Biomedical subjects
Publications and source records attributed to F M Gerlach.
The meanings of the terms "quality", "quality of care", and "quality management" were clarified with common international definitions. Based on that, the basic ideas, concepts, and objectives of quality management in medicine were explained. Finally some future trends related to quality were viewed, which represent challenges for the medical profession and entire medicine.
OBJECTIVE: To survey the quantitative development of quality circles (peer review groups; QC) and their moderators in ambulatory care in Germany, to describe approaches to documentation and evaluation, to establish what types of facilities and support is available and to assess opinions on the future importance of QC. DESIGN: Cross-sectional survey using a standardized questionnaire and supplementary telephone interviews. SETTING: All 23 German regional Associations of Statutory Health Insurance Physicians (ASHIP) were surveyed. RESULTS: The total number of QC in ambulatory care in Germany increased rapidly from 16 in 1993 to 1633 in June 1996, with about 17% (range 1.0-52.1%) of all practicing physicians (112 158) currently involved. Throughout Germany, 2403 moderators were trained in 168 training courses by the qualifying date. Follow-up meetings were held or being planned in 20 ASHIP, with approximately 39% (23-95%) of the moderators participating. Systematic documentation of QC work was undertaken or planned in all 23 ASHIIP, and 10 ASHIP carried out comparative evaluation, with at least five others planning to start it. The ASHIP promoted the work of QC by providing organizational (22) or financial (20) support, materials (20) or mediation of resource persons (16). Eleven ASHIP received grants from drug companies. ASHIP rated the future importance of QC as increasing (18) or stable (four), but in no case as decreasing. CONCLUSIONS AND RECOMMENDATIONS: The quantitative growth of QC in Germany is encouraging, but the extent of support and evaluation appears insufficient. Increased methodological support and facilitation, follow-up meetings on a more regular basis, improved documentation and evaluation of individual QC, and problem oriented evaluation of their impact on health care are essential for further successful development. Principles, problems and solutions discussed may be relevant for similar QI activities in other countries.
Explore the source record for details and available documents.
Considering the discrepancy between scientific knowledge and definite behaviour during consultation ("performance gap"), acceptance, proceedings and case oriented work in quality circles/peer review groups are described. 79% of 138 general practitioners declared that working in quality circles should base on cases from daily practice. Exchange of experiences and the expectation to get help for solving specific problems in the daily practice are the most important motives for participating in quality circles. For one circle as an example, the process of topic and case oriented work on the basis of objective documents from the practices of the participants and the following case oriented development of guidelines are described. Finally, the implicit chances of case oriented work in quality circles are shown with respect to existing experiences.
We report about the first 7 seminars of a training programme for presenters of quality circles for panel doctors. The seminars aim to train techniques of moderating a group and to give a methodological background for the work with quality circles. 65 (44.2%) of the 147 participants were general practitioners, 34 (23.1%) were internists and 32 (21.8%) were specialists of other disciplines. 16 (10.9%) were not physicians or not working as a physician. An evaluation of the seminars by a structured questionnaire showed mean ratings of 2.1 for lectures [in terms of school-marks from 1 (very good) to 6 (very poor)] and 1.8 for the work in small groups. Working atmosphere and opportunities for active participation were rated most positively. 6 months after the course, 64.9% of the participants already had arranged dates for meetings or had started with own quality circles.
Explore the source record for details and available documents.
Explore the source record for details and available documents.