote quality assurance in medicine]. / Das Leitlinien-Clearingprogramm der Selbstverwaltungskörperschaften im Gesundheitswesen--Ein Projekt zur Qualitätsförderung in der Medizin.

Within the German health system guidelines are increasing considered as a meaningful and necessary aid to decision making. In this context the effectiveness of guidelines essentially depends on their methodical quality. Because of the fact that most of the German-language guidelines introduced within the past years show obvious methodological defects, the Agency for Quality in Medicine developed within the last two years the following programme for quality-assurance and promotion of guidelines: 1. Definition of quality policies for clinical practice guidelines in Germany 2. Establishment of quality demands for guidelines 3. Methods and instruments for quality promotion of guideline programmes 4. Measures to promote and check the quality of guidelines ("German Guidelines Clearinghouse") The following article reports on background, aims, instruments, method development and acceptance of the programme.

[An online information system "LEITLINIEN-IN-FO"--a contribution to quality management in health care]. / Der Online-Informationsdienst "LEITLINIEN-IN-FO"--ein Beitrag zum Qualitätsmanagement im Gesundheitswesen.

An online-information service contianing clinical practice guidelines ("LEITLINIEN-INFO"--available via) based on similar programs from Scotland and Canada--was developed by the German Guidelines Clearinghouse (Agency for Quality in Medicine, Cologne). The service focuses on continuing medical education regarding guideline methodology and tools for critical appraisal of guidelines. It contains guideline appraisal reports developed in cooperation with the German Cochrane-Center. Special importance is given to a hyperlink collection of German and international guideline-data-bases. Backgrounds, aims, and structures of the information program are discussed.

[Medical guidelines in Germany--current status and future developments]. / Arztliche Leitlinien in Deutschland--aktueller Stand und zukünftige Entwicklungen.

Medical guidelines are considered more and more as a meaningful and necessary tool ensuring a high quality of medical care. However, some doubts were recently mentioned concerning the quality of German guidelines. In 1997, the Society of Physicians of Germany and the Association of Panel Physicians have therefore initiated a program for the promotion of the quality of guidelines in Germany. Tools have been developed with the purpose to report and assess the quality of guidelines. Additionally, a "clearing-procedure for guidelines" and recommendations for the development of evidence-based guidelines were introduced. Background and content of these evaluation tools are reported in this article.

[Quality assurance as the topic in medical periodicals. Results of a literature search]. / Qualitätssicherung als Thema ärztlicher Fortbildungszeitschriften. Ergebnisse einer Literaturrecherche.

Against the background of the increasing importance of quality assurance procedures for the medical profession, it was questioned to which extend the topic "quality assurance" is content in medical journals. The frequency of articles with the key word "quality assurance" in German journals for the period from 1/1992 to 9/1996 was analyzed by using a literature search on Knowledge Finder's Health Star database. Journals for the clinical physician and the physician in the medical practice, that listed more than 200 articles, were taken into account. By using the key word "quality assurance", 276 articles were found (79 in 6 interdisciplinary journals, 197 in 22 medical journals). Interdisciplinary journals published between 8 and 25 (median: 13, rank 1: Zeitschrift für ärztliche Fortbildung), medical journals between 2 and 56 (median 13, rank 1: Chirurg). This analysis leads to the conclusion that a comprehensive continuing education about medical and interdisciplinary aspects of quality assurance in medicine only by reading common German medical journals may not be sufficient.

[Quality assurance and continuous quality improvement--assessment of the current status of physician self-control for quality assurance in medicine 1955-1995]. / Qualitätssicherung und kontinuierliche Qualitätsverbesserung--Bestandsaufnahme der ärztlichen Selbstverwaltung zur Qualitätssicherung in der Medizin 1955-1995.

In April 1996 the working group of the leading statutory health service officials (Arbeitsgemeinschaft der Leitenden Medizinalbeamten der Länder [AGLMB]) organised a hearing in the course of which the German Medical Association and the National Association of CHI Physicians presented a joint stocktaking of their activities in the discipline of quality assurance during 1955 to 1995. On the basis of this analysis 10 theses have been evolved to develop quality assurance in Germany: (1) quality assurance and quality improvement are in the interest of the medical care of patients. (2) The main task of quality assurance and quality improvement is not the improvement of efficiency. (3) Quality assurance schemes must be problem-orientated and coordinated; there must not be a difference in the quality of out-patient and in-patient medical care. (4) There has to be a systematic evaluation of the suitability of quality assurance schemes. (5) Transparency, communication and cooperation are preconditions for a successful quality assurance and quality improvement. (6) Continuous quality improvement is based on an extensive internal quality assurance. (7) The initiative for the priority development of internal quality assurance procedures must come from external quality assurance. (8) Quality assurance has only a chance of being realised if the individual is convinced and anxious to provide high-quality services, to continuously review and improve his services and to compare them with other services. (9) Quality has its price. (10) Quality assurance and continuous quality improvement are the cornerstones of a quality policy in the health care system. The article concludes with extracts from the checkup and the relevant literature.

[Medical guidelines. Definitions, goals, implementation]. / Arztliche Leitlinien. Definitionen, Ziele, Implementierung.

Medical guidelines are an important part of quality control programs. They may act on knowledge, attitude, and behaviour of physicians as well as of medical laymen and, therefore, on the quality of medical care. As guidelines have been developed and distributed in the U.S. and in other countries for decades, recommendations for the medical practice termed "guidelines" or "consensus reports" are more and more distributed in Germany, as well. However, the internationally accepted quality criteria are only rarely taken into account for such independent guidelines. This review aims to impart such quality criteria. Additionally, a structure for a standardized review and organization of guidelines is proposed.