Development and initial evaluation of the usefulness of a question prompt list to promote patients' level of information about work-related medical rehabilitation: a pilot study.

Introduction: The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort. Methods: An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews). Results: The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure. Discussion: While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.

[Development of Practice Guidelines for Social Work in Medical Rehabilitation]. / Entwicklung von Praxisempfehlungen für die Soziale Arbeit in der medizinischen Rehabilitation.

PURPOSE: Social work services are a major part of the treatment spectrum in medical rehabilitation. Given new demands and differences in the practical implementation of social work interventions, there is a need for good clinical practice standards of care. Therefore, practice guidelines (PG) for social work in medical rehabilitation facilities were developed. These are intended to support decision-making processes in interventions and give other professions working in rehabilitative care insight into the range of social work services. The PG were developed in a multi-stage process involving experts from social work practice. METHODS: A national and international literature search was conducted on the current evidence on social work interventions in medical rehabilitation. In a survey of social work services in inpatient and outpatient medical rehabilitation facilities (all indications except addictive disorders, child/adolescent rehabilitation; Nmax=311), social workers were asked to provide information on current practice and their expectations towards the PG. On this basis, a preliminary version of the PG was modified and expanded in an expert workshop and evaluated in a second survey of social work services in rehabilitation facilities (Nmax=184). The results were discussed at a second workshop and on this basis the final PG version was prepared. RESULTS: The PG include information on framework conditions of social work in rehabilitation and on social diagnostics. At the center of the PG are frequent needs and problems of rehabilitation patients. These include work-related problems, social and financial problems, participation of persons with disability, and aftercare/follow-up. Each chapter provides information on needs assessment, the content and scope of suitable interventions, and additional materials and references. CONCLUSION: The PE are intended as a practical aid, based on both practical expertise and existing scientific evidence, to provide social work staff and other professional groups in rehabilitation with information on social work services and their implementation. The focus of the content reflects the expressed expectations of social services for PE.

Which teaching method is more effective in a communication course - role-playing versus simulated patients, taught by tutors or faculty staff? A randomized trial.

Aim: Communicative skills can be taught and trained as part of medical training. In these courses, lecturers or tutors serve as instructors, and students perform interviews with simulated patients (SP) or role-play (RP) with fellow students. The present study was conducted to identify the combination of applied teaching methods that is most effective. Method: n=144 third-year (5th semester) medical students attended a medical history-taking course that consisted of three separate sessions (90 minutes each). Students were randomized into three groups. Groups 1 and 2 received training with SP in sessions one and two, followed by RP training in session three; (teaching by lecturer = SP-Lecturer group vs. teaching by tutor = SP-Tutor group). Group 3 received two sessions of RP training and a SP-based training in session three (teaching by tutor = RP-Tutor group). After completing the course, students had to rate their learning success using a short questionnaire, pass an SP-OSCE station and were supposed to answer exam questions. Results: The OSCE performance of both the SP-Lecturer group (n=28) and the RP-Tutor group (n=44) was significantly better than that of the SP-Tutor group (n=26; p=.018 and p=.041, respectively). All groups reported an increase in self-rated history-taking skills (p<.001). There was no difference between groups in the results achieved on the final exam. Conclusions: Students receiving SP-based teaching benefit more from a lecturer-taught course, while students instructed by tutors benefit more from RP-based teaching. The significant learning progress highlights the great advantage of taking the course as part of medical studies. Further research should aim to determine at which time each teaching method improves learning progress most effectively.

Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research.

BACKGROUND: Identifying pain-related response patterns and understanding functional mechanisms of symptom formation and recovery are important for improving treatment. OBJECTIVES: We aimed to replicate pain-related avoidance-endurance response patterns associated with the Fear-Avoidance Model, and its extension, the Avoidance-Endurance Model, and examined their differences in secondary measures of stress, action control (i.e., dispositional action vs. state orientation), coping, and health. METHODS: Latent profile analysis (LPA) was conducted on self-report data from 536 patients with chronic non-specific low back pain at the beginning of an inpatient rehabilitation program. Measures of stress (i.e., pain, life stress) and action control were analyzed as covariates regarding their influence on the formation of different pain response profiles. Measures of coping and health were examined as dependent variables. RESULTS: Partially in line with our assumptions, we found three pain response profiles of distress-avoidance, eustress-endurance, and low-endurance responses that are depending on the level of perceived stress and action control. Distress-avoidance responders emerged as the most burdened, dysfunctional patient group concerning measures of stress, action control, maladaptive coping, and health. Eustress-endurance responders showed one of the highest levels of action versus state orientation, as well as the highest levels of adaptive coping and physical activity. Low-endurance responders reported lower levels of stress as well as equal levels of action versus state orientation, maladaptive coping, and health compared to eustress-endurance responders; however, equally low levels of adaptive coping and physical activity compared to distress-avoidance responders. CONCLUSIONS: Apart from the partially supported assumptions of the Fear-Avoidance and Avoidance-Endurance Model, perceived stress and dispositional action versus state orientation may play a crucial role in the formation of pain-related avoidance-endurance response patterns that vary in degree of adaptiveness. Results suggest tailoring interventions based on behavioral and functional analysis of pain responses in order to more effectively improve patients quality of life.

