[Evaluation of outpatient medical pain management in Germany : Results of an internet-based cross-sectional survey among pain specialists in outpatient departments]. / Bewertung der ambulanten ärztlichen Schmerztherapie in Deutschland : Ergebnisse einer internetbasierten Querschnittsbefragung unter ambulant tätigen Schmerzmedizinern.

BACKGROUND: On 31 December 2016, a total of 1206 physicians participated in the outpatient care of chronic pain patients according to the criteria of a special pain management program (QSV). Because of the largely existing shortage of treatment resources for chronic pain patients, there is a lack of data regarding the evaluation of outpatient pain management by highly specialized pain therapists. METHODS: In a hybrid Delphi procedure, a questionnaire concerning the content, structural and personal assessment of outpatient pain management in Germany was developed. With the help of this instrument, an internet-based cross-sectional survey of 281 QSV pain therapists from four German states (Berlin, Lower Saxony, Saxony, Baden-Württemberg) and of all the heads of university outpatient pain services (n = 36) in Germany was conducted. RESULTS: The adjusted response rate of the survey was 35.9%. The response rate of the heads of university outpatient pain services was 66.7%. In 91% of the respondents the proportion of chronic pain patients in the medical practices was more than 70%. Whereas 67.3% were satisfied with the situation in their medical practice, 63.4% were dissatisfied with the current organizational structure of the pain management in Germany. They expressed their dissatisfaction especially in terms of budgeting regulations (69.3%), the cooperation with psychotherapists (69.3%) and interdisciplinary networking (50.5%). The 1­year specialist training in pain management (87.1%) and the completion of a psychosomatic basic care course (90.1%) were assessed as a good preparation for the later profession. A multitude of free comments indicated that the pain specialist training is too short and insufficient. Most of the respondents considered the establishment of a specialist board certification for pain management more suitable from the perspective of physicians (61.4%) and the patients (54.5%). Of the heads of university outpatient pain services 70.8% expressed the wish for autonomous structures with separate budgets and 75.0% indicated that under the current conditions their outpatient pain services are not working profitably. Only 39.7% of the QSV pain therapists provided fellowship training for physicians and 57.6% were planning to retire during the next 10 years. CONCLUSION: Highly specialized pain therapists are dissatisfied because of the lack of independence of the organizational structure of pain management care and the insufficient interdisciplinary network in outpatient pain management. A possible solution for a better pain management care and the recruitment problems may be the establishment of a board certification for pain management.

[What motivates patients with atopic diseases to search the internet-a focus group study on expectations and demands]. / Was motiviert Patienten mit atopischen Erkrankungen zur Suche nach Informationen im Internet? Ergebnisse einer Fokusgruppenstudie zu Erwartungen und Anforderungen.

BACKGROUND: People affected by allergies with mild-to-moderate symptoms are often not treated adequately, despite the availability of prevention and self-therapy measures. Given their good and quick accessibility when seeking information, evidence- and web-based services that are user-friendly may strengthen a more independent way of handling an allergy and may also increase health literacy. In order for such services to be found and read, developers and providers need to know about information needs, demands and users' behavior. OBJECTIVES: On which occasions does the target group search for allergy-specific information? Which preferences and demands do affected persons have regarding a web-based service? MATERIALS AND METHODS: Three individual interviews and four focus groups with 37 participants (19-81 years; hay fever, n = 30; asthma, n = 17; eczema, n = 15) were conducted in four German cities. These were recorded and transcribed verbatim. A multiprofessional team developed a system for coding the texts (two independent encoders, MAXQDA analysis software). RESULTS: Those who are affected usually seek information only in case of a concrete need for action. Impulses are, among others, symptoms, suggestions from the social environment, the beginning of the allergy season or an allergy-related contact with the health system. A web-based service should primarily include information about treatment options, provide individualized support for everyday life action strategies, and promote adequate self-management skills. DISCUSSION: In order to promote self-management skills, a web-based service should focus on allergy symptoms, treatment options and day-to-day help.

[Clinical anamnestic characteristics in neurological work-related medical rehabilitation : Necessity for a qualitative identification of severe restrictions of work ability]. / Klinisch-anamnestische Charakteristika in der neurologischen MBOR : Notwendigkeit einer qualitativen BBPL-Identifikation.

