Perinatalzentren in Baden-Württemberg: Auswirkungen von Mindestmengen und Qualitätsprüfungen durch den Medizinischen Dienst der Krankenversicherung (MDK)

BACKGROUND: In the year 2009 the Federal Joint Committee (G-BA) obliged neonatal units in Germany to publish yearly data on the number of preterm infants treated and their outcome in the internet. At the same time annual minimum volumes were introduced for each level of perinatal care. The exact numbers of compulsory minimum volumes are heavily discussed both scientifically and politically. METHODS: 28 perinatal centres (PNC) in the state of Baden-Wurttemberg published data on mortality and short-term morbidity of preterm infants with a birth weight (BW) <1,500 g admitted in the year 2008 (n=1,141). These data were analysed on the background of quality assessments of structures and processes in all hospitals performed by the Medical Service of Statutory Health Insurance (MDK). RESULTS: By the end of 2008, 8 PNC had fulfilled the quality criteria of the G-BA nearly completely and reached a numerical benchmarking value of more than 300 of 465 maximally achievable points. Introducing annual minimum volumes of 36 preterm infants with a BW <1,250 g would lead to a concentration of perinatal care in 7 PNC and minimum volumes of 50 preterm infants with a BW <1,500 g per year in 8 such centres. CONCLUSION: Further centralisation of clinical care for low birth-weight preterm infants in a limited number of PNC in the state of Baden-Wurttemberg would be economically reasonable and could be achieved either by the introduction of higher minimum volume standards or a stringent interpretation of quality criteria of the G-BA. Based on self-reported data of the PNC currently available in the Internet it is not possible to predict the effect of such a centralisation process on patient outcome.