[Implementation and Formative Evaluation of a Health Navigator Service for Health and Wellness Guests in a Health Resort]. / Implementierung und formative Evaluation eines Gesundheitslotsen zur Beratung von Gesundheitsgästen in einem Kurort.

OBJECTIVES: To develop, implement and evaluate a health navigator service (HNS) for visitors and guests in a German health resort. METHOD: Information on local health services providers was collected and included in a database. A complementary national and international literature search was conducted. Health and wellness guests were interviewed about information needs and expectations with respect to a HNS. During the implementation of the HNS, all consultations were continuously documented. In interviews, cooperation partners and stakeholders were asked to evaluate the concept and its potentials. RESULTS: The literature search showed no comparable models or studies. The database was routinely used by the health navigator. In pre-implementation interviews, health and wellness guests stressed the need for neutral and objective counseling provided by a HNS. Routine documentation showed that more than half of the guests using the HNS were older than 65 years. Questions regarding local medical, healthcare and wellness institutions were frequent in consultations. The initial line of work of the HNS was modified during the implementation toward a stronger focus on involvement in health tourism-related issues. Cooperation partners and stakeholders rated this repositioning favorably. CONCLUSIONS: The HNS concept was successfully implemented. The realignment of HNS job specifications facilitated its local establishment. An implementation manual is intended to support the transfer of the HNS concept to other health resorts and spas.

Beyond Oncology: Question Prompt Lists in Healthcare-A Scoping Review Protocol.

Question prompt lists (QPL) are an instrument to promote patient participation in medical encounters by providing a set of questions patients can use during consultations. QPL have predominantly been examined in oncology. Less is known about their use in other contexts. Therefore, we plan to conduct a scoping review to provide an overview of the fields of healthcare in which QPL have been developed and evaluated. MEDLINE/PUBMED, PSYCINFO, PSYNDEX, WEB OF SCIENCE, and CINAHL will be systematically searched. Primary studies from different healthcare contexts that address the following participants/target groups will be included: persons with an acute, chronic, or recurring health condition other than cancer; healthy persons in non-oncological primary preventive measures. There will be no restrictions in terms of study design, sample size, or outcomes. However, only published studies will be included. Studies that were published in English and German between 1990 and 2019 will be examined. Two independent reviewers will apply defined inclusion/exclusion criteria and determine study eligibility in the review process guided by the PRISMA statement.

An instrument for quality assurance in work capacity evaluation: development, evaluation, and inter-rater reliability.

BACKGROUND: Employees insured in pension insurance, who are incapable of working due to ill health, are entitled to a disability pension. To assess whether an individual meets the medical requirements to be considered as disabled, a work capacity evaluation is conducted. However, there are no official guidelines on how to perform an external quality assurance for this evaluation process. Furthermore, the quality of medical reports in the field of insurance medicine can vary substantially, and systematic evaluations are scarce. Reliability studies using peer review have repeatedly shown insufficient ability to distinguish between high, moderate and low quality. Considering literature recommendations, we developed an instrument to examine the quality of medical experts' reports. METHODS: The peer review manual developed contains six quality domains (formal structure, clarity, transparency, completeness, medical-scientific principles, and efficiency) comprising 22 items. In addition, a superordinate criterion (survey confirmability) rank the overall quality and usefulness of a report. This criterion evaluates problems of inner logic and reasoning. Development of the manual was assisted by experienced physicians in a pre-test. We examined the observable variance in peer judgements and reliability as the most important outcome criteria. To evaluate inter-rater reliability, 20 anonymous experts' reports detailing the work capacity evaluation were reviewed by 19 trained raters (peers). Percentage agreement and Kendall's W, a reliability measure of concordance between two or more peers, were calculated. A total of 325 reviews were conducted. RESULTS: Agreement of peer judgements with respect to the superordinate criterion ranged from 29.2 to 87.5%. Kendall's W for the quality domain items varied greatly, ranging from 0.09 to 0.88. With respect to the superordinate criterion, Kendall's W was 0.39, which indicates fair agreement. The results of the percentage agreement revealed systemic peer preferences for certain deficit scale categories. CONCLUSION: The superordinate criterion was not sufficiently reliable. However, in comparison to other reliability studies, this criterion showed an equivalent reliability value. This report aims to encourage further efforts to improve evaluation instruments. To reduce disagreement between peer judgments, we propose the revision of the peer review instrument and the development and implementation of a standardized rater training to improve reliability.

