Hospital quality reports in Germany: Patient and physician opinion of the reported quality indicators

Public Health Programme, University Hospital of the Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
BMC Health Services Research (Impact Factor: 1.71). 02/2007; 7(1):157. DOI: 10.1186/1472-6963-7-157
Source: PubMed


Starting in 2005, Germany's health law required hospital quality reports to be published every two years by all acute care hospitals. The reports were intended to help patients and physicians make informed choices of hospitals. However, while establishing the quality indicators that form the content of the reports, the information needs of the target groups were not explicitly taken into account. Therefore, the aim of our study was to determine patient and physician opinion of the relevance of the reported quality indicators for choosing or referring to a hospital.
Convenience samples of 50 patients and 50 physicians were asked to rate the understandability (patients), suitability (physicians) and relevance (both groups) of a set of 29 quality indicators. The set was drawn from the reports (24 indicators) and supplemented by five indicators commonly used in hospital quality reports. We analysed the differences in patient and physician ratings of relevance of all indicators by applying descriptive statistics, t-tests and Wilcoxon tests.
Only three indicators were considered not understandable by the interviewed patients and unsuitable by the interviewed physicians. The patients rated 19 indicators as highly or very relevant, whereas the physicians chose 15 indicators. The most relevant indicator for the patients was "qualification of doctors", and for the physicians "volume of specified surgical procedures". Patient and physician rankings of individual indicators differed for 25 indicators. However, three groups of indicators could be differentiated, in which the relevance ratings of patients and physicians differed only within the groups. Four of the five indicators that were added to the existing set of reported indicators ranked in the first or second group ("kindness of staff", "patient satisfaction", "recommendation", and "distance to place of living").
Most of the content of Germany's hospital quality reports seems to be useful for patients and physicians and influence their choice of hospitals. However, the target groups revealed that approximately one third of the indicators (mostly hospital structural characteristics), were not useful and hence could have been omitted from the reports. To enhance the usefulness of the reports, indicators on patient experiences should be added.

1 Follower
8 Reads
  • Source
    • "These results correspond to the assessment of other QR user groups which the legislature intended to target [11]. Other providers, patients and the public also consider the current QR to be of limited use only as an information resource [15,18]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Public reporting of hospital quality is to enable providers, patients and the public to make comparisons regarding the quality of care and thus contribute to informed decisions. It stimulates quality improvement activities in hospitals and thus positively impacts treatment results. Hospitals often use publicly reported data for further internal or external purposes.As of 2005, German hospitals are obliged to publish structured quality reports (QR) every two years. This gives them the opportunity to demonstrate their performance by number, type and quality in a transparent way. However, it constitutes a major burden to hospitals to generate and publish data required, and it is yet unknown if hospitals feel adequately represented and at the same time consider the effort appropriate.This study assesses hospital leaders' judgement about the capability of QR to put legally defined aims effectively and efficiently into practice. It also explores the additional purposes hospitals use their QR for. Methods: In a cross-sectional observational study, a representative random sample out of 2,064 German hospitals (N=748) was invited to assess QR via questionnaire; 333 hospitals participated. We recorded the suitability of QR for representing number, type and quality of services, the adequacy of cost and benefits (6-level Likert scales) and additional purposes QR are used for (free text question). For representation purposes, the net sample was weighted for hospital size and hospital ownership (direct standardization). Data was analyzed descriptively and using inferential statistics (chi-2 test) or for the purpose of generating hypotheses. Results: German hospitals rated the QR as suitable to represent the number of services but less so for the type and quality of services. The cost-benefit ratio was seen as inadequate. There were no significant differences between hospitals of different size or ownership.Public hospitals additionally used their reports for mostly internal purposes (e.g. comparison with competitors, quality management) whereas private ones used them externally (e.g. communication, marketing) (p=0.024, chi-2 test, hypotheses-generating level). Conclusions: German hospitals consider the mandatory QR as only partially capable to put the legally defined aims effectively and efficiently into practice. In order for public reporting to achieve its potentially positive effects, the QR must be more closely aligned to the needs of hospitals.
    BMC Health Services Research 10/2012; 12(1):378. DOI:10.1186/1472-6963-12-378 · 1.71 Impact Factor
  • Source
    • "Table 1.North American and European articles/ conferences proceedings on health mobility Author, year, ref. State Topic of the study Geraedts, 2007 [8] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intra-regional, extra-regional and international health mobility are important phenomena for regional and national healthcare planning. Pediatric data on this topic are scarce. We therefore conducted a systematic literature search on the PubMed database. Because of the insufficiency of published data we also resorted to conference proceedings and publications retrieved by Google Scholar and Google search engines. Thirty-one articles were identified. Main components of patients mobility were looking for better quality and timely treatment, advanced technology, expertise, and major organization. Our analysis highlights that pediatric mobility causes relevant medical, sociological and financial consequences.
    09/2012; 4:57-61.
  • Source
    • "Patients use more comparative information in future choices and in advice to others than they used in previous choices. Reasons for not using it are that they encounter barriers to its use, e.g. the short time frame in which to select a provider and geographical barriers [62], unavailability of the right information [31,74,76,84,90,99], distrust of the information [49], information overload [31,60,100] and an insufficiently clear presentation of the information [30,31,60,92,100,101]. So, although patients indicate that they find comparative information important, research suggests that relatively few patients make use of comparative information, are aware of its existence or understand it [16,31,48,62,64,102]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.
    BMC Health Services Research 08/2012; 12(1):272. DOI:10.1186/1472-6963-12-272 · 1.71 Impact Factor
Show more

Preview (2 Sources)

8 Reads
Available from