[Quality evaluation in cardiovascular medicine : Legal frameworks, practical implementation and challenges].

The quality assurance procedure for coronary surgery and heart valve interventions (QS KCHK) is designed to systematically evaluate and enhance the quality of complex cardiological interventional and cardiac surgical procedures. In this respect, the inclusion of indicators based on routine data facilitates the efficient and standardized analysis of the long-term quality of treatment; however, experiences from the first feedback procedures show that the use of social data is associated with challenges. For example, for the rehospitalization rates due to heart failure nonspecific exclusions and the lack of a differentiation between comorbidities and primary complications lead to distortions. The situation is similar for the 1‑year mortality. In this case, due to the long follow-up period of 365 days a sufficient association between the quality characteristic and the service provider carrying out the index procedure is often not possible to establish using social data. In addition, documentation problems, such as discrepancies between operative data and social data make a precise assessment more difficult. Nevertheless, the QS procedure KCHK makes a substantial contribution to quality assurance by creating transparency and comparability between service providers. In order to enhance the strength of the indicators methodological refinements, such as the harmonization of data standards and the improvement of the validity of the individual indicators, are essential for the documentation of a quality characteristic.