Limnologica (2004) 34,160-166 New approaches to integrated quality assessment of lakeshores 163 Again, these general terms need further characterisa- tion, which is being done in the CIS WETLANOS WG (2003) document, and during the standardization pro- cess in the CEN TC230/WG2. Tourism in Luftkurort North Rhine-Westphalia, Evaluation and Perspectives (Tourismus in Luftkurorten Nordrhein-Westfalens, Bewertung und Perspektiven). (Doctoral dissertation).
Kostuj, T; Schulze-Raestrup, U; Noack, M; Buckup, K; Smektala, R
2011-05-01
A minimal provider volume for total knee replacement (TKR) was introduced in 2006. Does this lead to an improvenment in quality or not? The records of treatment in the compulsory external quality assurance program of the Land of NorthRhine-Westphalia (QS-NRW) were evaluated. A total of 125,324 comparable records from the QS-NRW program were available to determine the appearance of general and surgical complications. In a logistical regression model the risk factors age, gender, ASA classification, comorbidity and duration were taken into account. A significant reduction could only be shown for pneumonia, thrombotic events and lung embolisms as well as vascular injury. In 2006 and 2007 malpositioning of implants was significantly higher and from 2005 to 2008 the number of fractures rose compared to 2004. Deep infections and reoperations did not change significantly during the whole study period. This evaluation could not show an improvement in quality due to the minimal provider volume. Thus the minimal provider volume should not be taken into account as a main criterion to improve quality. Further outcome studies and creating an arthroplasty register in Germany are more useful.