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Gemäß Nationalem Krebsplan sollen alle an Krebs erkranken Personen eine qualitativ hochwertige Versorgung entsprechend evidenzbasierten Behandlungsleitlinien in einheitlich qualifizierten Zentren erhalten. Die WiZen-Studie konnte für alle 11 untersuchten Krebsarten relevante Überlebensvorteile bei Erstbehandlung in einem durch die Deutsche Krebsgesellschaft (DKG) zertifizierten Zentrum gegenüber nicht zertifizierten Krankenhäusern zeigen. Dennoch wird ein hoher Anteil an Krebserkrankten in nicht-zertifizierten Krankenhäusern behandelt. Das Krankenhausversorgungsverbesserungsgesetz (KHVVG) sieht für den Bereich der onkologischen Chirurgie eine Konzentration vor; dabei sollen die die Krankenhausstandorte, die bei einer Krebsentität zusammen die wenigsten und zusammen 15% der Fälle mit entsprechenden onkochirugischen Leistungen erbringen, von der Vergütung ausgenommen werden. Wir untersuchten mittels einer Auswirkungsanalyse basierend auf Daten nach § 21 KHEntgG des Jahres 2022, inwieweit die vorgesehene Leistungskonzentration zur Umsetzung des Nationalen Krebsplans und der Ergebnisse der WiZen-Studie führt. Betrachtet wurden die Entitäten Mammakarzinom, Pankreaskarzinom, Bronchialkarzinom, Kolonkarzinom, Rektumkarzinom, Magenkarzinom und Ösophaguskarzinom. Von den Standorten, die die Kriterien des KHVVG erfüllen würden, sind zwischen 17,9% (Mammakarzinom) und 85,5% (Magenkarzinom) nicht gemäß den Kriterien der DKG zertifiziert. Somit würde bei Umsetzung des § 40 KHG (neu) ein beträchtlicher Anteil an Patientinnen und Patienten weiterhin außerhalb zertifizierter Zentren behandelt werden und entsprechende Qualitätspotenziale ungehoben bleiben. Dazu kommt, dass durch die vorgesehene Neuregelung nur die operativen Eingriffe pro (Karzinom)Entität adressiert wird – und damit alle nicht onkochirurgischen Krebsbehandlungen von der qualitätsbasierten Leistungskonzentration ausnehmen. Insgesamt erscheint es zur Erreichung des Ziels der Krankenhausreform, nämlich Morbidität und Mortalität von Patientinnen und Patienten mit einer Krebserkrankung zu verbessern, wesentlich zielführender, die onkologische Versorgung wie im Nationalen Krebsplan vorgesehen exklusiv auf diejenigen Einrichtungen zu begrenzen, die den Zertifizierungsbedingungen der Deutschen Krebsgesellschaft entsprechen und damit nachweislich eine leitlinienkonforme, evidenzbasierte Versorgung von Krebserkrankten sicherstellen. Entsprechend einer Analyse der Regierungskommission würde dadurch die Erreichbarkeit für die Bevölkerung nicht in relevantem Maße eingeschränkt werden.

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„Jede Studie hat Limitationen“, gibt Prof. Dr. med. Jochen Schmitt vom Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV) und einer der Hauptverantwortlichen der WiZen-Studiengruppe (1) gegenüber „Monitor Versorgungsforschung“ zu Protokoll. Wer behaupte, dass es versorgungswissenschaftliche Studien ohne Einschränkungen gebe, habe die Grundlagen wissenschaftlichen Arbeitens nicht verstanden. Wichtiger Teil einer jeden wissenschaftlichen Arbeit sei deshalb die Diskussion der Ergebnisse, die eine Abhandlung der methodischen Stärken, aber auch eventueller Limitationen inkludiert, wie es in der Originalpublikation der WiZen-Studie im „Deutschen Ärzteblatt“ ausführlich geschehen ist (2). Umso verwunderlicher ist, dass ausgerechnet Prof. Josef Hecken, unparteiischer Vorsitzender des G-BA und Vorsitzender des beim G-BA angesiedelten Innovationsausschusses, in seiner Eröffnungsrede des Kongresses „Der Innovationsfonds: Zwischen Verstetigung und Weiterentwicklung“ (s. S. 16 ff.) auf – Zitat Hecken – „die ein oder andere methodische Schwäche“ des vom Innovationsfonds geförderten WiZen-Projekts zur „Wirksamkeit der Versorgung in onkologischen Zentren“ (3) einging. MVF macht den Faktencheck.

