[The desire and the experience of participation among children and adolescents in inpatient mental healthcare]

The desire and the experience of participation among children and adolescents in inpatient mental healthcare Abstract. Objective: Children have the right to participate in decisions that affect them. However, the stages and domains of participation relevant within inpatient child and adolescent psychiatry have rarely been empirically investigated. The present study closes this research gap. Method: A prospective, multicenter, questionnaire-based survey was conducted. The questionnaire comprised 100 items, summarized in 16 scales, to assess the desire and the experience of participation. The data were quantitively evaluated. Results: 81 children and adolescents from 5 psychiatric hospitals took part in the study. Overall, they wished more participation than experienced. The higher the level of participation, the greater the difference was between wish and reality. The desire for participation is particularly high for decisions regarding communication with family and friends. The largest difference between desire and experience related to respectful and trusting interaction with patients, and for female patients, this difference was even higher. Conclusion: Participation means more than informed consent. There is still potential for expanding participation in child and adolescent psychiatry, especially at higher levels of participation and concerning decisions about communication with family and friends. A respectful and trusting interaction with patients, regardless of age, sex, or illness, is fundamental.

[Patient orientation and patient participation in research: Deficits, modes and expectations from a patient representative's point of view]

The article addresses deficits in patient orientation and patient involvement in medical research from a patient's perspective and provides recommendations for their further development. Researchers often practice patient orientation as well as patient involvement in an unstructured and inconsistent manner. The decision if and how patient involvement takes place is, to a considerable extent, the researchers' responsibility. This decision should always be part of a patient-oriented alignment of the research project, which researchers pursue regardless of the existence, initiative and participation of a patient organization. Possible modes of involvement are assigned to different phases of the research process. In this article, patient orientation and the choice of the form of involvement is considered to constitute an obligation of researchers and decision makers early in the process. Involvement should take place on a fair basis. Decision makers should consider determining specific requirements for patient orientation, e. g. in their calls for proposals or selection/award criteria.

[Patient oriented healthcare planning]

Patient orientation has already been taken into account in healthcare planning approaches in Austria by using constantly improved routine health data, though primarily falling in the category of an indirect influence on or improvement of the individual patient-provider interaction. Data bases available in "Österreichische Gesundheitsinformationssystem (ÖGIS)" at Gesundheit Österreich GmbH (GÖG) have been used for years to both intensify the patient orientation within the needs-based planning framework (designed as "integrated regional healthcare planning", bearing the interactions between the sectors in mind) and to define and monitor the ten "Health Goals Austria". For the next few years, we can expect a further advancement and completion of the database in favour of healthcare planning to support the necessary adaptation and reorganization of the regional healthcare systems, the intensification of healthcare research and subsequently an improved patient orientation in Austria. In general, efforts are being made in Austria to improve the integration of the patient's perspective in the area of health care planning (e.g. by involving patients 'attorneys' or self-help groups). However, these efforts have not yet reached the stage of full implementation (inter alia also because the organizational potential for improvement or the quality of results from the patient's perception could not yet be adequately taken into account). Accordingly, further efforts to this end will be necessary in the upcoming years.

Shared decision making as part of value based care: New U.S. policies challenge our readiness

Shared decision making in the United States is increasingly being recognized as part of value-based care. During the last decade, several state and federal initiatives have linked shared decision making with reimbursement and increased protection from litigation. Additionally, private and public foundations are increasingly funding studies to identify best practices for moving shared decision making from the research world into clinical practice. These shifts offer opportunities and challenges for ensuring effective implementation.