BACKGROUND: Severe restrictions of work ability (SRWA) as a condition for participation in neurological work-related medical rehabilitation (WMR) have not been adequately described up to now. Similarly, the applicability of the screening instrument SIMBO-C for evaluating SRWA in neurological rehabilitation has not yet been answered conclusively. OBJECTIVE: Determination of clinical and anamnestic characteristics of neurological SRWA and assessment of the applicability of the screening instrument SIMBO-C in neurological WMR. MATERIAL AND METHODS: For the identification of SRWA clinical and anamnestic characteristics of 344 rehabilitants were routinely collected. The clinically and anamnestically determined SRWA was described quantitatively and content-analytically and correlated with SIMBO-C. RESULTS: Of the rehabilitants 66% exhibited SRWA. Apart from the established characteristics of SRWA further person and disease-specific factors were found. The SIMBO-C score was significantly higher in the group with SRWA compared to the group without SRWA (45.6 ± 18.9 vs. 31.5 ± 12.5, p < 0.001); however, 31% of the group with SRWA and 50% of the group without SRWA demonstrated a SIMBO-C score ≤ 36 points and thereby a large overlap. The profile of the clinical and anamnestic characteristics in the group with SRWA was homogeneous, regardless of the SIMBO-C score. CONCLUSION: The characteristics of neurological SRWA are mainly qualitatively shaped and may only partly be identified by SIMBO-C. A combined quantitative and qualitative approach is necessary in neurological WMR.

[Network for Oncological Advisory Service (NOF) - a Pilot Project for (Long-Term) Follow-Up Care of Pediatric Cancer Patients]. / Netzwerk für onkologische Fachberatung (NOF) ­ Modellprojekt für (Langzeit-) Nachsorge nach einer Krebserkrankung im Kindes- und Jugendalter.

Background: In Germany some 2 000 children and adolescent are diagnosed with cancer every year. Curing rates are increasing and therewith also the number of survivors is growing. Survivors frequently suffer from long-term effects of the disease and its treatment, but long-term follow-up care shows deficits. Method: The Network for oncological advisory service (NOF) started in 11/2013, researching and building up a network of available support in Lower Saxony. A telephone hotline was installed in 01/2014 in order to advice survivors on their problems. At the same time, an interview study on survivors needs was conducted throughout Germany. Results: In the first 2 years, the NOF gave advice to 79 patients. Whilst enquiries of medical or psychological nature were transferred to the cooperation partner, requests on psychosocial and social legal issues are being deled by the NOF due to lack of appropriate partners. The evaluation of 25 interviews shows key issues in long-term after-care: (1) transition from acute therapy to everyday life, (2) problems due to pediatric cancer and therapy, (3) patients perception of own disposition, (4) social reactions towards survivors, (5) structure of long-term follow-up care, (6) information flow. Conclusion: Many survivors suffer from long-term effects of cancer and treatment. The lack of available contact person and being in limbo between cured and simultaneously affected by the cancer treatment and chronic diseases is perceived as being problematic. This translates to various requirements on a patient-oriented long-term care, mainly in the psychosocial field.

[Strengthening Public and Global Health in Germany - an Appraisal of the Statement "Public Health in Germany" by the German Scientific Academies from June 16th 2015]. / Public und Global Health in Deutschland stärken - Eine Einordnung der Stellungnahme "Public Health in Deutschland" der wissenschaftlichen Akademien vom 16.6.2015.

In June 2015 the scientific academies "Leopoldina" and "acatech" and the union of the German academies of sciences and humanities published a statement on public and global health in Germany. The statement contains many valuable albeit generic and well-known recommendations. The few specific recommendations focus on centralizing research while weakening the role of universities and on the relative increase of research on public health genomics. These recommendations are not based on empirical or theoretical analyses and risk subverting successful developments of the recent past. To actually strengthen public and global health in Germany the existing institutions need to be backed up while designated funding of public and global health needs to be extended.

[Leaflets and websites on colorectal cancer screening and their quality assessment from experts' views]. / Printmedien- und Internetangebote mit Informationen zur Darmkrebsfrüherkennung und ihre kriteriengestützte Bewertung aus Expertensicht.

