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Background: There are only limited possibilities for doctors in outpatient services to establish quality management that is based on data-driven feedback regarding the quality of health care. However, transparency about one's own activities is a prerequisite for refining this quality. The aim of this project was to make the quality of care for patients with coronary heart disease (CHD) more transparent, use this as a basis to initiate improvement processes, and explore the framework conditions and factors promoting or inhibiting the intended improvement of health care quality., Method: 48 general practitioners (GPs) in 32 GP practices from a Bavarian doctors' network (Qualität und Effizienz, QuE) participated in the project. On the basis of claims data from the AOK-Bayern (a statutory health insurance in Bavaria), data from disease management programs (DMP) and medically documented data, 11 quality indicators for patients with CHD were calculated. The indicator scores were individually presented in feedback reports for each doctor's practice. These were the basis for two quality circles. The indicators were measured again after 12 months, and changes against the baseline measurement were registered. GPs from Bavaria formed the control group. Focus groups with the quality circle moderators and two participant surveys were used to identify promoting and inhibiting factors., Results: The baseline values showed a good level of care. Potential for improvement became apparent for pharmacotherapy with beta blockers and statins. After conducting the quality circles four of the eleven indicators showed an increase as intended ("beta blockers for CHD and cardiac insufficiency", "beta blockers after myocardial infarction", "statins", "successful blood pressure control"). For three of these indicators the increase rates were higher than those in the Bavarian control group. One indicator ("statins") was striking because of the wide variation of practice values suggesting differences in care within the network. The majority of participating doctors regarded the database as valid. Quality circles were highly appreciated as an opportunity for professional exchange among colleagues. The data-based feedback reports helped to make deficits in health care transparent and to identify actions that need to be taken. Barriers to implementing quality improvement measures in clinical practice became apparent., Discussion: Reflecting quality indicators in quality circles can effectively trigger quality improvement processes. Barriers would appear to exist, in particular, to the implementation of measures into daily practice routine. Additional organizational support offered by higher-level quality management structures, IT solutions for patient-related data processing as well as a system of financial compensation, which rewards professional concern for quality, may help to overcome the existing barriers., (Copyright © 2018. Published by Elsevier GmbH.)

Background: Quality circles (QC) are viewed as one of the most important tools of quality improvement and continuing education in ambulatory care. Yet, little is known about the quality of QC work., Methods: From 1995 to 2007, an external assessment of QC work took place at four regional Associations of Statutory Health Insurance (SHI) Physicians. After each meeting, QC leaders completed questionnaires. This basic documentation focused on important features of QC work--continuity, topics, methods, results and satisfaction., Results: 28,800 meetings in 1,640 quality circles were documented, and 27,255 documents from 1,241 groups analysed. Continuity was high over long periods, and medical topics were dealt with in more than 80% of the time. The use of appropriate methods, however, have room for improvement. Participants were very satisfied., Conclusions: For the first time the quality of QC structures, processes and results was assessed in Germany using a broad dataset. The working principles of QC appear to be well-established. Using the basic documentation practical recommendations are made to improve the quality of QC.

Evaluation by Participants: For a project aimed at improving the prescribing performance of general practitioners (GPs) in Northern Hessia, 53 GPs who exceeded average prescribing costs by more than 20% were approached. 32 agreed to participate in 10 peer-review group meetings and to discuss an analysis of their own prescriptions issued during a three-months period. These 32 GPs in three quality circles as an intervention group were compared with a group of 15 GPs as a "gold standard" who had been working for two years already on other items than rational prescribing and who had not had any problems with prescribing costs. Apart from positive effects in changing actual prescribing behaviour, discussed elsewhere, an evaluation of the group work by participants in structured questionnaires and open discussions revealed differences between the intervention and the "gold standard" groups. Members of the intervention group had to overcome feelings of being controlled by the authorities in the first session, and felt less satisfied with the effect of the group work on their daily work in practice. This article discusses matters of working in groups, and points out the importance of volunteer participation.

We report about the first 7 seminars of a training programme for presenters of quality circles for panel doctors. The seminars aim to train techniques of moderating a group and to give a methodological background for the work with quality circles. 65 (44.2%) of the 147 participants were general practitioners, 34 (23.1%) were internists and 32 (21.8%) were specialists of other disciplines. 16 (10.9%) were not physicians or not working as a physician. An evaluation of the seminars by a structured questionnaire showed mean ratings of 2.1 for lectures [in terms of school-marks from 1 (very good) to 6 (very poor)] and 1.8 for the work in small groups. Working atmosphere and opportunities for active participation were rated most positively. 6 months after the course, 64.9% of the participants already had arranged dates for meetings or had started with own quality circles.