IT-structures and Algorithms for Quality Assurance in the Health Insurance Medical Advisory Service Institutions in Germany

Vera Ries, Klaus-Peter Thiele, Martin Schuster, Reinhard Schuster

2020

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.

Paper Citation

in Harvard Style

Ries V., Thiele K., Schuster M. and Schuster R. (2020). IT-structures and Algorithms for Quality Assurance in the Health Insurance Medical Advisory Service Institutions in Germany. In Proceedings of the 13th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2020) - Volume 5: HEALTHINF; ISBN 978-989-758-398-8, SciTePress, pages 353-360. DOI: 10.5220/0008912303530360

in Bibtex Style

@conference{healthinf20,
author={Vera Ries and Klaus-Peter Thiele and Martin Schuster and Reinhard Schuster},
title={IT-structures and Algorithms for Quality Assurance in the Health Insurance Medical Advisory Service Institutions in Germany},
booktitle={Proceedings of the 13th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2020) - Volume 5: HEALTHINF},
year={2020},
pages={353-360},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0008912303530360},
isbn={978-989-758-398-8},
}

in EndNote Style

TY - CONF

JO - Proceedings of the 13th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2020) - Volume 5: HEALTHINF
TI - IT-structures and Algorithms for Quality Assurance in the Health Insurance Medical Advisory Service Institutions in Germany
SN - 978-989-758-398-8
AU - Ries V.
AU - Thiele K.
AU - Schuster M.
AU - Schuster R.
PY - 2020
SP - 353
EP - 360
DO - 10.5220/0008912303530360
PB - SciTePress