Table of contents:
Quality in healthcare
As early as the 1960s, Avedis Donabedian defined quality in healthcare as the degree of correspondence between defined goals and the care actually provided. This definition makes it clear that decisions in the healthcare system must be assessed with regard to their effects on the quality of structures, processes and results.
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- Legal basis
- Quality work in hospitals
- Quality work in the private sector
The aim of quality work is to optimize the quality of patient care on the basis of available resources and to implement quality assurance measures. Quality in health care is a challenging and constantly changing cross-sectional matter.
In addition to any professional laws or other legal bases (ASVG, KAKuG, etc.) that contain quality-relevant provisions, the Federal Act on the Quality of Health Services (Health Quality Act - GQG) represents the essential basis for nationwide assurance of quality in the health system. It defines terms and Fundamentals that allow a common understanding of quality in the healthcare system and make it possible to develop and implement nationwide recommendations or guidelines for healthcare services. The guiding principles of the law are:
- Patient orientation
With the agreements according to Article 15a B-VG Organization and Financing of the Health System and Target Control Health and the federal and state governments implement the law on the basis of which the “quality strategy” was developed. With coordinated measures in the areas of patient safety, structure, process and outcome quality, risk management as well as education, training and further education, the strategy aims to provide the best possible and qualitatively equivalent care for all patients. You can find information on health targeting from 2017 on the website of the Federal Ministry of Labor, Social Affairs, Health and Consumer Protection (BMSGPK).
At the institutional level, the BMSGPK, the Federal Institute for Quality in Health Care of Gesundheit Österreich GmbH, the social insurance agencies and the Austrian Medical Association are legally mandated to deal with the issue of quality in the health care system at the national level.
National activities based on the federal law on the quality of health services
- Structural quality : The required quantity and quality of personnel and material equipment of facilities (e.g. the number of specialists, devices or beds in a care region or in a hospital) are regularly collected, evaluated and further developed.
The Austrian Health Structure Plan (ÖSG) defines standards for the hospital sector. The ÖSG, which will be published in 2017, also includes specifications for the outpatient area
- Process quality: Treatment and work procedures (processes) are described in accordance with the state of the art, for example in the form of quality standards, and recommended for use as federal quality guidelines.
- Federal quality guidelines for admission and discharge management (revision 2018)
- Federal quality guideline for the integrated care of adult patients for preoperative diagnostics in elective interventions - BQLL PRÄOP (revision 2018)
- Quality standard for the program for breast cancer early detection through mammography screening and for performing diagnostic mammograms (revision 2017)
- Quality standard organization and strategy of hospital hygiene (2015)
- Quality Standard Patient Blood Management (2016)
- Quality standard for integrated stroke care (2018)
- Quality of results: Changes in the state of health and quality of life are measured, documented and evaluated. In addition, the satisfaction of patients and their experiences with the health system (in the form of Austria-wide patient surveys) are regularly surveyed across sectors. By comparing the results, the quality of medical care can be observed and improved.
- A-IQI (Austrian Inpatient Quality Indicators)
- Quality register for selected medical areas (e.g. adult cardiac surgery register, stroke unit register, pacemaker, ICD and loop recorder register, premature infant outcome register, register for radical cystectomies)
- Cross-sector patient survey
- Concept for quality measurement in the outpatient area
- Information: In order to improve transparency in the healthcare system, information on health and quality issues is made available to the public. Quality reports and health technology assessments (HTA) are created as the basis for decisions made by those involved in the health system (e.g. federal, state, social insurance)
- The Austrian health portal: www.gesundheit.gv.at
- The Austrian rehabilitation compass: rehakompass.goeg.at
- The Austrian portal for the clinic search based on quality data: www.kliniksuche.at
Quality work in hospitals
Quality work and quality requirements of the Austrian hospitals are regulated in various laws (KAKuG, various professional laws (e.g. Doctors Act, GuKGetc.,), Working Hours Act, hygiene guidelines, etc.).
According to the KAKuG, bedside hospitals are legally obliged to set up a quality assurance commission, in which the medical service, the nursing service, the medical-technical service and the administrative service are represented, as a concrete measure with regard to quality. The task of the commission is to initiate, coordinate and support quality assurance measures as well as to promote the implementation of quality assurance and to advise the management level.
Furthermore, uniform minimum requirements for quality management systems were defined for Austria, which describe the content structure of quality work in inpatient and outpatient / resident areas. These are to be taken into account by all health service providers (GDA) and represent a central basis for the implementation of cross-sector reporting. All Austrian acute hospitals and inpatient rehabilitation facilities as well as from 2018 also all independent outpatient clinics report on the current status of quality work in the regular, Austria-wide quality reporting. Reporting takes place via the web-based platform www.qualitaetsplattform.at, where questions are asked about the following topics: quality strategy, quality models,Patient and employee surveys, complaint management.
The quality of results is measured by the legally anchored system "A-IQI" (Austrian Inpatient Quality Indicators). Here, quality data is collected in hospitals. If there are any abnormalities, a team of doctors (peers) comes to the affected house, looks through individual cases and discusses possibilities for improvement with the doctors on site (peer review process). A report with quality data and peer review results will also be published.
The population has practical access to the results of A-IQI via the website www.kliniksuche.at, where for selected diagnoses or operations the number of cases treated, other criteria of stay, e.g. length of stay, day clinic, surgical technique and other general criteria about the hospital, e.g. patient survey or reporting system for infections acquired in hospital) are published. Selected results from the Austria-wide quality reporting are also published on this page.
Quality work in the private sector
Quality work in the private sector has become increasingly important in recent years, although there are currently only detailed regulations for a few professional groups. The quality assurance of the doctor's ordinances is regulated in the medical law and that of the dentist's ordinances by an ordinance of the Austrian Dental Association. For all other professional groups there are currently only limited provisions in the professional laws.
For resident doctors, a new quality assurance ordinance must be adopted by the Austrian Medical Association every five years. Quality assurance in resident medical practices is carried out by ÖQMed (Austrian Society for Quality Assurance & Quality Management in Medicine GmbH), a subsidiary of the Austrian Medical Association (ÖÄK). On the website of the ÖQMed you will find current information about the quality initiatives of the Austrian Medical Association.
While result quality measurement has already been implemented in the inpatient area, there is currently no nationwide uniform project for the outpatient area in Austria. A corresponding concept was developed in 2016 and pilot projects initiated in individual federal states on this basis. In addition to specific measures to improve the data basis, the successive rollout of individual initiatives at federal level is now to take place.