In Germany, individuals who have statutory health insurance have free access to colorectal cancer (CRC) screening tests, and can choose between a fecal occult blood test and a screening colonoscopy. Evidence-based health information may support informed choices regarding whether or not to undergo CRC screening. The aim of this study was to assess whether the available German information materials on CRC screening meet evidence-based health information standards. A systematic search was made for print media and websites on CRC screening addressed to German people with average CRC risk (search period for print media August 2010, for websites January-March 2012). The identified information was assessed with a newly developed comprehensive list of criteria. In all, 41 print media, including 28 flyers and 13 brochures, and 36 websites were identified and assessed. These materials reported more often the benefits than the risks of CRC screening, and quantified presentations of benefits and risks were less frequently given. Most of the materials called for participation and did not indicate the option to decide whether or not to attend CRC screening. This bias in favor of screening was increased by fear-provoking or downplayed wording. Most materials included false and misleading information. The requirements for evidence-based patient information were currently not met by most of the leaflets and websites in Germany. Feedback was given to the producers of the leaflets including a discussion of the findings. The results may be used to revise existing leaflets or to develop new health information on CRC screening.

[Are German information materials on colorectal cancer screening understandable or do they fail? Rating of health information by users with different educational backgrounds]. / Sind Informationsmaterialien zur Darmkrebsfrüherkennung in Deutschland verständlich oder verfehlen sie ihre Wirkung? : Bewertung von Gesundheitsinformationen durch Nutzerinnen und Nutzer mit unterschiedlichem Bildungshintergrund.

Evidence-based patient information is an essential part of decision making in health issues. A qualitative study was conducted to examine whether consumers consider the health information on colorectal cancer screening in Germany helpful in supporting their decision making. In this study, eight texts from different German authors about colorectal cancer screening were evaluated with a criteria-based selection. The texts were tested for understandability, structure, design, and effect on readers. Thirteen semi-structured focus groups were formed including 59 higher-educated and 15 lower-educated testers, 46 % of them being male with a mean age of 62.9 years. The transcripts were analyzed by content-analytic assessment. The testers provided detailed comments on the content and design of the texts. They revealed inaccuracies and suggested improvements of the texts. The testers differed from each other in terms of the intensity of their participation in the discussions and comprehension of the material. The reception of the flyers and brochures varied according to the educational level of the testers. Lower-educated testers often skipped passages of texts about risks as well as passages containing numbers and graphics. The texts had different effects on the testers, regardless of the level of education. If adverse effects were presented, some testers became scared while others were reassured because they felt informed. Most of the testers appreciated a call for participation as a central message of the text. Sometimes, if there was no clear appeal to attend the screening, the testers even asked for it. The recently introduced political strategy of promoting an informed choice is applied to an unprepared population who was used to getting a clear yes-or-no recommendation. Thus, at first, the population has to learn how to make an informed choice. This topic must be addressed and taken into account in the process of developing health information. Since this is not always the case, we conclude that current materials are limited in their contribution toward the decision of attending CRC screening.

Establishment of prevention: what do dentists in northern Germany suggest?

OBJECTIVE: Dentists' suggestions for the establishment of preventive care were investigated on 3 levels; dentist, dental associations and unions (DAU), and health care system (HCS). Associations between categories of suggestions and dentists' characteristics were explored. METHODS: A postal survey was sent to 2,075 dentists practicing in Bremen and Lower Saxony. The answers on 3 open-ended questions were analysed in a qualitative manner based on the quality control protocol (QCP) of the Federal Joint Committee. Quantitative methods were used for exploring associations between categories of suggestions and gender as well as age. RESULTS: Response rate was 33% (n=685). Dentists made 2,120 suggestions (dentist=752, DAU= 574, HCS= 794). The majority of dentists (90%) suggested educating and motivating patients. Dentists stated that support from DAU is needed in educating the public (50%), offering preventive-oriented training (35%), and in advertising for prophylaxis (18%). On the HCS level, about 60% of the suggestions concerned remunerating prophylaxis and expanding the existing bonus system. Significantly more female (p=0.010) and younger dentists (p=0.031) contributed to educating patients than male and older dentists. CONCLUSION: Education is the key message of this work. Essential topics such as prevention for elderly and risk groups were not a focal point. Education on the DAU and HCS levels can be realised through organising nation-wide health campaigns. Funding options for prevention and regulating multidisciplinary work between dentists and other health-care providers should be examined. These changes can contribute enormously to further establish prevention.