[Telephone-Based Psychological Counselling of Accident Victims: Initial Evaluation of a Pilot Project of the German Statutory Accident Insurance in the Healthcare and Welfare Services]. / Pilotprojekt "Telefonisch-psychologische Beratung Unfallverletzter" der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege ­ Wie wird das Angebot bewertet?

A telephone-based psychological counselling service was implemented and evaluated in four regional offices of the German statutory accident insurance in healthcare and welfare services (BGW). Insurance employees/caseworkers, psychotherapists, and insured persons were asked to rate the counselling service in terms of their experiences and satisfaction. 15.5% of all insured persons initially contacted made use of the counselling service. Those using the service reported a slightly higher level of psychological distress, were less likely to be able to work 3 months after using the service and were more likely to attend a subsequent psychotherapy session. Telephone-based counselling by psychotherapists was rated as helpful by most insured persons. Caseworkers and psychotherapists also rated the concept favorably. All in all, the implementation can be regarded as successful. In a next step, the approach should be evaluated regarding its efficacy in a randomized, controlled trial.

Development and evaluation of a standardized peer-training in the context of peer review for quality assurance in work capacity evaluation.

BACKGROUND: The German quality assurance programme for evaluating work capacity is based on peer review that evaluates the quality of medical experts' reports. Low reliability is thought to be due to systematic differences among peers. For this purpose, we developed a curriculum for a standardized peer-training (SPT). This study investigates, whether the SPT increases the inter-rater reliability of social medical physicians participating in a cross-institutional peer review. METHODS: Forty physicians from 16 regional German Pension Insurances were subjected to SPT. The three-day training course consist of nine educational objectives recorded in a training manual. The SPT is split into a basic module providing basic information about the peer review and an advanced module for small groups of up to 12 peers training peer review using medical reports. Feasibility was tested by assessing selection, comprehensibility and subjective use of contents delivered, the trainers' delivery and design of training materials. The effectiveness of SPT was determined by evaluating peer concordance using three anonymised medical reports assessed by each peer. Percentage agreement and Fleiss' kappa (κm) were calculated. Concordance was compared with review results from a previous unstructured, non-standardized peer-training programme (control condition) performed by 19 peers from 12 German Pension Insurances departments. The control condition focused exclusively on the application of peer review in small groups. No specifically training materials, methods and trainer instructions were used. RESULTS: Peer-training was shown to be feasible. The level of subjective confidence in handling the peer review instrument varied between 70 and 90%. Average percentage agreement for the main outcome criterion was 60.2%, resulting in a κm of 0.39. By comparison, the average percentage concordance was 40.2% and the κm was 0.12 for the control condition. CONCLUSION: Concordance with the main criterion was relevant but not significant (p = 0.2) higher for SPT than for the control condition. Fleiss' kappa coefficient showed that peer concordance was higher for SPT than randomly expected. Nevertheless, a score of 0.39 for the main criterion indicated only fair inter-rater reliability, considerably lower than the conventional standard of 0.7 for adequate reliability.

[The Update of the Rehabilitation Therapy Standards of the German Pension Assurance]. / Die Aktualisierung der Reha-Therapiestandards der Deutschen Rentenversicherung.

OBJECTIVES: To report on the process of updating the German Pension Insurers' rehabilitation therapy standards (RTS) from 2013 to 2015. METHODS: Four methodical approaches were taken to gather evidence: a) systematic literature searches, b) the formation of expert groups, expert workshops, and online discussion forums to bring together the experiences from clinicians and patients, c) an analysis of the latest KTL data to understand the extent to which the RTS are currently being fulfilled, and d) conceptual consideration of the significance of current developments in rehabilitation in light of the RTS revision. RESULTS: There are now updated versions of all 9 RTS. Over half of the therapy modules are based on scientific evidence. Other modules are based on clinical experience with good clinical-practice standards. The scientific evidence has not changed much overall in the last few years, although there are some indications of higher evidence levels. CONCLUSION: The revised RTS can make a positive contribution to ensuring that rehabilitation is of high quality. Further research is needed to increase the level of evidence - especially regarding the intensity of therapy.

