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Lehmann I, Zielasek J, Blumenröder T, Engemann S, Vrinssen J, Gaebel W, Banger M, Grümmer M, Janssen B, Marggraf R, Muysers J, Rinckens S, Scherbaum N, Supprian T, Tönnesen-Schlack A, Mennicken R, Wenzel-Jankowski M, Gouzoulis-Mayfrank E. Development and implementation of quality indicators in a group of nine psychiatric hospitals. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:8-16. [PMID: 37884419 DOI: 10.1016/j.zefq.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/26/2023] [Accepted: 09/16/2023] [Indexed: 10/28/2023]
Abstract
Quality indicators (QI) are becoming increasingly important in mental healthcare in Germany. QI can be used for various purposes, such as for creating transparency as well as for benchmarking between hospitals. QI themselves are subject to high quality standards. The aim of this report is to describe the development and implementation of QI in a group of psychiatric hospitals. Since 2015, the LVR hospital group has developed and gradually implemented QI for the purposes of quality measurement, quality assurance and internal benchmarking in its nine psychiatric hospitals in a comprehensive, multidisciplinary, scientifically accompanied process. The full LVR-QI set, consisting of eight structure-, twelve process- and four outcome indicators as well as one patient satisfaction questionnaire, was implemented by 2019. In order to create high documentation quality and acceptance by clinicians, various implementation and dissemination strategies were used, such as written documentation manuals, staff training as well as regular face-to-face communication between the LVR hospitals, the LVR Institute for Health Services Research as the central coordinating body and the headquarters of the LVR hospital group. The QI led to a quality-oriented dialogue within and between the LVR hospitals.
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Affiliation(s)
- Isabell Lehmann
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Jürgen Zielasek
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany; Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tilman Blumenröder
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Sandra Engemann
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Jürgen Vrinssen
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Wolfgang Gaebel
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany; Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; WHO Collaborating Center DEU-131, LVR-Hospital Düsseldorf - Clinics of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Tillmann Supprian
- LVR-Hospital Düsseldorf - Clinics of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Roman Mennicken
- LVR-Hospital Group, Cologne, Germany; FOM University of Applied Sciences for Economics and Management, Essen, Germany
| | | | - Euphrosyne Gouzoulis-Mayfrank
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany; LVR-Hospital Cologne, Academic Hospital of the University of Cologne, Cologne, Germany.
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Derendorf L, Stock S, Simic D, Lemmen C. Developing quality indicators for cross-sectoral psycho-oncology in Germany: combining the RAND/UCLA appropriateness method with a Delphi technique. BMC Health Serv Res 2023; 23:599. [PMID: 37291536 DOI: 10.1186/s12913-023-09604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Internationally, the need for appropriately structured, high-quality care in psycho-oncology is more and more recognized and quality-oriented care is to be established. Quality indicators are becoming increasingly important for a systematic development and improvement of the quality of care. The aim of this study was to develop a set of quality indicators for a new form of care, a cross-sectoral psycho-oncological care program in the German health care system. METHODS The widely established RAND/UCLA Appropriateness Method was combined with a modified Delphi technique. A systematic literature review was conducted to identify existing indicators. All identified indicators were evaluated and rated in a two-round Delphi process. Expert panels embedded in the Delphi process assessed the indicators in terms of relevance, data availability and feasibility. An indicator was accepted by consensus if at least 75% of the ratings corresponded to category 4 or 5 on a five-point Likert scale. RESULTS Of the 88 potential indicators derived from a systematic literature review and other sources, 29 were deemed relevant in the first Delphi round. After the first expert panel, 28 of the dissented indicators were re-rated and added. Of these 57 indicators, 45 were found to be feasible in terms of data availability by the second round of expert panel. In total, 22 indicators were transferred into a quality report, implemented and tested within the care networks for participatory quality improvement. In the second Delphi round, the embedded indicators were tested for their practicability. The final set includes 16 indicators that were operationalized in care practice and rated by the expert panel as relevant, comprehensible, and suitable for care practice. CONCLUSION The developed set of quality indicators has proven in practical testing to be a valid quality assurance tool for internal and external quality management. The study findings could contribute to traceable high quality in cross-sectoral psycho-oncology by providing a valid and comprehensive set of quality indicators. TRIAL REGISTRATION "Entwicklung eines Qualitätsmanagementsystems in der integrierten, sektorenübergreifenden Psychoonkologie-AP "Qualitätsmanagement und Versorgungsmanagement" zur Studie "integrierte, sektorenübergreifende Psychoonkologie (isPO)" a sub-project of the "integrierte, sektorenübergreifende Psychoonkologie (isPO)", was registered in the German Clinical Trials Register (DRKS) (DRKS-ID: DRKS00021515) on 3rd September 2020. The main project was registered on 30th October 2018 (DRKS-ID: DRKS00015326).
