Public reporting, expert standards and indicators –

different routes to improve quality in German long-term care

London, 21 May 2009

Dr. Andreas BüscherInstitute of Nursing Science at the University of Bielefeld

Overview

• Long-term care in Germany

• Principles for quality development and assurance

• LTC reform in 2008

• Expert standards

• External quality control

• Public reporting

Social insurance and security in Germany

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Five Pillars of Social Security

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Social Assistance

Obligatory Insurance Scheme

Principle: 50% employer/Employee

Appr. 20% of employee‘s salary

Universal insurance coverage

Key data on long term care system

Joint agreement on quality principles

• Negotiated and agreed by stakeholders (self-regulation)

• Basis for external quality control by Medical Boards

• Guidelines and recommendations for internal quality development

• Structure, process and outcome criteria

• Results of quality tests by Medical Boards reveal problems in direct care (pressure sore prevention, food and fluid intake, incontinence care and gerontopsychiatric care)

LTC reform in 2008

• Concerns about quality

• Three different measures on quality of services: – National expert standards– Expansion of external quality control– Introduction of public reporting system

• Implementation of an arbitration board

LTC reform in 2008

• Procedure developed by German Network for quality development in Nursing

• Existing National Expert Standards:– Pressure sore prevention– Discharge management– Pain management– Fall prevention– Promotion of urinary continence– Care for people with chronic wounds– Nutrition management for ensuring and

promoting oral nutrition in nursing

LTC reform in 2008

• External quality control on a yearly basis and without announcement

• Refinement of control guideline

• Development of public reporting system based on control guideline covering the areas of:

– Nursing and medical care, care of residents with dementia, social and everyday life support and housing, food and domestic aspects in nursing homes

– Nursing care, activities prescribed by a physician, quality of the organisation an grade of service

First results of public reporting (May 2010)

• More than 7.000 reports

• 4.700 reports published

• Appr. 1.000 reports under review

• Appr. 1.000 reports awaiting additions from providers

• Appr. 280 reports with blocked publication, awaiting court decision

Conclusions

• Development of indicators has been commissioned for institutional long-term care

• Development of indicators also needed with regard to home care

• Attention needs to be given to recipients of cash payments and quality of care in the lifeworld setting

• Improvements and refinement of public reporting system to be expected

• LTC quality meanwhile involves different stakeholders and the public debate is ongoing

Institute of Nursing ScienceInstitute of Nursing ScienceAt the University of BielefeldAt the University of BielefeldPost Box 10 01 31Post Box 10 01 31D - 33501 BielefeldD - 33501 BielefeldTel. +49 521 106 - 6880Tel. +49 521 106 - 6880Fax +49 521 106 - 6437Fax +49 521 106 - 6437

andreas.buescher@uni-bielefeld.deandreas.buescher@uni-bielefeld.de

http://www.uni-bielefeld.de/IPWhttp://www.uni-bielefeld.de/IPW