Quality Assurance (QA) in dialysis treatment
A German QA program
Medical Netcare, entrusted by the Federal Joint Committee (G-BA), created quarterly quality reports for approximately 720 dialysis facilities in Germany and 17 Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) as a central data analyst from 2007 to 2017. Furthermore, we wrote a summarising report for the Federal Joint Comitee (G-BA) once a year.
Quality Assurance in dialysis care in Germany
QA dialysis in Germany
in the evaluation
more than 70,000 of them in permanent need of dialysis
More than
for dialysis in Germany
on average, every facility attends to more than 110 patients in permanent treatment
MNC creates more than
for QA dialysis every year
each facility gets their reports through the 17 Associations of SHI Physicians
More than
dialysis processes in data stock
one dialysis patient passes about 160 dialysis procedures per year
Currently
for all dialysis facilities in Germany
weekly duration and frequency of dialysis, type of vascular access, weekly Kt/V
Conspicuities
reduced
the QA program has enhanced the dialysis treament significantly
Quality Assurance in dialysis treatment
Since the mandatory Quality Assurance in dialysis was introduced in 2007, Medical Netcare evaluated the QA data for dialysis treatment until 2017. For all facilities in Germany, MNC created quarterly reports which give an overview of the quality of their treatment.
Additionally, we created summarising reports for the 17 Associations of SHI Physicians (Kassenärztlichen Vereinigungen) in Germany. Each Association got the results of each facility in their region as they act as a supervisory body. The Associations can take a closer look at facilities in case the common quality goals were missed three times in a row.
Quality results in hemodialysis
of all dialysis patients were dialysed via catheter
The Quality Assurance (QA) guideline
The QA reports created by Medical Netcare are conceptualised following the guideline for QA in dialysis treatment ("Richtlinie zur Sicherung der Qualität von Dialyse-Behandlungen nach den §§ 136 und 136a SGB V"). The guideline was enacted on April 18th, 2006 by the G-BA and enured on June 24th, 2006. It aims at the implementation of constant progress in enhancing quality.
Reasons for creating a special guideline for QA in dialysis were
- the disease burden accompanying terminal renal failure, which can be reduced with an adequate therapy,
- the transition to a flatrate payment,
- the existence of suiting quality indicators for covering process and result quality, and
- the availability of valid international guidelines.
The content of the QA guideline dialysis can be roughly subdivided into:
- Benchmark and sample tests relating to data of appendixes 1 to 3 in QA guideline dialysis
- Benchmark referring to data of appendix 4 in QA guideline dialysis
Tasks adopted by MNC
MNC was exclusively in charge of benchmarking and sample testing relating to data of appendixes 1 to 3 in the QA guideline dialysis between 2007 and 2017. The QA guideline dialysis has to be taken into consideration with each treatment given within the framework of a statutory health insurance physician's care by professional health care providers, i.e. dialysis institutions.
MNC analysed the data provided by dialysis institutions and composed quaterly reports concerning trans-institutional benchmarking for each dialysis institute and quaterly reports for each health insurance company regarding sample testing, as well as a yearly report for the Federal Joint Comitee (G-BA), each in accordance with the requirements of appendix 5 in the QA guideline dialysis. Each report could have differentiating content depending on the receiver.
Yearly reports on Quality Assurance (QA)
You can get our yearly reports from 2007 until 2017 of the QA results here (source: website of the Federal Joint Committee (G-BA)). Furthermore, you can download our last powerpoint presentation charts from some of the latest QA meetings of the Federal Joint Committee and two information documents by the Federal Joint Committee.
In the annual report of 2017 on data analysis dialysis, the good trend continues in the achievement of the quality assurance objectives. Above all, the proportions of conspicuous facilities that could not achieve a quality goal in the process parameters have been very low and are hardly subject to any fluctuation.
In the annual report of 2016 on data analysis dialysis, the good trend continues in the achievement of the quality assurance objectives. Above all, the proportions of conspicuous facilities that could not achieve a quality goal in the process parameters have been very low and are hardly subject to any fluctuation.
In the year 2015, one major alteration came into force: the kind of vascular access is established as a new indicator of quality. While the kind of access has merely been documented in the past, it gets a threshold for inconsistency now: a maximum of 30% of all haemodialysis patients in a doctor’s surgery shall be dialysed via catheter access.