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Affiliation(s)
- Lisa Derendorf
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany.
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Dusan Simic
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Clarissa Lemmen
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Faculty of Medicine and University Hospital Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
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von Peter S, Jänchen P, Göppert L, Beeker T, Ziegenhagen J, Glück RK, Krispin H, Pfennig A, Heinze M, Schwarz J, Ignatyev Y. [Experience-based items of quality in psychiatric treatment: A first multivariate construct]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 176:51-60. [PMID: 36754717 DOI: 10.1016/j.zefq.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023]
Abstract
In the context of psychiatric care, user-generated measurement instruments may contribute to quality development and assurance. An explorative construct of experience-related quality components was developed in participative-collaborative cooperation that grasps the users' experiences of psychiatric care. After developing the components using a grounded theory methodology, they were quantified, and their interrelations were investigated using a multidimensional scaling method to explore their internal cohesion. The construct makes it possible to separate structural from interpersonal requirements of the quality components. It further indicated which components are more feasible for the home treatment setting, and which ones for an institutional setting. The components and the construct may be perceived as first steps towards the development of user-generated quality indicators; however, further validation steps are necessary.
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Affiliation(s)
- Sebastian von Peter
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland.
| | - Patrick Jänchen
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Lena Göppert
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Timo Beeker
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Jenny Ziegenhagen
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Rosa Kato Glück
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Helene Krispin
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
| | - Yuriy Ignatyev
- Hochschulklinik für Psychiatrie und Psychotherapie an der Medizinischen Hochschule Brandenburg Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland
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Efkemann SA, Haußleiter IS, Steinert T, Hoffmann K, Juckel G. [Documentation, Application and Efforts to Reduce Involuntary Admissions and Coercive Measures - Results from a Nationwide Study on Acute Psychiatric Hospitals in Germany]. PSYCHIATRISCHE PRAXIS 2022; 49:345-351. [PMID: 35595493 DOI: 10.1055/a-1757-4697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This nationwide full census survey investigated the documentation status regarding involuntary admissions and coercive measures in psychiatric hospitals in Germany. METHODS As part of the ZIPHER study, a questionnaire survey on the documentation, application and reduction of coercion was conducted (N = 147, response rate = 34.4 %). RESULTS The majority of participating hospitals reported a comprehensive documentation of the use of coercion. However, substantial regional differences could be found in this regard as well as for the use of guidelines. The involuntary admission quote was M = 13.4 % (± 10.9). Of those, 33.9 % (± 22.2) were affected by mechanical restraint, 8.9 % (± 17.2) by seclusion, and 11.8 % (± 18.0) by compulsory medication. CONCLUSION The regional differences plead for a unification of legal bases and applied practice as well as for a merge of respective data on a nationwide level of the relevant stakeholders.
