Zusammenfassung
Die weitere Verbesserung der Qualität der medizinischen Versorgung ist eines der wichtigsten Ziele der Reformen im Gesundheitswesen. Für viele herzchirurgische Eingriffe lässt sich eine signifikante Assoziation zwischen der Anzahl der pro Krankenhaus oder Operateur durchgeführten Eingriffe und der Prognose der Patienten nachweisen. Der kausale Zusammenhang ist aber nicht geklärt.
Übertriebene Forderungen nach einer Konzentration und Subspezialisierung auf dem Gebiet der Herzchirurgie erscheinen daher problematisch. Bereits bestehende Empfehlungen zu Leistungsmengen in den Richtlinien der nationalen oder internationalen Fachgesellschaften geben allerdings Anhaltspunkte für die vorsichtige Einführung von Mindestmengen, die eine empirische Annäherung an die Ergebnisse retrospektiver Studien erlauben.
Offensichtlich sind Mindestmengen jedoch nur ein relativ grober Surrogatparameter für die Versorgungsqualität und stellen lediglich ein Hilfsmittel zur Zeitüberbrückung dar, bis bessere Indikatoren für die Qualität der Versorgung vorhanden sind.
Summary
Continuous improvement of health care is one of the most important goals of recent political reforms. A positive correlation between hospital or surgeon volume and patient outcome has been demonstrated for several procedures in cardiac surgery although the proof of causality remains pending.
Based on these observations it appears questionable to introduce a further concentration and sub-specialization in cardiac surgery. However, recommendations of national or international societies and boards related to the field may allow a cautious introduction of minimum volumes into clinical practice in order to evaluate the results of published retrospective studies.
Minimum volumes nevertheless merely represent a fairly rough surrogate parameter for health care quality and may serve as a tool to improve health care service as long as more accurate indicators of the quality of health care performance have not been identified.
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Schmoeckel, M., Reichart, B. Stationäre Qualitätssicherung durch Einführung von Mindestmengen in der Herzchirurgie. Z Herz- Thorax- Gefäßchir 20, 83–95 (2006). https://doi.org/10.1007/s00398-006-0539-z
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DOI: https://doi.org/10.1007/s00398-006-0539-z