[Satisfaction with dental care from the patient's perspective - the dental-ZAP-V1]. / Zufriedenheit mit der zahnärztlichen Versorgung aus Perspektive der Patienten - Der Zahn-ZAP-V1.

BACKGROUND: Patient satisfaction is a central topic in quality management in outpatient dental care. The ZAP questionnaire was validated to explore patient satisfaction in general and specialist outpatient settings. This study aims at assessing the psychometric properties of the ZAP in dental care. METHODS: A minimally modified version of the ZAP consisting of 4 domains (office organisation, cooperation, interaction, information) was administered in personal interviews to a population-based sample. Descriptive, exploratory and confirmatory psychometric analyses were conducted with random subsets of the study sample. RESULTS: The study population comprised 1 773 subjects with at least one dental visit during their lifetime (mean age=50 years, female=51.6%). The exploratory factor analysis identified 3 subscales (office organisation, interaction, information). Based on these results, items of the subscale "cooperation" were excluded from further analyses. The remaining items had a medium difficulty of 0.75, all item-total-correlations were above 0.4. Missing values ranged between 2.3% and 28.7%. Cronbach's alpha ranged between 0.79 and 0.95. After introduction of 3 residual correlations, the confirmatory factor analyses reached a good model fit (TLI: 0.97; CFI: 0.97, RMSEA: 0.06). Partial standardised factor loadings ranged between 0.77 and 0.87. The 3 latent factors were highly correlated. There was a positive correlation between the 3 subscales and global patient satisfaction with the dentist. CONCLUSION: The psychometric assessment can be used in the 3 modified subscales (office organisation, interaction, and information) to assess patient satisfaction with dental care. To assess dentist's competence in relation to dental anxiety and pain as well as shared decision making new scales specific to dental care should be explored.

[Memorandum prevention research - research areas and methods]. / Memorandum zur Präventionsforschung - Themenfelder und Methoden (Langfassung).

From 2004 to 2012, the German Ministry of Education and Research (BMBF) established its first funding programme for the promotion of prevention research. 60 projects on primary prevention and health promotion and the meta-project entitled "Cooperation for Sustainable Prevention Research" (KNP) received BMBF grants under this programme during this period. The experience and knowledge gained and recommendations arising from the research funded under this programme are compiled in memorandum format. The "Memorandum on Prevention Research - Research Areas and Methods" highlights 5 research areas that are considered to be especially relevant from the perspective of the involved scientists and practice partners.The promotion of structural development and sustainability enhancement in disease prevention and health promotion are central areas that should branch out from existing nuclei of crystallization. Improving the health competence of the population and of specific subpopulations is another major area. Research in these areas should contribute to the development of theoretical concepts and to the empirical testing of these concepts. The transfer of knowledge for effective use of developed disease prevention and health promotion programmes and measures is still a scarcely researched area. Among other things, studies of the transfer of programmes from one context to another, analyses of the coop-eration between politics and science, and the continued theoretical and conceptual development of transfer research are needed. Long-term data on the effects of intervention studies are also needed for proper evaluation of sustainability. The latter dem-onstrates the importance of method development in disease prevention and health promotion research as an area that should receive separate funding and support. This research should include, in particular, studies of the efficacy of complex interventions, health economic analyses, and participative health research.

[Situation and perspectives of public health in Germany--research and teaching. Position paper of the German Public Health Association]. / Situation und Perspektiven von Public Health in Deutschland--Forschung und Lehre. Positionspapier der Deutschen Gesellschaft für Public Health e. V.

This position paper of the German Public Health Association describes current situation and perspectives of public health in Germany with emphasis on research and teaching. It outlines those measures necessary for strengthening of public health research in Germany.

[Selected aspects of citizen and patient orientation in Germany. Assessment from the point of view of users]. / Ausgewählte Aspekte einer Bürger- und Patientenorientierung in Deutschland. Die Beurteilung aus der Sicht der Nutzer.

The growing citizen and patient orientation of the German healthcare system reflects a health policy process which aims to achieve more individual and social responsibility as well as more autonomy on the part of healthcare users. At the same time the process is regarded as an essential component of a future oriented quality development involving raising transparency, developing competence, strengthening patient rights and improving complaints management. Representative data on these parameters and on people's level of satisfaction with their most recent contact with the healthcare service were collected in the 2009 GEDA survey 'Information Behaviour and Self-determination of Citizens and Patients' by the Robert Koch Institute. It reveals knowledge deficits in the population relating to selected areas of the healthcare service and there are also deficits in people's knowledge and assertion of their rights and in the way complaints are handled. These deficits vary according to demographic and socio-economic criteria (age, sex, educational and social status, status vis à vis health insurance companies). It emerges that different population groups have different needs, which can be used for a target group orientation in the communication of knowledge and the development of competencies.