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Affiliation(s)
- Simone Agnes Efkemann
- LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin
| | - Ida Sibylle Haußleiter
- LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin
| | - Tilman Steinert
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau), Zentrum für Psychiatrie
| | - Knut Hoffmann
- LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin
| | - Georg Juckel
- LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin
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Ignatyev Y, Habicht J, Schwarz J, Neumann A, Schmitt J, Pfennig A, Geraedts M, Heinze M. [Biometric properties of QUALIFY: a tool for assessing quality indicators]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 170:7-13. [PMID: 35450830 DOI: 10.1016/j.zefq.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Accurate health care evaluation using quality indicators (QIs) is of vital clinical importance for a quality-oriented health care system. The QUALIFY tool is the current research standard for assessing QIs of health care; however, its biometric properties in psychiatry have not yet been evaluated empirically. Our aim was to evaluate the internal consistency and structure of QUALIFY. METHODS This study applies a literature-based post-hoc analytical design to a sample of 289 QIs of mental health care. First, the indicators were assessed on the basis of nineteen ordinal QUALIFY criteria as a single measuring tool. Second, using Cronbach's alpha the internal consistency of the measuring tool was evaluated and the structure of QUALIFY using an explorative principal component analysis was tested. RESULTS AND DISCUSSION The tool showed an acceptable internal consistency (Cronbach's α=0.75), with three criteria (consideration of potential risks/side effects when using the indicator, implementation barriers taken into account, and the ability to influence the indicator) being inconsistent with the full scale. If these three criteria were not taken into account, the tool had a good internal consistency (Cronbach's α=0.81). The QUALIFY structural matrix comprises three components, one of which reflected six from eight original quality criteria of the scientific category. The other two components represent the semiotic structure of the QIs. CONCLUSION QUALIFY is an internally inconsistent instrument, which may be useful to assess mental health care QIs. The information about the structure of QUALIFY can be applied for the purposes of research planning as well as the interpretation and development of QIs.
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Affiliation(s)
- Yuriy Ignatyev
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland; Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland.
| | - Juri Habicht
- Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland
| | - Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Anne Neumann
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie der Philipps-Universität Marburg, Marburg, Deutschland
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Immanuel Klinik, Rüdersdorf bei Berlin, Deutschland; Zentrum für Versorgungsforschung (ZVF-BB), Medizinische Hochschule Brandenburg Theodor Fontane Brandenburg, Deutschland
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Gaebel W, Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Tosevski DL, Milosavljevic M, Nakov V, Winkler P, Zielasek J. Quality indicators for mental healthcare in the Danube region: results from a pilot feasibility study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1017-1025. [PMID: 32270290 DOI: 10.1007/s00406-020-01124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
Quality indicators are vital for monitoring the transformation of institution-based mental health services towards the provision of person-centered mental healthcare. While several mental healthcare quality indicators have been identified as relevant and valid, their actual usability and utility for routine monitoring healthcare quality over time is significantly determined by the availability and trustworthiness of the underlying data. In this feasibility study, quality indicators that have been systematically identified for use in the Danube region countries of Bulgaria, the Czech Republic, Hungary, and Serbia were measured on the basis of existing mental healthcare data in the four countries. Data were collected retrospectively by means of the best available, most standardized, trustworthy, and up-to-date data in each country. Out of 21 proposed quality indicators, 18 could be measured in Hungary, 17 could be measured in Bulgaria and in the Czech Republic, and 8 could be measured in Serbia. The results demonstrate that a majority of quality indicators can be measured in most of the countries by means of already existing data, thereby demonstrating the feasibility of quality measurement and regular quality monitoring. However, data availability and usability are scattered across countries and care sectors, which leads to variations in the quality of the quality indicators themselves. Making the planning and outputs of national mental healthcare reforms more transparent and evidence-based requires (trans-)national standardization of healthcare quality data, their routine availability and standardized assessment, and the regular reporting of quality indicators.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany. .,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Lehmann
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - H Hinkov
- NCPHA-National Center of Public Health and Analyses, Sofia, Bulgaria
| | - C Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - G Kapócs
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Institute for Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - T Kurimay
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - M Milosavljevic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Nakov
- Mental Health, National Center of Mental Health and Analyses, Sofia, Bulgaria
| | - P Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
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Schwarz J, von Peter S, Baumeister H, Dahling V, Gühne U, Gouzoulis-Mayfrank E, Härter M, Haun MW, Jacke C, Lehmann I, Neumann A, Pfennig A, Salize HJ, Timm S, Wiegand-Grefe S, Riedel-Heller SG, Heinze M. [DNVF-Discussion paper - Specificities, Challenges and Aims of Mental Health Service Research in Germany]. DAS GESUNDHEITSWESEN 2021; 83:541-552. [PMID: 34169490 DOI: 10.1055/a-1478-3580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.
