Authors:
Vera Ries
1
;
Klaus-Peter Thiele
2
;
Martin Schuster
3
and
Reinhard Schuster
4
Affiliations:
1
Project Coordinator and Assistant to the Medical Director of the Medical Advisory Service Institution of the Statutory Health Insurance in North Rhine (MDK Nordrhein), 40212 Düsseldorf, Germany
;
2
Medical Director of the Medical Advisory Service Institution of the Statutory Health Insurance in North Rhine (MDK Nordrhein), 40212 Düsseldorf, Germany
;
3
Faculty of Epidemiology, Christian-Albrechts University Kiel, 24105 Kiel, Germany
;
4
Chair of Department of Health Economics, Epidemiology and Medical Informatics, Medical Advisory Service Institution of the Statutory Health Insurance in Northern Germany (MDK Nord), 23554 Lübeck, Germany
Keyword(s):
Quality Assurance, Statutory Health Insurance, Medical Advisory Service Institution, Communication Structures between Different IT-systems, Server Data Structures, Data Protection, Script Programming, Client Office Answers using Perl Modules, Integer Linear Programming.
Abstract:
The 15 Regional Medical Advisory Service Institutions of the Statutory Health Insurance in Germany (MDK) create medical expertises (sozialmedizinische Gutachten) on behalf of the Statutory Health Insurance Funds in the fields of inpatient and outpatient treatment, incapacity of work and other fields. The process of internal quality assurance within the local advisory service institutions as well as between them plays an increasing role and got new impulses by actual national legislation. The assessment process was established in 2004 and covers only one single indication: long-term care. It consists in a paper-based procedure focusing on a manual distribution process performed by staff of the central quality assurance bureau. We will present organizational concepts of the new standardized regional and nationwide peer review process that will cover the multitude of all existing indications of health care. It is completely digitalized using mathematical IT-based procedures not only for
randomized sampling, but as well to achieve an equal distribution of the medical expertises to be assessed by the peer Medical Advisory Service Institutions. These peer reviews are supposed to be distributed among the institutions depending on occasion groups and further subtypes of medical expertises, posing a constraint satisfaction problem that needs to be solved. Therefore we discuss models that address this kind of problem type and present possible solutions for the concrete distribution problem mentioned above. We further present our technical framework that will support the workflow needed for peer review distribution, data collection and final result analysis. The 15 regional medical service institutions with different IT-system have to be connected, while data protection concerns have to be taken into account. Finally, the statistical distribution of the review results is analyzed.
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