Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Dec 2000
["Medical decision making in the tension field between medical possibilities, cost pressure and humanity."].
The progress in medicine has contributed to the fact that for 50 years life expectancy in Germany has increased by three to four years per decade. The number of older people has considerably increased and at the same time there has been a decline in the birthrate with the effect that the portion of the people over 60 years, now a quarter of the population, will rise to a third of the population in 2040. The dual relationship between patient and physician has changed due to the extension of the statutory health insurance to more than 90% of the population. ⋯ Thus the financial, organizational and structural deficits in the health care system that are resulting from the social legislation are shifted by means of the liability law to the individual physician or to other service providers. Even treatment guidelines cannot protect them from this because the "standard patient" does not exist. What we really need are appropriate reforms including adjustments of the insurance structures which offer the insured alternatives: Expansion of the financial elements of the statutory health insurance Adjustments of the health care structures with integration between the outpatient and inpatient sector Restriction of the legislator to the definition of framework provisions and service limits Orientation of the health care necessities to the health care needs of the patients Economy must not dominate over humanity Adjustment of the social legislation and the liability law Settlement of the details by the joint self-administration of physicians and health insurance funds.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Genuine medical accreditation systems in the USA according to standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)--reflections on the transferability of the procedures to Germany].
In a number of anglophone countries in parallel to the industrial trend accreditation systems have been developed for health care organizations and specially for hospitals. These systems were introduced and instituted as a part of the health care system in the countries. Central elements and central procedures of these genuine-medical accreditation systems for hospitals in the United States, in Australia, Canada, France and in Great Britain are mostly identical. ⋯ Core of the systems is a catalogue with standards, which in a systematic and comprehensive way gives ideas of good professional performance in hospitals. The catalogues can be used internally to develop and improve quality and quality management in a hospital. Primarily, however, the accreditation systems are designed to provide most objective measures for external evaluation of quality and quality management.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].
The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. ⋯ National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.
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Z Arztl Fortbild Qualitatssich · Sep 2000
[From data entry to data presentation at a clinical workstation--experiences with Anesthesia Information Management Systems (AIMS)].
Anesthesia Information Management Systems (AIMS) are required to supply large amounts of data for various purposes such as performance recording, quality assurance, training, operating room management and research. It was our objective to establish an AIMS that enables every member of the department to independently access queries at his/her work station and at the same time allows the presentation of data in a suitable manner in order to increase the transfer of different information to the clinical workstation. Apple Macintosh Clients (Apple Computer, Inc. ⋯ This additional information is of great advantage in comparison to previous working conditions. The implementation of an AIMS allowed to greatly enhance the quota but also the quality of documentation and an increased flow of information at the anesthesia workstation. The circuit between data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was put into practice.