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Affiliation(s)
- Julian Schwarz
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
| | - Sebastian von Peter
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Ulm, Deutschland
| | - Volker Dahling
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
| | - Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland
| | | | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Markus W Haun
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg Zentrum für Psychosoziale Medizin, Heidelberg, Deutschland
| | - Christian Jacke
- WIP - Wissenschaftliches Institut der PKV, Köln, Deutschland
| | | | - Anne Neumann
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland
| | | | - Stephanie Timm
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
| | - Silke Wiegand-Grefe
- Universitätsklinikum Hamburg Eppendorf Zentrum für Psychosoziale Medizin, Hamburg, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland
| | - Martin Heinze
- Hochschulklinik für Psychiatrie und Psychotherapie, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
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Gaebel W, Stricker J. [Quality psychiatry and destigmatization : Can quality psychiatry and psychotherapy contribute to destigmatization of mental illnesses?]. DER NERVENARZT 2020; 91:792-798. [PMID: 32607603 DOI: 10.1007/s00115-020-00941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Among the many reasons for the stigmatization of mental illnesses and those affected by it, the supposedly insufficient treatability plays a central role. In fact, treatability is not worse compared to various somatic diseases, although different factors impair the use and thus the effect of optimal treatment options. This is where measures to optimize treatment and care within the framework of quality psychiatry and psychotherapy come into play, whose resource-backed systematic introduction and implementation can contribute to overcoming stigma. OBJECTIVE This article examines whether and how the quality of psychiatric treatment and care can contribute to reducing stigmatizing attitudes in the general public and the stigma experienced or anticipated by persons with mental illnesses. METHODS Components of quality assured psychiatric treatment and care were identified at the conceptual level, which can hypothetically contribute to the destigmatization of persons with mental illnesses. RESULTS AND CONCLUSION The components of quality psychiatry that can contribute to the destigmatization of persons with mental illnesses include the implementation of regularly updated evidence-based treatment guidelines, the individualization of psychiatric treatment (precision psychiatry) and the application of quality indicators within the framework of comprehensive quality management. The postulated relationships must be empirically verified, further analyzed and communicated to the public to be made systematically useful for the destigmatization of mental illnesses.
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Affiliation(s)
- W Gaebel
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, LVR-Klinikum Düsseldorf - Kliniken der Heinrich-Heine-Universität Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland.
| | - J Stricker
- WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, LVR-Klinikum Düsseldorf - Kliniken der Heinrich-Heine-Universität Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland
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9
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Jacobs R, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Gutacker N, Kasteridis P, Kendrick T, Mason A, Rice N, Ride J, Siddiqi N, Williams R. The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality.
Objectives
We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes.
Design and setting
We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome.
Participants
Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria.
Interventions
Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners).
Main outcome measures
Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care.
Results
Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care.
Limitations
There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences.
Conclusions
Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings.
Future work
Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Lauren Aylott
- Expert by experience
- Hull York Medical School, York, UK
| | | | | | - Simon Gilbody
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Tony Kendrick
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
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European Psychiatric Association (EPA) guidance on quality assurance in mental healthcare. Eur Psychiatry 2020; 30:360-87. [DOI: 10.1016/j.eurpsy.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
AbstractPurpose:To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.Methods:We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).Results:Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).Discussion:There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.Conclusion:Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.
