status quo of quo vadis? - KCE

26 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
global payment is negotiated as a capitation per member or per insured patient,
covering all services by all SHI-affiliated physicians of all specialties. In a second step, the
regional associations of physicians settle the budgets among themselves.
2.4.2.2 Quality development in action: culture, legislation, financing, organization and
implementation
CERTIFICATION
Certification is mandatory in most contracts with the sickness funds. The criteria within
these contracts are about minimum yearly volumes of procedures, case-verification and
the evaluation of skills.
Since 2004, continuing education is obligatory for all health professionals. Individual
proof is required every 5 years. 92 The absence of proof might lead to a reduction of
reimbursement. The contracts also include agreements that physicians should start up
quality development initiatives in their practices like significant event monitoring and
clinical audit.
QUALITY CIRCLES
The history of quality development for general practice before 2004 in Germany was
closely linked to local/regional activities in quality circles. These were organized e.g. by
universities, CME courses given by specialists. The academic departments were the
strongest promoters of quality development but lacked financial resources. 93 Quality
circles were introduced in 1993. Moderators were trained and a growing network is
now operational. 40 The participation to these circles is voluntary and the content of the
peer review is variable. The activities are not adequately evaluated. Some of these
quality circles discuss their feedback on their prescription. The acceptance of the
feedback reports seems to be rather high. 94
GUIDELINES
In 1999 a committee for quality development in the German Society for General
Practice (DEGAM) started guidelines development. 95 One of the characteristics of the
German guidelines is that they all provide materials for the involvement of patients. 95
QUALITY INDICATORS
The ‘Gesundheitskasse AOK’ -the biggest group of sickness funds- together with the
AQUA institute, developed quality indicators based on the work of the UK national
Primary Care Research and Development Centre. The content of these indicators relies
on guidelines. The indicators are used in groups or networks of GPs (quality circles). 96
Sickness funds support these quality circles and offer feedback reports on indicators.
Target value is for example 70% for influenza vaccination in people over 65 years whilst
the current coverage is 51%. 97
CRITICAL INCIDENT REPORT SYSTEM
The Frankfurt department of general practice has established an internet-based critical
incident reporting system for general practice teams. This system works quite
successfully under the title ‘Jeder Fehler zählt’ (‘every error counts’). 98
PRACTICE BASED NETWORKS
The departments of general practice in Göttingen and Heidelberg with the support of
the Federal ministry of Research and Education (BMBF) have established practice based
networks to analyze data from medical records based on ICD-10 99 and ICPC-2R. 100 The
aim is to give feedback to the practices. Audit (as reported in the UK) is not yet of
importance.