Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 2005
[Introduction of quality management with the EFQM Self-Assessment method. Implementation and experience in a university department of dermatology].
In the near future, the German legislative and health insurance agencies will increasingly demand proof of quality in hospital health care. The role of quality management in hospitals is emphasized by the introduction of per-case payment (DRG) in Germany. The implementation of internal quality management at an early stage sets the course of a systematic and continuous quality improvement process, with the goal to increase performance and results by efficient utilization of resources. ⋯ A high degree of motivation of the personnel is fostered by the creation of a local guidance circle, a coordinating group, and several Self-Assessment teams. However, formulation and deployment of improvement actions are necessary for the long-term implementation of quality management. The application of Self-Assessment in quality management appears a suitable tool to promote excellence.
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Z Arztl Fortbild Qualitatssich · Jan 2005
[Suspicion of COPD--development of an algorithm for stepwise diagnosis in primary care].
The implementation of the disease management programme (DMP) for asthma and COPD in the German health system in 2005 requires an optimal and evidence-based work-up of patients by general practitioners in routine daily practice. The German and international guidelines for COPD do not provide recommendations for a stepwise diagnostic work-up in primary care. Therefore, an evidence-based algorithm was developed for a stepwise diagnosis of COPD and its different stages in general practice, based on national and foreign guidelines that provide specific advice on diagnostic procedures.
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Z Arztl Fortbild Qualitatssich · Jan 2005
[Cognition-based medicine from the viewpoint of evidence-based medicine].
The anthroposophic medicine plays a prominent role among the special forms of therapy. The concept of a cognition-based medicine (CBM)--in critical analogy to the evidence-based medicine (EBM)--has emerged from the circle of promoters of this type of therapy. The present paper attempts to identify common and different features of EBM and CBM. ⋯ The EBM can certainly accept the critical relevance and justification of this concept, particularly with regard to the constantly educational (self)evaluation of the clinical decision. Individual causal recognition, on the other hand, is unable to replace the summatory evaluation of controlled studies. In certain single cases, the CBM makes "evident" the effect of a given therapy, on the other hand it is unable to establish a generally valid efficacy, which is so critical for the orientation of patients, physicians, and the socially-based healthcare system.