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Steinert T, Flammer E. [Frequency of coercive measures as a quality indicator for psychiatric hospitals?]. DER NERVENARZT 2018; 90:35-39. [PMID: 30215134 DOI: 10.1007/s00115-018-0611-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The percentage of patients subjected to coercive measures has been proposed as 1 of 10 quality indicators for psychiatric inpatient treatment by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN). Internationally, there are similar recommendations and corresponding reporting systems. METHODS The registry of coercive measures of psychiatric hospitals in Baden-Württemberg that was established in 2015, yields the possibility to examine the appropriateness of this indicator, based on raw data of 108,863 cases in 2016. This study investigated how the indicator is influenced by patient variables and characteristics of hospital structure. RESULTS The percentage of cases exposed to coercive measures was strongly (r = 0.6) correlated with the percentage of involuntarily treated cases. With respect to the latter, hospitals varied widely with a range from 0.7% up to 24.1%. Specialized wards serving patients outside the catchment area with a high number of coercive measures also had a strong influence on the results of a benchmarking comparison. CONCLUSION The indicator is a good instrument for longitudinal evaluation of an institution; however, due to a high number of known and unknown confounding factors, it is inappropriate for the purpose of comparing psychiatric hospitals.
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Affiliation(s)
- T Steinert
- Zentrum für Psychiatrie Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weingartshofer Str. 2, 88214, Ravensburg-Weissenau, Deutschland.
| | - E Flammer
- Zentrum für Psychiatrie Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weingartshofer Str. 2, 88214, Ravensburg-Weissenau, Deutschland
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12
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Neumann A, Swart E, Häckl D, Kliemt R, March S, Küster D, Arnold K, Petzold T, Baum F, Seifert M, Weiß J, Pfennig A, Schmitt J. The influence of cross-sectoral treatment models on patients with mental disorders in Germany: study protocol of a nationwide long-term evaluation study (EVA64). BMC Psychiatry 2018; 18:139. [PMID: 29776348 PMCID: PMC5960179 DOI: 10.1186/s12888-018-1721-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 05/03/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Close, continuous and efficient collaboration between different professions and sectors of care is necessary to provide patient-centered care for individuals with mental disorders. The lack of structured collaboration between in- and outpatient care constitutes a limitation of the German health care system. Since 2012, a new law in Germany (§64b Social code book (SGB) V) has enabled the establishment of cross-sectoral and patient-centered treatment models in psychiatry. Such model projects follow a capitation budget, i.e. a total per patient budget of inpatient and outpatient care in psychiatric clinics. Providers are able to choose the treatment form and adapt the treatment to the needs of the patients. The present study (EVA64) will investigate the effectiveness, costs and efficiency of almost all model projects established in Germany between 2013 and 2016. METHODS/DESIGN A health insurance data-based controlled cohort study is used. Data from up to 89 statutory health insurance (SHI) funds, i.e. 79% of all SHI funds in Germany (May 2017), on inpatient and outpatient care, pharmaceutical and non-pharmaceutical treatments and sick leave for a period of 7 years will be analyzed. All patients insured by any of the participating SHI funds and treated in one of the model hospitals for any of 16 pre-defined mental disorders will be compared with patients in routine care. Sick leave (primary outcome), utilization of inpatient care (primary outcome), utilization of outpatient care, continuity of contacts in (psychiatric) care, physician and hospital hopping, re-admission rate, comorbidity, mortality, disease progression, and guideline adherence will be analyzed. Cost and effectivity of model and routine care will be estimated using cost-effectiveness analyses. Up to 10 control hospitals for each of the 18 model hospitals will be selected according to a pre-defined algorithm. DISCUSSION The evaluation of complex interventions is an important main task of health services research and constitutes the basis of evidence-guided advancement in health care. The study will yield important new evidence to guide the future provision of routine care for mentally ill patients in Germany and possibly beyond. TRIAL REGISTRATION This study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713 ).
