[Quality and quality development in medical practices--epidemiological results of the accompanying evaluation of the new KBV quality management system].

The motivation for quality management has now reached medical and psychotherapeutic practices. This is partly due to exogenous factors, including regulatory requirements such as Sect. 135a SGB V (German Book of Social Code) demanding the implementation and further development of internal quality management from both out-patient and in-patient healthcare providers. The National Association of SHI-Accredited Physicians in Germany (KBV), along with several regional associations, responded to these internal demands and external requirements by developing the quality management system "Quality and Development in Practices (QEP)". Assisted by an independent institute, 61 selected practices participated in the pilot study. The pilot phase included five interview rounds held between April and November 2004 with 60 practices taking part. The results describe practitioners' expectations for the current state of and the demand for internal quality management. Only one in five practices expects improvements from the implementation of quality management in the area of healthcare processes and management. The improvement of organizational processes, patients' safety and patient outcomes are considered more important. In a self-assessment procedure which included 73 targets with 236 verifications from the quality target catalogue a distinct potential for quality improvement has been revealed. The greatest need for improvement has been identified in cases where quality management defines specific requirements for the practices. These include: treatment pathways, patient information, risk management, case discussions and instruction, quality improvement, regulations and quality measurement. Even practices with advanced quality development activities were able to detect some potential for improvement with the application of the QEP catalogue. In order to attain 15 selected quality targets with 45 verifications, the practices were provided with tools like sample documents and suggestions for internal regulations to be used for quality improvement and requiring relatively small efforts. The effectiveness of implementing a quality management system cannot be adequately demonstrated by an accompanying evaluation. However, established instruments (such as the quality target catalogue and verifications), complemented with suitable outcome indicators, allow the effects of the implementation of internal quality management to be measured in a comparative, or, ideally in a randomized study.