How can quality reports help you find the right hospital?

Hospital quality reports contain information about things like the qualifications of their staff, special areas of clinical expertise, noteworthy instruments and equipment available at the hospital, and the frequency of complications. Having this information makes it much easier to evaluate a hospital. For example, if you need hip surgery and have heard that a certain hospital has a good reputation, you can find out more, such as: How many artificial hip implants have they done there? How often did patients have wound infections afterwards? What other hospitals in the same area offer this kind of procedure? Where can a person who comes with you to offer moral support stay during surgery?

Quality assurance information is not recorded for all treatments, though. It is only documented in certain areas of treatment.

German hospital quality reports are available in German on the website of the Gemeinsamer Bundesausschuss (Federal Joint Committee, G-BA). But these quality reports contain a lot of technical jargon and codes, which often makes them difficult to understand. To help with this problem, there are a number of online search engines specifically designed to find information on hospitals. They summarize the quality reports for patients and can help you find what you’re looking for. The G-BA website also provides an overview of search engines.

The first step is to enter a city or postal code, as well as the medical condition or planned treatment, into the search engine. You can also use an ICD or OPS code. All medical conditions have an ICD code, and all types of surgery or treatment have an OPS code (the German modification of the international ICPM codes). A list of the hospitals that provide that treatment is then displayed. There will also be information on how far the hospital is from the city that was entered, how many people have been treated there and what kind of equipment is available there. If the treatment is part of one of the areas of treatment for which quality assurance has been documented, you will also see how each hospital was rated.

Search example: Gallbladder removal

Ms. Miller has gallstones that are causing such severe pain that she needs to have her gallbladder removed. She is looking for a hospital close by that has good ratings for gallbladder removal.

• She first enters "gallbladder removal" or the OPS code (5-511) and a city or town.
• A list of the hospitals in that region appears.
• Ms. Miller can select hospitals in order to find out more about them. For example: How many people have had their gallbladder removed at this hospital? Do the specialist departments of the hospital offer liver, gallbladder, or pancreatic surgery?
• Under the headings “Quality indicators” ("Qualitätsindikatoren") and “Legal Quality Assurance” ("Gesetzliche Qualitätssicherung") Ms. Miller can find information about the quality of gallbladder removal procedures, such as how often further surgery was needed for complications or how many people died during this procedure.
• By looking under “Staff” ("Personal") or “Medical Qualifications” ("Ärztliche Qualifikation") she can see whether the hospital employs doctors who are qualified in general surgery or specialized in surgery on organs of the digestive system.

Each search engine is a little different in terms of how you start your search and how the results are presented. So the search results might vary a bit. You will also often find additional information that is not in the actual quality reports, such as details on patient satisfaction based on surveys done by various health insurers. Because there are some differences between them, it may be worth trying out different search engines.

The success of a treatment depends on a number of things, including whether doctors comply with certain standards, like whether they use antibiotics to prevent infections, or whether they remove enough tissue around a tumor when they remove the tumor. Two aspects of high-quality medicine are the avoidance of complications whenever possible and starting treatment at the right time. For example, a pacemaker needs to be implanted soon enough for it to be able to serve its purpose. Its electrodes must be kept from slipping too. Hospitals have to document these kinds of complications. So, for example, the quality indicator “Complications during or after the implantation of a pacemaker” tells us something about the quality of treatment.

But it's not the skill of the physicians or a standardized procedure alone that determine whether someone who is ill gets healthy again. The same medical treatment can have different effects in different people. Some people may already have conditions that increase their risk of complications, like diabetes or high blood pressure. It also makes a difference if you are treated as planned afterwards. Your overall physical condition when you enter the hospital is also important. Hospitals generally have little influence on these kinds of factors. So to make the comparison between hospitals more fair, specialists have tried to use statistics to account for the variation between patients at different hospitals.

Only a comparison can help to tell whether quality is better or worse. For this reason, “reference areas” are used when describing quality indicators. A reference area is a standard that has been defined using scientific studies and guidelines: It is either a range within which quality is described as being “good,” or a set value that acts as an upper or lower limit that should not be exceeded. A result within the reference area is considered to be "normal." A value that falls outside of the reference area is considered to be “abnormal” and is then analyzed more closely.

One example of a reference area:

• Mortality for pneumonia: Pneumonia can become life-threatening, especially in older people or people who have other serious illnesses. Inadequate treatment can increase the risk of dying. So the number of people who die of pneumonia at one hospital can be seen as a quality indicator: For pneumonia that was picked up outside of the hospital, the reference area for mortality is 13.8 percent. If 8 percent of the people in a hospital who have pneumonia die of it, that is considered to be normal: It is within the reference area.

The data is gathered and recorded by the individual hospitals themselves. They are required to document the data for each quality indicator and each patient. This information is then sent to independent auditing agencies.

If a hospital’s results are worse than the expected level of quality, a specific procedure is started to find out the cause. This procedure is called a “structured dialog” because the auditing agency and the hospital have to work together.

The first goal is usually to look for the cause. The auditing agency asks the hospital to provide them with a statement. This way they can try to find out what caused the abnormal outcomes: Is it simply a documentation error? Can the hospital provide good reasons for the abnormal outcome? Or were quality standards not upheld? The hospital must answer these questions.

The failure of a hospital to fulfill their obligation to file quality reports is made public. The Federal Joint Committee (G-BA) compiles a list of hospitals that have not supplied any data. Hospitals that do not comply a second time face a financial penalty. Incomplete documentation is punished too.

Auditors also check whether the data that is supplied by a hospital is true: Once a year, a random sample of hospitals are tested for completeness in selected areas, and the data is compared with the medical records there.

The Federal Joint Committee offers more detailed information on the quality reports on its website (in German).

It also provides an overview of various hospital search engines and a database of the full hospital quality reports.

Patients seeking support when deciding on a hospital can also consult

• their family doctor or specialist doctor,
• their health insurer, or
• the Independent Patient Counselling Service in Germany (Unabhängige Patientenberatung Deutschland, UPD).