[PrefCheck: patient-centered treatment planning with older multimorbid patients. Method and design]. / PräfCheck: Patientenzentrierte Behandlungsplanung mit älteren multimorbiden Patienten. Methodik und Design.

BACKGROUND: The aim of the study is to develop and test a consultation guide (PrefCheck) for general practitioners (GPs) based on geriatric assessment results. The goal of the consultation guide is to facilitate priority setting and treatment planning based on building a partnership with geriatric patients with multiple chronic diseases. METHODS AND AIMS: The mixed method study consists of three complementary parts: (A) health and treatment priorities of 32 patients and their 8 GPs are determined and explored on the basis of assessment results. These findings lead to the development of the consultation guide, which is subsequently tested in a cluster-randomized controlled intervention study (B) with 40 GPs and 320 patients. The aim of this study is to assess whether PrefCheck results in improved agreement in the number of health and treatment priorities between patients and their doctors. The study concludes with an evaluation study (C) with 5 GPs and 15 patients. CONCLUSIONS: Results will be presented in a future publication. In particular it will be demonstrated whether the consultation guide can strengthen the position of older patients in the doctor-patient relationship, increase the level of information on both sides, and contribute to a shared and holistic treatment planning.

[Evaluating the health target "Increasing health competence, strengthening patient sovereignty"]. / Ansätze zur Evaluation des Gesundheitsziels "Gesundheitliche Kompetenz erhöhen, Patient(inn)en-souveränität stärken".

Establishing citizen and patient orientation is a national objective of German health policy. The cooperation network gesundheitsziele.de has defined the target area "Increasing health competence, strengthening patient sovereignty", and its Working Group 8, which bears the same name, has identified four key areas for action: increasing transparency, developing competence, strengthening patients' rights, and improving complaint management. As in the case of all the other targets defined by gesundheitsziele.de, attention is drawn to the need to evaluate the effects and success of the targets and related measures. A group of experts was given the task of developing an evaluation strategy, defining success indicators, and examining the availability of data sources for evaluation. With regard to the health target "Increasing health competence, strengthening patient sovereignty", the evaluation is focusing on what effect the corresponding targets and measures are having on users and how they are perceived (summative evaluation), i.e., primarily on measuring outcomes at the population level. An examination of available studies and surveys shows that to date little is known about the expectations and assessments of health-service users. At the same time, the analysis makes it clear that priority should be given to using continuous data in order to arrive at a continuous and systematic evaluation of the "Increasing health competence, strengthening patient sovereignty" health target and the implementation of citizen and patient orientation in healthcare in general. It would also be useful to include all hitherto underrepresented indicator questions in these surveys and to also examine the implementation of the health target among vulnerable population groups, e.g., elderly people in nursing homes.

[Empowerment and health literacy in medical rehabilitation - recommendations for strengthening patient education]. / Teilhabebefähigung und Gesundheitskompetenz in der medizinischen Rehabilitation - Empfehlungen zur Stärkung von Patientenschulungen.

UNLABELLED: The recommendations aim to increase patient participation and health literacy by strengthening the role of patient education in medical rehabilitation. Research shows patient education to be effective and efficient; making the implementation of high quality patient education a top priority. To strengthen the role of patient education it is important to address known obstacles, identify potential for improvement, and define future demands for rehabilitative care. Led by the German Society for Medical Rehabilitation (DEGEMED), the Centre for Patient Education at the Würzburg University, and the Institute for Quality Management and Clinical Audit in Medical Rehabilitation (IQEM) an inter- and multidisciplinary panel of 28 experts from research and practice developed recommendations to further patient education in medical rehabilitation. The recommendations address topics such as the implementation of legal requirements under book IX of the German Social Code, SGB 9, structural and organisational prerequisites to promote the importance of patient education in rehabilitation units, the incorporation of quality criteria for patient education in quality assurance, quality management, and certification, as well as networking between medical rehabilitation and other health care sectors. CONCLUSION: Providers of medical rehabilitation hold the power to strengthen patient education: by implementing patient education programmes that are well-evaluated, manual-based, and standardised, by providing sufficient resources within their institutions, and by placing patient education in the centre of their quality policy, i.e. by nomination of a patient education representative. Stakeholders need to acknowledge these activities by incorporating quality criteria for patient education in clinical audit, and last but not least by adequate funding of medical rehabilitation.