[Compatibility of Work and Family Life of Employees in the Healthcare Sector: An Issue in Health Services Research]. / Vereinbarkeit von Familie und Beruf bei Beschäftigten im Gesundheitswesen als Handlungsfeld der Versorgungsforschung.

BACKGROUND: Healthcare professionals are confronted with specific work-related demands that influence work-family relations and might indirectly affect the quality of healthcare. This paper seeks to provide an overview of the current state of research on this topic of relevance to health services research. The overview may serve as a starting point for modifying structures in the healthcare system (especially in rural regions) with the aim of improving work-family compatibility. METHODS: A systematic national and international literature search was conducted in terms of a scoping review. The following criteria/contents to be covered in publications were defined: work-family compatibility; work-family interface and work-family conflict in employees working in healthcare; healthcare professions in rural areas and links with work-family issues; interventions to improve work-family compatibility. 145 publications were included in the overview. RESULTS: The available literature focuses on physicians and nursing staff while publications on other professions are largely lacking. The methodological quality of existing studies is mostly low, including a lack of meta-analyses. Several studies document dissatisfaction in physicians and nursing staff regarding reconciliation of work and family life. Only few intervention studies were found that seek to improve work-life compatibility; few of them focus on employees in healthcare. There are also deficits with respect to linking work-family issues with aspects of healthcare in rural areas. CONCLUSIONS: There is a shortage of systematic national and international research regarding work-family compatibility, especially when it comes to the evaluation of interventions. The overview provides starting points for improving work-family compatibility in healthcare.

Short Questionnaire for Workplace Analysis (KFZA): factorial validation in physicians and nurses working in hospital settings.

BACKGROUND: In recent years, there has been an increasing interest in psychosocial workplace risk assessments in Germany. One of the questionnaires commonly employed for this purpose is the Short Questionnaire for Workplace Analysis (KFZA). Originally, the KFZA was developed and validated for office workers. The aim of the present study was to examine the factorial validity of the KFZA when applied to hospital settings. Therefore, we examined the factorial structure of a questionnaire that contained all the original items plus an extension adding 11 questions specific to hospital workplaces and analyzed both, the original version and the extended version. METHODS: We analyzed questionnaire data of a total of 1731 physicians and nurses obtained over a 10-year period. Listwise exclusion of data sets was applied to account for variations in questionnaire versions and yielded 1163 questionnaires (1095 for the extended version) remaining for factor analysis. To examine the factor structure, we conducted a principal component factor analysis. The number of factors was determined using the Kaiser criterion and scree-plot methods. Factor interpretation was based on orthogonal Varimax rotation as well as oblique rotation. RESULTS: The Kaiser criterion revealed a 7-factor solution for the 26 items of the KFZA, accounting for 62.0% of variance. The seven factors were named: "Social Relationships", "Job Control", "Opportunities for Participation and Professional Development", "Quantitative Work Demands", "Workplace Environment", "Variability" and "Qualitative Work Demands". The factor analysis of the 37 items of the extended version yielded a 9-factor solution. The two additional factors were named "Consequences of Strain" and "Emotional Demands". Cronbach's α ranged from 0.63 to 0.87 for these scales. CONCLUSIONS: Overall, the KFZA turned out to be applicable to hospital workers, and its content-related structure was replicated well with some limitations. However, instead of the 11 factors originally proposed for office workers, a 7-factor solution appeared to be more suitable when employed in hospitals. In particular, the items of the KFZA factor "Completeness of Task" might need adaptation for the use in hospitals. Our study contributes to the assessment of the validity of this popular instrument and should stimulate further psychometric testing.

Addressing Work-Related Issues in Medical Rehabilitation: Revision of an Online Information Tool for Healthcare Professionals.

Background. Medical rehabilitation increasingly considers occupational issues as determinants of health and work ability. Information on work-related rehabilitation concepts should therefore be made available to healthcare professionals. Objective. To revise a website providing healthcare professionals in medical rehabilitation facilities with information on work-related concepts in terms of updating existing information and including new topics, based on recommendations from implementation research. Method. The modification process included a questionnaire survey of medical rehabilitation centers (n = 28); two workshops with experts from rehabilitation centers, health payers, and research institutions (n = 14); the selection of new topics and revision of existing text modules based on expert consensus; and an update of good practice descriptions of work-related measures. Results. Health payers' requirements, workplace descriptions, and practical implementation aids were added as new topics. The database of good practice examples was extended to 63 descriptions. Information on introductory concepts was rewritten and supplemented by current data. Diagnostic tools were updated by including additional assessments. Conclusions. Recommendations from implementation research such as assessing user needs and including expert knowledge may serve as a useful starting point for the dissemination of information on work-related medical rehabilitation into practice. Web-based information tools such as the website presented here can be quickly adapted to current evidence and changes in medicolegal regulations.

