[Can quality assurance in medical care be practically implemented?].

The German discussion on the necessity and form of quality assurance in health care was promoted through legal changes. The objective of quality assurance is to control to assure and to improve quality in health care. For this reason a desired level of quality has to be determined and compared with the actually achieved level. If a deviation of quality is observed, actions for quality improvement are instituted. There are some problems in this context since the level of quality is a result of a patient's individual perception it is very difficult to set a common level. Furthermore the theoretical value of an analysis of deviations is restricted in those areas of health care, in which the relevant data are deeply distorted by statistical outliers caused by a heterogeneous structure of patients and a small number of cases. Therefore, quality assurance is only possible in such areas of medical care, in which numerous identical and non-complex services are provided to patients with a similar morbidity structure.