Background: Certification of centers for weaning from a ventilator in neurological neurosurgical early rehabilitation (NNER) by the German Society for Neurorehabilitation (DGNR) is possible since 1 October 2021. Objective: The results of certification of facilities in the first year after starting the procedure are presented. Material and methods: As part of the certification process 28 criteria are assessed including a set of mandatory characteristics of the facility. The criteria are divided into structural criteria (i = 7), diagnostic criteria (i = 6), personnel criteria (i = 3), internal organization criteria (i = 7), and quality management criteria (i = 5). Results: A total of 13 centers were certified in the first year, with a combined total of 283 beds for weaning from a ventilator in the NNER and served 2278 persons to be weaned from a ventilator in the year before certification, with a median of 134 per facility (range 44–414). Only rarely was weaning unsuccessful, requiring conversion to home mechanical ventilation before discharge (invasive home mechanical ventilation median per facility 10 persons, range 2–25; non-invasive home mechanical ventilation median 0 persons, range 0–57). A high level of process and structural quality was documented for the certified centers: across all areas of assessment, the individual certification criteria were met in the vast majority of cases (median degree of complete fulfilment 86%) or met with improvement potentials documented by the auditors (median 11%). Conclusion: Successful weaning in NNER and a high level of process and structural quality can be demonstrated by the certification results of centers that follow this integrative approach to weaning from a ventilator in a NNER setting. [ABSTRACT FROM AUTHOR]

The lead project TransHyDE with a duration from April 2021 to March 2025 evaluates and tests hydrogen transport solutions in eleven demonstration projects. The practical testing is complemented by accompanying scientific research, which includes the TransHyDE standard sub‐project. To enable the implementation of the transport options dealt with in TransHyDE, uniform specifications in the form of norms, standards and certification programmes are needed. The aim of the project is therefore to holistically investigate the standardisation, certification and standardisation of transport, distribution and storage options for hydrogen and other chemical energy carriers. In this way, regulatory gaps are to be identified and solutions developed. [ABSTRACT FROM AUTHOR]

Background: The functionality and treatment capacity of hospitals are decisive components to safeguard the in-hospital treatment of patients in crises and catastrophes. This is shown by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic and the war in Ukraine. The aim of this study is the elicitation of treatment capacities of hospitals in the trauma network of the German Society for Trauma Surgery (DGU) assuming a damage situation with a multitude of trauma patients needing treatment. Material and method: The 622 hospitals in the trauma network were surveyed to elicit the current treatment capacities depending on the principles and standards of treatment. For this purpose, a questionnaire for voluntary participation in the survey was placed online via the Academy of Trauma Surgery (AUC) of the DGU and an electronic platform (SurveyMonkey). The data presented in this article represent an extract of the total data focussed on the issues involved in the study. Results: A total of 252 of the 622 hospitals certified in December 2022 (40%) participated in the survey and 250 datasets could be utilized. Local, regional and supraregional trauma centers were equally represented. Using a tactical abbreviated surgical control (TASC) focussed on survival, the treatment capacities in the individual triage categories could be increased with respect to the scenarios in question. It was also clear that the availability of teams skilled in the surgical treatment of body cavity injuries still represents a challenge. Conclusion: The results of the survey demonstrate the extent to which treatment capacities for the care of injured and wounded patients are currently available in the hospitals of the DGU trauma network and to what extent they can be increased. In this way, due the dynamics a mass casualty incident can initially lead locally and temporarily to a decompensated crisis management. The aim of all efforts and preparations must therefore be to durably strengthen hospitals so that this can be avoided as reliably as possible and to include these considerations in the hospital structural reform. [ABSTRACT FROM AUTHOR]

