Joint Statement on Quality Criteria for Shared Decision Making in Germany
Im Folgenden finden Sie ein internationales Statement zur Festlegung validierter Mindeststandards für Kranken-kassenvergütungen von Shared Decision Making. Sie sind eingeladen, dieses Statement am Fuß der Seite zu unterstützen.
Below is an international statement on establishing validated minimum standards for reimbursement of shared decision making. You are invited to endorse this statement at the bottom of the page.
Reimbursement of Shared Decision Making in hospitals requires validated quality criteria
Read the full statement
Shared decision making is a linchpin of healthcare
Shared Decision Making (SDM) is mandated by law in many countries. In Germany, the Patients’ Rights Act prescribes that medical decision making is conducted in accordance with basic SDM criteria (Patientenrechtegesetz §630 BGB).
Beyond this normative foundation, SDM is recommended by the World Health Organization as a core strategy for patient safety (see Global Patient Safety Action Plan). Accordingly, studies have shown how SDM can increase quality and cost-effectiveness in healthcare (e.g. Veroff 2013).
Consequently, the main stakeholders of the healthcare system, i.e. patients, healthcare professionals, healthcare organizations and payors, are increasingly interested in broad implementation of SDM.
Proof of SDM implementation on the organizational level
The core of SDM takes place during consultations and could in principle be measured on this level. However, it is not feasible to set standards at the level of individual consultations to control the quality of system-wide implementation of SDM. Instead, it is common practice in most healthcare systems to define indicators of process and structural quality that can be assessed during auditing procedures leading to a certification of an organizational unit or hospital. Common examples are Comprehensive Cancer Centers where such a certification helps patients to identify high-quality care. At the same time, the certificate is a prerequisite for conducting and invoicing certain medical procedures.
Establishment of an SDM certificate in Germany
The German Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) funded the development of the SHARE TO CARE (S2C) program for hospital-wide implementation of SDM. It has been successfully applied at the University Hospital Schleswig-Holstein, Kiel, Germany. Complete implementation of SDM within a department is approved by an SDM certificate. Based on 15 criteria, the certificate documents the implementation of the four modules of the implementation program. It covers aspects of structural quality (e.g. SDM-specific trainings of healthcare professionals) and process quality (e.g. integration of decision aids in the clinical pathway). This certificate proved sensitive and specific for a significant increase of SDM. In addition, patient safety and cost-effectiveness was improved. Savings with SDM clearly outweighed investment costs (see Geiger 2021, full German report here; English summary here).
This SDM certificate is approved by the first health insurance companies as a proxy measure of SDM in hospital departments and qualifies for additional reimbursement of SDM for every case. This enables sustainable SDM implementation (see Stolz-Klingenberg 2022) and hence continuously generates the corresponding benefits for patients, healthcare organizations and payors.
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