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Public reporting, expert standards and indicators –

Public reporting, expert standards and indicators – different routes to improve quality in German long-term care London, 21 May 2009 Dr. Andreas Büscher Institute of Nursing Science at the University of Bielefeld. Overview. Long-term care in Germany

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Public reporting, expert standards and indicators –

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  1. Public reporting, expert standards and indicators – different routes to improve quality in German long-term care London, 21 May 2009 Dr. Andreas Büscher Institute of Nursing Science at the University of Bielefeld

  2. Overview • Long-term care in Germany • Principles for quality development and assurance • LTC reform in 2008 • Expert standards • External quality control • Public reporting

  3. Social insurance and security in Germany Obligatory Insurance Scheme Principle: 50% employer/ Employee Appr. 20% of employee‘s salary Universal insurance coverage Five Pillars ofSocial Security Sickness Insurance Pension Insurance Accidental Insurance Unemployment Insurance Long-term care Insurance Social Assistance

  4. Key data on long term care system

  5. 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)

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. Institute of Nursing Science At the University of Bielefeld Post Box 10 01 31 D - 33501 Bielefeld Tel. +49 521 106 - 6880 Fax +49 521 106 - 6437 andreas.buescher@uni-bielefeld.de http://www.uni-bielefeld.de/IPW

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