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Background: Due to the high incidence of obesity and the effectiveness of obesity (metabolic) surgery, the number of metabolic operations and the formation of certified obesity centers continue to increase. The aim of this study was to compare the experiences of two hospitals during establishing a certified obesity center in Heidelberg/Salem (HD/Salem) and in Baden-Baden (Bad). Material and methods: The operation numbers, surgical procedures, the need for revision and the length of hospital stay were analyzed from August 2012 to June 2015 in HD/Salem and from May 2017 to December 2021 in Bad. In addition, a structured survey of patients took place to find out the preferred discharge date. The statistical evaluation was carried out with T-tests and χ2-tests for binary data. Results: This analysis comprised 387 patients (181 patients Bad). There were 258 female patients (131 Bad). The mean age of all patients was 44.6 years (44.0 years Bad), the mean body mass index was 47.5 kg/m2 (47.0 kg/m2 Bad). In 12 of 206 patients (5.8%) from HD/Salem and 8 of 181 patients (4.4%) from Bad a revision was necessary. The average length of hospital stay decreased in HD/Salem from 6.5 days to 4.4 days (p < 0.05) and from 3.7 days to 3.4 days in Bad. Late revisions were necessary in HD/Salem in 4 of 206 patients (2.2%) and in Bad in 8 out of 181 patients (4.4%). The needed number of yearly operations required for certification was achieved for the first time in HD/Salem after 7 years and in Bad after 4 years. Conclusion: Building an obesity center at a different location from scratch to certification can be initiated and carried out by one experienced surgeon without loss of treatment quality regarding morbidity and mortality. From the start, the team should be familiar with early and late complications of metabolic surgery. [ABSTRACT FROM AUTHOR]

Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Specialized centers for weaning in neurological and neurosurgical early rehabilitation can be certified by the German Society for Neurorehabilitation (DGNR) since 1 October 2021. The certification criteria are indicators for structure and process quality and for treatment results for weaning of neurological patients from mechanical ventilation. In Germany these patients are treated in departments for neurological and neurosurgical early rehabilitation in acute care hospitals as well as in specialized rehabilitation hospitals. Acknowledging this diversity of care, certification is possible for both kinds of institutions. Certification is granted by the DGNR in cooperation with TÜV Rheinland as the certification authority, analogous to the certification of stroke units. Institutions apply for certification by sending all necessary documents to the TÜV Rheinland. Afterwards auditors of the TÜV Rheinland (lead auditor) and the DGNR (medical speciality auditor) visit the institution on site. The results of this visit are reported to the certification committee of the DGNR, which in turn recommends or declines certification. The certification of centers for weaning in neurological and neurosurgical early rehabilitation is an important step towards defining neurorespiratory care and the role of the neurologist for intensive care and weaning in Germany. Thereby, the interdisciplinary dialogue between pneumologists, anesthesiologists, and neurologists is fostered. Also, the dialogue on treatment capacities and strategies with healthcare politicians, health insurances, and patient associations is facilitated. [ABSTRACT FROM AUTHOR]

A group of public libraries in North-Rhine Westphalia gathered to tackle the issue of quality management in 2001, headed by specialist units of the state. They went through the initial certification process according to ISO 9001 by T�V-S�d in 2006. Today, the group has become considerably smaller, but two libraries from the founding team are still active and routinely ISO-certified. For them, library life without a quality management system is inconceivable. [ABSTRACT FROM AUTHOR]