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Zusammenfassung. Die Wirksamkeit von Psychotherapie ist für eine Vielzahl von psychischen Störungen durch zahlreiche randomisierte kontrollierte Studien (RCT) und Metaanalysen gut belegt. Aus Sicht der praktisch tätigen Psychotherapeuten sind RCT jedoch aufgrund ihrer Eigenschaften (z.B. strenge Ein- und Ausschlusskriterien) oft nur mässig klinisch relevant. Ziel der patientenorientierten Psychotherapieforschung ist es, die psychotherapeutische Praxis durch empirisch fundierte und auf den Einzelfall zugeschnittene Rückmeldungen zum Psychotherapieverlauf unmittelbar zu unterstützen. Dazu beschäftigt sich die patientenorientierte Psychotherapieforschung mit dem Monitoring und der Vorhersage des individuellen Fortschritts während der Behandlung, mit dessen Evaluation durch Entscheidungsregeln und mit der zeitnahen Rückmeldung des Therapieverlaufs an die Behandler und Patienten während der noch laufenden Behandlung.

[Expectations and patient satisfaction in hospitals: construction and application of an expectation-based experience typology and its use in the management of quality and expectations]

Patient satisfaction (PS) surveys are frequently used evaluation methods to show performance from the customer's view. This approach has some fundamental deficits, especially with respect to theory, methodology and usage. Because of the significant theoretical value of the expectation confirmation/disconfirmation concept in the development of PS, an expectation-based experience typology has been developed and tested to check whether this approach could be a theoretical and practical alternative to the survey of PS. Due to the mainly cognitive-rational process of comparison between expectations and expectation fulfilment, it is easier to make changes in this stage of the process than in the subsequent stage of the development of PS that is mainly based on emotional-affective processes. The paper contains a literature review of the common concept of PS and its causal and influencing factors. Based on the theoretical part of this study, an expectation-based experience typology was developed. In the next step, the typology was subjected to exploratory testing, based on two patient surveys. In some parts of the tested typology explorative differences could be found between hospitals. Despite this rather more complex and unusual approach to expectation-based experience typology, this concept offers the chance to change conditions not only retrospectively (based on data), but also in a prospective way in terms of a "management of expectations".

[Quality analyses of the development of preterm infants: results of the Lower-Saxonian preterm infant follow-up project and a comparison group of term infants]

Based on perinatal and neonatal quality assurance programmes, a follow-up project for the high-risk group of extremely preterm infants, unparalleled in Germany, was initiated in the federal state of Lower Saxony in 2004. Here we describe the new approach of examining a comparison group of term infants, which, for the first time, allows a valid interpretation of the collection of area-wide long-term outcome data on preterm children. The prospective long-term outcome project investigates the medical care situation for children born at less than 28 weeks of gestation up to school age. Based on the information obtained about the children's development the quality of health care will be optimised. A standardised examining concept with established development tests at defined follow-up intervals (at the age of 6 months, 2, 5 and 10 years) is used. At the age of five years 75 % of the examined premature children exhibited impairments. In order to better assess remarkable results, a comparison group of term infants (n=305) selected by a matched-pairs method was examined at the age of five using an analogous concept in kindergartens in Lower Saxony. The results were compared with the first two age cohorts of the follow-up-project (n=226) and quality analyses performed. As expected, significant differences have been found in the children's motor, cognitive and linguistic development between the preterm and term infants examined. This fact draws attention to the importance of early support for the majority of extremely premature infants. Feedback on the results given to the medical staff involved allows for the implementation of best practices and quality improvements. Identifying potential for improvement in everyday health care will help to develop specific optimisation measures.

[The significance of quality of life--an ethical approach]

Quality of life is highly appreciated as an evaluation criterion and a goal of interventions in medicine, but it is insufficiently applied. There is no unanimous definition of "quality of life". From a philosophical point of view, subjectivistic concepts can be differentiated from objectivistic ones. In medicine there are the three concepts of general, health-related and disease-specific quality of life. In this paper it is argued that a general and subjectivistic account of quality of life is of prevailing ethical significance, due to patient orientation and patient autonomy reasons. The normative function of quality of life should be given much more consideration by the responsible players in clinical research, healthcare and allocation decisions within the healthcare system.