In 2014, a new guideline for QA inured, that should allow for future longitudinal analysis of QA data. Furthermore, quality indicators were matched, e.g. for haemodialysis, process quality indicators were reduced to “length of dialysis per week” and “weekly dialysis frequence”.
The reports for the years 2011 to 2013 show largely one thing: Quality Assurance (QA) provides for significant and especially rapid improvements in all areas, for it gives quarterly feedback to each German dialysis facility. By now, the tolerance limit of 15% in patients with “bad outcomes” is by far gone below in almost every dialysis facility. There are just a few isolated cases for facilities showing inconsistency in two quarters successively. The percentage of inconsistent cases for e.g. Kt/V values is under 10% ever since the end of 2009.
The reports for the years 2011 to 2013 show largely one thing: Quality Assurance (QA) provides for significant and especially rapid improvements in all areas, for it gives quarterly feedback to each German dialysis facility. By now, the tolerance limit of 15% in patients with “bad outcomes” is by far gone below in almost every dialysis facility. There are just a few isolated cases for facilities showing inconsistency in two quarters successively. The percentage of inconsistent cases for e.g. Kt/V values is under 10% ever since the end of 2009.
The reports for the years 2011 to 2013 show largely one thing: Quality Assurance (QA) provides for significant and especially rapid improvements in all areas, for it gives quarterly feedback to each German dialysis facility. By now, the tolerance limit of 15% in patients with “bad outcomes” is by far gone below in almost every dialysis facility. There are just a few isolated cases for facilities showing inconsistency in two quarters successively. The percentage of inconsistent cases for e.g. Kt/V values is under 10% ever since the end of 2009.
The report for the year 2010 was subject to a complete restructuring of the annual report. A new guideline for QA inured in January 2011 and gave new directions for the requested evaluations. Trend line diagrams were shown for the first time, which reveal the qualitative enhancements in Germany’s dialysis care at one glance.
MNC provided a entirely new design including new charts for this novel kind of report.
The report for the year 2008 already envisioned major improvement in quality as compared to the preceding report – mainly within haemodialysis therapy, percentages of deviant outcomes in patients or facilities respectively were significantly reduced. Quality assurance already proved its first achievements.
The report design was slightly revised by MNC.
In 2007, Quality Assurance (QA) by the Federal Joint Committee (G-BA) became mandatory in the general care of Statutory Health Insurance Physicians. The participation in QA was optional in the first and second quarter, but compulsory from the third quarter onward.
The first QA report demonstrated that QA processes can be implemented within a short period of time – the data quality is high from the beginning, to the effect that data from 738 different dialysis facilities were analyzable in the very first annual report.
Other downloads
QA conference presentation
We were invited to give a short presentation about the QA dialysis program in QA conferences by the Federal Joint Committee (G-BA). You can download some of the charts here.
Documents of the Federal Joint Committee (G-BA)
Take a look at the patient information sheet or the data flow model in the QA dialysis program.
In past years, MNC held brief lectures on the results in QA in dialysis at the annual QA conference by the Federal Joint Committee (G-BA).
This year’s presentation highlights the constellation of the patient population and shows the qualitative enhancements in outcome parameters.
You can download the related charts here.
In past years, MNC held brief lectures on the results in QA in dialysis at the annual QA conference by the Federal Joint Committee (G-BA).
This year’s presentation highlights the constellation of the patient population and shows the qualitative enhancements in outcome parameters.
You can download the related charts here.
In past years, MNC held brief lectures on the results in QA in dialysis at the annual QA conference by the Federal Joint Committee (G-BA).
This year’s presentation highlights the constellation of the patient population and shows the qualitative enhancements in outcome parameters.
You can download the related charts here.
In past years, MNC held brief lectures on the results in QA in dialysis at the annual QA conference by the Federal Joint Committee (G-BA).
This year’s presentation highlights the constellation of the patient population and shows the qualitative enhancements in outcome parameters.
You can download the related charts here.
The patient information sheet for Quality Assurance in dialysis treatment by the Federal Joint Comittee (G-BA) can be downloaded here. You will find a detailed explanation on data protection, a brief description of the data flow as well as links to further patient information.
The link leads you to the data flow model by the Federal Joint Committee (G-BA). It depicts the current data flow within Quality Assurance in dialysis. The complicated procedure works with pseudonymisation and multiple encryption. The pseudonymisation is performed by the trust authority (VST). The VST is the only actor in QA-Dialysis to know the secret of pseudonymisation. This bars out the traceability of data to individual patients while a longitudinal analysis is rendered possible.