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Affiliation(s)
- Anne Neumann
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Economics, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Dennis Häckl
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
| | - Roman Kliemt
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
| | - Stefanie March
- Institute of Social Medicine and Health Economics, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Denise Küster
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Katrin Arnold
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Thomas Petzold
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Fabian Baum
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Martin Seifert
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Jessika Weiß
- Clinic for Child and Adolescence Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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13
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Stegbauer C, Willms G, Kleine-Budde K, Bramesfeld A, Stammann C, Szecsenyi J. Development of indicators for a nationwide cross-sectoral quality assurance procedure for mental health care of patients with schizophrenia, schizotypal and delusional disorders in Germany. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 126:13-22. [PMID: 29029972 DOI: 10.1016/j.zefq.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 07/14/2017] [Accepted: 07/16/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE This paper describes the development of quality indicators for an external statutory and cross-sectoral quality assurance (QA) procedure in the context of the German health care system for adult patients suffering from schizophrenia, schizotypal and delusional disorders (F20-F29). METHODS Indicators were developed by a modified RAND/UCLA Appropriateness Method with 1) the compilation of an indicator register based on a systematic literature search and analyses of health care claims data, 2) the selection of indicators by an expert panel that rated them for relevance and for feasibility regarding implementation. Indicators rated positive for both relevance and feasibility formed the final indicator set. RESULTS 847 indicators were identified by different searches. Out of these, 56 were selected for the indicator register. During the formal consensus process the expert panel recommended another 45 indicators so that a total of 101 indicators needed to be considered by the panel. Of these, 27 indicators rated both relevant and feasible were included in the final set of indicators: this set included 4 indicators addressing structures, 19 indicators addressing processes and 4 indicators addressing outcomes. 17 indicators of the set will be reported by hospitals and 8 by psychiatric outpatient facilities. Two indicators considered to be cross-sectoral will be reported by both sectors. DISCUSSION F20-F29 and its treatment show some specific features which so far have not been addressed by any procedure within the statutory QA program of the German health care system. These features include: Schizophrenia and related disorders a) are potentially chronic conditions, b) are mainly treated in outpatient settings, c) require a multi-professional treatment approach and d) are treated regionally in catchment areas. These specific features in combination with the peculiarities of some legal, political and organizational characteristics of the German health care system and its statutory QA program have strongly influenced the development of indicators. The result was a seemingly "imbalanced" set of indicators with a greater number of indicators for inpatient than for outpatient care despite the fact that clinical reality is otherwise. CONCLUSIONS The circumstances of the German health care system that restricted the development of this cross-sectoral QA procedure addressing care for F20-F29 are also most likely to emerge with the development of cross-sectoral QA procedures for other (potentially) chronic conditions that are mainly treated in the outpatient setting by multi-professional teams or by networks of different providers. In order to be able to develop a QA procedure that mirrors the reality of service provision for (potentially) chronic diseases such as F20-F29 we need to explore further current and new data sources, diminish sectoral borders, and implement health care responsibility on the level of catchment areas.
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Affiliation(s)
- Constance Stegbauer
- AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany.
| | - Gerald Willms
- AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Katja Kleine-Budde
- AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Anke Bramesfeld
- AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Carina Stammann
- AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Joachim Szecsenyi
- AQUA Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany; Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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14
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Identifying primary care quality indicators for people with serious mental illness: a systematic review. Br J Gen Pract 2017; 67:e519-e530. [PMID: 28673958 PMCID: PMC5519123 DOI: 10.3399/bjgp17x691721] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/08/2017] [Indexed: 01/24/2023] Open
Abstract
Background Serious mental illness (SMI) — which comprises long-term conditions such as schizophrenia, bipolar disorder, and other psychoses — has enormous costs for patients and society. In many countries, people with SMI are treated solely in primary care, and have particular needs for physical care. Aim The objective of this study was to systematically review the literature to create a list of quality indicators relevant to patients with SMI that could be captured using routine data, and which could be used to monitor or incentivise better-quality primary care. Design and setting A systematic literature review, combined with a search of quality indicator databases and guidelines. Method The authors assessed whether indicators could be measured from routine data and the quality of the evidence. Results Out of 1847 papers and quality indicator databases identified, 27 were included, from which 59 quality indicators were identified, covering six domains. Of the 59 indicators, 52 could be assessed using routine data. The evidence base underpinning these indicators was relatively weak, and was primarily based on expert opinion rather than trial evidence. Conclusion With appropriate adaptation for different contexts, and in line with the relative responsibilities of primary and secondary care, use of the quality indicators has the potential to improve care and to improve the physical and mental health of people with SMI. However, before the indicators can be used to monitor or incentivise primary care quality, more robust links need to be established, with improved patient outcomes.