Background: The increase of minimum volumes for complex esophageal resections decided by the Federal Joint Committee (GBA) in Germany is currently the subject of intensive discussions. Objective: To shed light on the effects of minimum volume requirements from the perspective of a tertiary care hospital. Results: Strict adherence to the valid minimum volume requirements for esophageal surgery would significantly reduce the number of hospitals offering these procedures in Germany. The associated loss of revenue should not have any relevant negative economic consequences for most hospitals; however, the loss of complex esophageal surgery may result in a competitive disadvantage for these hospitals in times of shortage of qualified medical personnel. Another point of criticism is the assumption that the treatment quality can be recognized based solely on the numbers of patients. Conclusion: Despite the well-known volume-outcome relationship, minimum volume requirements do not define the lower limit of quality of surgical treatment. Therefore, additional evidence of treatment quality, such as structural or process quality as well as outcome parameters should be required, e.g. through certification. An obligatory synchronous certification could contribute to increasing the acceptance of minimum volume requirements in Germany. [ABSTRACT FROM AUTHOR]

The Lower Saxony certification process "Library with Quality and Seal" was developed to establish binding standards for public libraries and define uniform quality features for internal work processes. The criteria catalog focuses on the areas of organization and management, resources, communication structures, and technical equipment. Participation in the voluntary and free process is based on a successful audit and is awarded with a certificate. So far, 40 libraries in Lower Saxony have been awarded the quality seal. The process aims to optimize internal organization and improve service quality for customers. A revision of the criteria catalog has been made to reflect social change and the new tasks of libraries. Due to the pandemic, some adjustments have been made to catch up on the backlog of audits. The Lower Saxony quality assurance program provides a professionally sound framework for good library work. [Extracted from the article]

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Um als herausragendes Unternehmen wahrgenommen zu werden, müssen Unternehmen über ihre Aktivitäten oder Produkte kommunizieren. Die Darstellung von Exzellenz, im Sinne von Spitzenleistung und Bessersein als Andere, bietet Unternehmen die Möglichkeit sich abzuheben. Auf Basis von Länderstudien in Österreich und Deutschland wird im vorliegenden Beitrag Exzellenz sowie die Kommunikation darüber in der Molkereibranche verglichen. Die Thematisierung von Nachhaltigkeit (Selbstberichte) sowie das Aufzeigen von Prämierungen und Zertifizierungen (Drittberichte) werden dabei als Darstellungsoptionen für Exzellenz herangezogen. Die Auswertung von 22 in Österreich und Deutschland geführten Experteninterviews erfolgte mittels kategorialer Inhaltsanalyse nach Mayring. Die deskriptive Website-Analyse von 197 österreichischen und deutschen Molkereien ergänzt die Studie.

Eine Arbeitsgruppe, die im Rahmen des Netzwerks für RepositorienmanagerInnen (RepManNet) entstanden ist, hat sich mit gängigen Zertifizierungen für Repositorien beschäftigt. Weiters wurden aktuelle Vorgaben der Forschungsförderer FWF und EU herangezogen. Das Core Trust Seal wurde genauer betrachtet. Hierfür wurde jenen Organisationen, die in Österreich bereits mit CTS zertifiziert sind, ein Fragebogen übermittelt. Die Antworten wurden anonymisiert zusammengefasst und ausgewertet. Plädiert wird für eine Zertifizierung von Repositorien und die Entwicklung einer DINI-Zertifizierung in Österreich.

The discipline of orthopedics and trauma surgery strives for constant improvement of the quality of results in arthroplasty; however, in order to enable targeted alterations to the establish standard operating procedures, dedicated documentation of the current quality of results is necessary. This can be achieved by so-called external quality assurance, evaluation of routine data of healthcare providers, analysis of clinical studies and the consultation of registry data. To achieve further improvement of the quality of results, legislature has been passed setting requirements for minimum quantities and by the specialist society (German Society for Orthopedics and Orthopedic Surgery, DGOOC) the adherence to certain process and structural guidelines within the framework of the certification system EndoCert®. A valid score for risk adjustment for assessment of the level of difficulty of orthopedic surgical interventions is so far lacking. As a future direction, the application of risk stratification concerning patient-specific anatomy should be developed. Through the combination of dedicated certification systems, the recording and evaluation of external inpatient quality assurance data, further quality assurance through routinely collected data and the development of adequate minimum quantity regulations, sustainable improvement of the quality of results can be achieved. [ABSTRACT FROM AUTHOR]

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Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)