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Indikatoren im Rahmen des internen Qualitätsmanagements in Arztpraxen

Aim: Various systems of quality assurance and promotion (e.g. DIN-ISO, EFQM) compete for the outpatient sector of health care. A national guideline is expected to determine minimum standards for internal quality management in doctor’s practices. The evaluation of efficiency of QM in this kind of outpatient care has to assess a complex intervention in the healthcare system. App rop riate quality indicators are needed for system-wide evaluation as well as internal quality assessment . Methods: Literature and internet database research. Results: Quality indicators are developed in various ways. Standardized requirements for their development are missing. The available systems have similarities, and in some cases are based on each other. Outcome indicators for addressing outpatient care are rare. In view of the lack of evidence of an association between the input of different systems of QM and outcome for the patients, indicators may be chosen under the priority of system conformity and practicability which includes the avoidance of duplication of documentation. Different domains of care should be addressed. Conceivable sources include indicator sets from disease management programmes, quality a ssessment concepts used in the outp atient sector and for national quality assurance in hospitals (BQS). Relevant indicators from systems developed and tested abroad could profitably be applied to improve system-wide information input in outcome research projects and within collaborative projects for quality control (e. g. quality circles). Comparisons are not possible without adjustment for the risk-structure of the patient collective. Discussion: The choice of indicator programmes may have favourable as well as destructive consequences. At the present time, non-systematic selections of indicators are suited only for monitoring outcomes in local internal quality management assessment, not for comparison of practices or system-related assessment. Patient satisfaction and comp liance are only of limited use asquality indicators. Conclusions: Appropriate indicators are needed soon. The systematic transformation, modification and testing of indicators already used in foreign systems should be considered.