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15
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Großimlinghaus I, Hauth I, Falkai P, Janssen B, Deister A, Meyer-Lindenberg A, Roth-Sackenheim C, Schneider F, Wobrock T, Zeidler R, Gaebel W. [DGPPN recommendations on quality indicators for schizophrenia]. DER NERVENARZT 2017; 88:779-786. [PMID: 28484822 DOI: 10.1007/s00115-017-0347-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Germany, several quality indicators have been proposed for the measurement of quality of mental healthcare. Some of these quality indicators have been tested in feasibility studies. The German Association for Psychiatry and Psychotherapy (DGPPN) established the "Task Force Quality Indicators (QI)" that, based on previous experience in the development and pilot testing of indicators, considered the further development and practical realization of QI for schizophrenia. AIM The aim was to select a set of QI for schizophrenia that can also be applied to other diagnoses or used in generic measurements. Another goal was to focus on high feasibility of indicators. METHODS In a multistage selection process, the DGPPN Task Force selected QI that focus on essential quality aspects from an inventory of 161 existing QI developed by national and international research groups. Indicators were adapted in consultation with the "trialogic forum" of the DGPPN. RESULTS The DGPPN proposes the following ten indicators for quality measurement in mental healthcare for schizophrenia: QI1 Long-term treatment/Monitoring of side effects, QI2 Seclusion and restraint, QI3 Number of suicides, QI4 Psychoeducational-oriented intervention for significant others, QI5 Timely beginning of outpatient treatment after discharge from inpatient treatment, QI6 Aggression management - inpatient treatment, QI7 Diagnostic procedures/Physical examination, QI8 Antipsychotic polypharmacy, QI9 Rehabilitation/Vocational rehabilitation, QI10 Diagnostic procedures/Psychosocial functioning. DISCUSSION Most of our proposed QI have to be measured by means of additional data documentation. Based on prior experience in the pilot testing of QI, the DGPPN estimates that the additional efforts in data documentation would be manageable, but have to be refinanced. The indicators will be tested in feasibility studies in different mental healthcare hospitals in Germany.
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Affiliation(s)
- I Großimlinghaus
- LVR-Institut für Versorgungsforschung, WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Medizinische Fakultät, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Bergische Landstraße 2, 40629, Düsseldorf, Deutschland
| | - I Hauth
- Zentrum für Neurologie, Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph Krankenhaus Berlin-Weißensee, Berlin, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - B Janssen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - A Deister
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Deutschland
| | - A Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim, Deutschland
| | - C Roth-Sackenheim
- Fachärztin für Psychiatrie und Psychotherapie in eigener Praxis, Berufsverband Deutscher Psychiater, Andernach, Deutschland
| | - F Schneider
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, RWTH Aachen University, Aachen, Deutschland.,JARA-BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Deutschland
| | - T Wobrock
- Zentrum für Seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Groß-Umstadt, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - R Zeidler
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN-Geschäftsstelle), Berlin, Deutschland
| | - W Gaebel
- LVR-Institut für Versorgungsforschung, WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Medizinische Fakultät, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Bergische Landstraße 2, 40629, Düsseldorf, Deutschland.
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16
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Godemann F, Wolff-Menzler C, Löhr M, Wiegand H. Routine Data Indicators of Treatment for Dementia and Old-Age Depression. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2017. [DOI: 10.1024/1662-9647/a000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Complications in the course of dementia are one of the leading reasons for treatment in German psychiatric hospitals. One way to assess treatment quality with a moderate effort is to analyze existing routine data. A large routine dataset exists for psychiatric hospitals in Germany. This work reports on the indicators of inpatient treatment of patients with dementia and compares them to those found with old-age depression. Among other results it was shown that no specific dementia diagnosis was defined in more than 15% of all cases, and that the readmission rate within 30 days was more than 25%. Depressed people, on the other hand, showed lower readmission rates: They got more specific diagnoses and more therapeutic contacts. In conclusion, several aspects of diagnosis and treatment demand improvement among patients with dementia.