[Framework of palliative care in Germany and development of public health targets. Study design and methods]. / Rahmenbedingungen für die palliative Versorgung in Deutschland und Entwicklung von Public-Health-Zielen. Studiendesign und Methodik.

To provide adequate end-of-life care is a substantial task of the health care system. However, it has been largely disregarded. For public health research, important activities include analysing the societal requirements as well as the health system-related possibilities and framework. Therefore, a study, funded by the German Research Foundation, for the first time (1) examines the viewpoints of a wide range of stakeholders that operate on different levels of the German health system, and (2) develops broadly based public health targets for palliative care in Germany. This article presents the conceptual framework, design and methods of the study.

[Does the service of the federal government commissioner for patient issues appeal to the elderly?]. / Spricht das Angebot einer Patientenbeauftragten der Bundesregierung ältere Menschen an?

BACKGROUND: For the first time, this study investigates to which extent elderly persons write to the federal government commissioner for patient issues in Germany. METHODS: A 33% sampling (n=850) of the written inquiries (correspondence and emails) addressed to the commissioner in the first six months of the year 2005 (n=2580) was investigated. Socio-demographic data were extracted from the material; furthermore, it was registered which diseases the citizens described. RESULTS: Older persons outweigh the younger (69% over 60 years, mean age 63 years). Within the group of the elderly, approximately as many persons belong to the age group 60-69 years and to the age group 70 years and older. Most frequently, the citizens describe chronic diseases of the musculoskeletal system. DISCUSSION: The new service of the federal government commissioner for patient issues appeals to the elderly in Germany. The high proportion of people with chronic illness among the inquirers emphasizes the need for information, advice and support for this target group. Further research is needed on the answers to the inquirers, and on the question how helpful the contact to the government commissioner's office is from the viewpoint of the citizens; furthermore, possible barrieres (e.g. social state) should be analyzed.

[The changing role of intraoperative mammary frozen sections in breast cancer: comparison of data from East and West Germany before and after reunification]. / Geänderte Rolle histopathologischer Schnellschnittuntersuchungen beim Mammakarzinom: Datenvergleich in Ost- und Westdeutschland vor und nach der Wiedervereinigung.

The goal of the present study lies in the comparison of differently funded health care structures, with emphasis on certain aspects regarded to be essential for medical progress. For this purpose, mammary intraoperative frozen sections pooled from a total of 4163 intraoperative frozen sections obtained from representatively selected departments of pathology from East and West Germany before and after reunification were analysed comparatively. Our results clearly demonstrate a profound change in the role of intraoperative mammary frozen sections, with a predominantly diagnostic function in the former German Democratic Republic as a tool for histopathologically evaluating "questionable" mammary lesions. The use of such sections changed towards a predominantly therapeutic function during surgical treatment as a means of organ preservation after the German reunification.

[Surveys on patient satisfaction in ambulatory care. Practicability, acceptance and relevance from the physician's perspective]. / Patientenbefragungen in der Arztpraxis. Praktikabilität, Akzeptanz und Relevanz aus der Sicht von niedergelassenen Arzten.

Surveys on patient satisfaction have become an integral part in quality management. Adequate survey conduction and appropriate feed back of survey results are essential prerequisites for a successful transfer of survey results into practice. During the validation of a new instrument to assess patient satisfaction in ambulatory care, we assessed the practicability, acceptance and relevance of the procedure used in this study (distribution and return of questionnaires, preparation of results and comparative feed back) from the perspective of the participating physicians (N = 60). Our results confirm, that physicians gain a considerable amount of information on quality of care from the patient's perspective, provided that results are fed back appropriately. Two thirds of the participating physicians (65%) obtained ideas and suggestions for quality management and improvement. Most of the ideas were realised at the time the physician survey took place. Recommendations for conducting patient surveys in ambulatory care and feed back of survey results for participating physicians are presented.