Andreas Dietz
The following definition of the quality concept was developed in 1990 by the
Institute of Medicine of the National Academy of Sciences, USA: “Quality of
care is the degree to which health services for individuals and populations increase
the likelihood of desired health outcomes and are consistent with current
professional knowledge.” This definition is helpful for the patient because
it is “patient-centered”. The focus is not placed on the outcome of
medical treatment alone, but rather on the (ideally desired) result perceived by the
patient (patient-reported outcome, PRO), on the basis of sound medical knowledge
(guidelines, evidence). The use of the quality aspect is very popular, but also
highly inflationary and not clear in its exact meaning, on advertising homepages of
medical service providers, and it is also frequently used by cost bearers and the
industry. This is also reflected by an increasing number of certificates and quality
labels, which are often difficult to assess in terms of quality from the
patients’ perspective.
The measurement and assessment of the quality of medical treatment is complex,
methodologically not easy and prone to errors. Among other things, the IQWiG
(Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen;
German Institute for Quality and Efficiency in Healthcare) has the statutory mandate
to evaluate the advantages and disadvantages of medical procedures, for example to
compare different drugs or, more recently, surgical procedures. The IQWiG uses the
methods of evidence-based medicine to select and evaluate the studies. This
international standard method allows estimating how reliable the existing knowledge
actually is. However, considering the study situation alone, the aspects of the
structural quality of the – generally very heterogenic – treatment
centers participating in the studies are difficult to assess. Only recently, these
aspects also started playing a major role in trials. For example, current
publications on the quality of the outcome after head and neck cancer therapy show
a
significantly different overall survival depending on the structural quality of the
treatment center after supposedly the same therapy.
The following presentations of 8 ENT-related topics and one journalist’s
external view should help to create a critical assessment of the quality standards
that are relevant from a medical point of view. I hope that these extremely
extensive and highly detailed contributions will give many valuable impulses for our
daily work and the continuous development of our interesting discipline.
Prof. Dr. med. Andreas Dietz
President German Society of
Oto-Rhino-Laryngology,
Head and Neck Surgery 2019/2020