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Affiliation(s)
- Frank Godemann
- Klinik für Psychiatrie und verhaltenstherapeutische Medizin, Alexianer St. Joseph Berlin-Weißensee Berlin, Germany
| | | | - Michael Löhr
- Fachbereich Psychiatrische Pflege und Psychische Gesundheit, Fachhochschule der Diakonie Bielefeld, Germany
| | - Hauke Wiegand
- Klinik für Psychiatrie und verhaltenstherapeutische Medizin, Alexianer St. Joseph Berlin-Weißensee Berlin, Germany
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17
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Abstract
The German healthcare system offers comprehensive coverage for people with mental illness including inpatient, day hospital and outpatient services. These services are primarily financed through the statutory health and pension insurances. According to legal regulations, providers are required to base their services on current scientific evidence and to continuously assure the quality of their services. This paper gives an overview of recent initiatives to develop, evaluate and disseminate routine outcome measurement (ROM) in service settings in Germany. A large number of projects have shown outcome monitoring to be feasible, and that feedback of outcome may enhance routine care through an improved allocation of treatment resources. However, none of these initiatives have been integrated into routine care on a nationwide or trans-sectoral level, and their sustainability has been limited. This is due to various barriers in a fragmented mental health service system and to the lack of coordinated national or state-level service planning. The time is ripe for a concerted effort including policy-makers to pick up on these initiatives and move them towards wide-spread implementation in routine care accompanied by practice-oriented research including service user involvement.
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18
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[Concept and results of the German Research Network on Schizophrenia]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:412-9. [PMID: 26955980 DOI: 10.1007/s00103-016-2311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The aim was to obtain a better horizontal and vertical networking of German research and care facilities on schizophrenia, in order to investigate open research questions, to transfer the results into clinical practice and improve care and quality of life in patients with schizophrenia. OBJECTIVES/METHODS This paper describes the concept and operations of the GRNS as well as its results on the basis of selected research projects. RESULTS The GRNS comprised about 25 clinical trials of high practical relevance, which were closely interrelated regarding content, methodology and organization. The trials primarily served the development and evaluation of new and established diagnostic and therapeutic approaches, the assessment of the status quo of clinical care, as well as its improvements, together with the investigation of basic scientific questions. Many substantial results to highly relevant issues were obtained, which led or will lead to an improvement in mental health care. CONCLUSIONS Quantitative and qualitative evaluation parameters, such as scientific publications and obtaining additional grants, as well as promotion of young scientists, public relations activities, congress activities and the foundation of a European Schizophrenia Association, document the successful work of the network. Successful funding requests will allow us to continue cooperative schizophrenia research in Germany as initiated by the GRNS, without necessarily always binding these activities formally to the GRNS.
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Bramesfeld A, Willms G, Szecsenyi J. [Voluntary and mandatory quality assurance in mental health care: European examples]. DER NERVENARZT 2015; 86:1326-32. [PMID: 26395264 DOI: 10.1007/s00115-015-4334-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the turn of the century, quality assurance (QA) programs are increasingly being implemented; both generally in health systems and specifically for mental health services. These QA programs can be implemented on a mandatory basis as well as voluntarily. Benefits of mandatory QA programs are a reliable, country-wide dataflow, as well as their long-term sustainability and comparability. Shortcomings relate to the limitations imposed by legal requirements. Benefits of voluntary QA programs are their freedom and flexibility in terms of methods and data sources. Shortcomings relate to the impossibility of country-wide implementation and a lack of sustainability, as well as to the data quality. Examples for QA in mental health care from different European countries show that mandatory and voluntary QA initiatives could complement each other. Specialist medical societies play an important role in the development of voluntary QA and the promotion of high quality care. An example is the accreditation to mental health services offered by the Royal College of Psychiatrists in the United Kingdom.
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Affiliation(s)
- A Bramesfeld
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Deutschland. .,Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | - G Willms
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Deutschland
| | - J Szecsenyi
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Deutschland.,Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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