[Development and Evaluation of a Teacher Training for the Early Recognition of Depressive Symptoms in Students]. / Entwicklung und Evaluation einer Lehrerfortbildung zur Früherkennung depressiver Symptome bei Schülern.

BACKGROUND AND STUDY OBJECTIVES: Although teachers play an important role regarding early recognition of psychological problems in students, they have been largely neglected in research as a target group for interventions. In this study, a training for teachers was developed that aimed at improving knowledge and self-efficacy/subjective competencies with regard to the early recognition of mental distress in secondary school students with a specific focus on depressive symptoms (by means of providing information, interviewing techniques, and important contact persons). METHODS: A training module comprising 4 h directed at teachers in secondary schools was developed and tested in 6 schools in a pre-post evaluation design. Participating teachers rated the training as well as their knowledge and self-efficacy/subjective competencies at 3 time points (before training (T1); after training (T2); 6-months-follow-up (T3)). RESULTS: Questionnaire data from N=44 teachers were available for all 3 data points (baseline sample: N=100). There was a slight but nonsignificant post-training increase in knowledge regarding depressive symptoms (partial Eta(2)=0,047). A significant benefit was found for most self-efficacy items (partial Eta(2)=0,14-0,67). Participants reported gains in subjective competencies with regard to initiating a dialogue with a distressed student and approaching his/her parents. Training contents and realization were rated positively immediately after the training as well as at follow up. DISCUSSION: The evaluation of the teacher training for early recognition of mental distress in students showed promising preliminary results that should be substantiated in a randomized controlled design.

Long-term effects of interprofessional biopsychosocial rehabilitation for adults with chronic non-specific low back pain: a multicentre, quasi-experimental study.

BACKGROUND: Improvement of the long-term effectiveness of multidisciplinary ortho-paedic rehabilitation (MOR) in the management of chronic non-specific low back pain (CLBP) remains a central issue for health care in Germany. We developed an interprofessional and interdisciplinary, biopsychosocial rehabilitation concept named "PASTOR" to promote self-management in adults with CLBP and compared its effectiveness with the current model of MOR. METHODS: A multicentre quasi-experimental study with three measurement time points was implemented. 680 adults aged 18 to 65 with CLBP were assed for eligibil-ity in three inpatient rehabilitation centres in Germany. At first the effects of the MOR, with a total extent of 48 hours (control group), were assessed. Thereafter, PASTOR was implemented and evaluated in the same centres (intervention group). It consisted of six interprofessional modules, which were provided on 12 days in fixed groups, with a total extent of 48 hours. Participants were assessed with self-report measures at baseline, discharge, and 12 months for functional ability (primary outcome) using the Hannover Functional Ability Questionnaire (FFbH-R) and vari-ous secondary outcomes (e.g. pain, health status, physical activity, pain coping, pain-related cognitions). RESULTS: In total 536 participants were consecutively assigned to PASTOR (n=266) or MOR (n=270). At 12 months, complete data of 368 participants was available. The adjusted between-group difference in the FFbH-R at 12 months was 6.58 (95% CI 3.38 to 9.78) using complete data and 3.56 (95% CI 0.45 to 6.67) using available da-ta, corresponding to significant small-to-medium effect sizes of d=0.42 (p<0.001) and d=0.10 (p=0.025) in favour of PASTOR. Further improvements in secondary out-comes were also observed in favour of PASTOR. CONCLUSION: The interprofessional and interdisciplinary, biopsychosocial rehabilita-tion program PASTOR shows some improvements of the long-term effectiveness of inpatient rehabilitation in the management of adults with CLBP. Further insights into mechanisms of action of complex intervention programs are required. TRIAL REGISTRATION: ClinicalTrials.gov NCT02056951.

Benefits and challenges in practice-oriented psychotherapy research in Germany: the TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy.

OBJECTIVE: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study ("Quality Assurance in Outpatient Psychotherapy in Bavaria"; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. METHOD: Both projects and their results indicating high effect sizes are briefly described. RESULTS: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. CONCLUSIONS: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

Paediatric rehabilitation treatment standards: a method for quality assurance in Germany.

OVER THE LAST FEW YEARS, THE GERMAN PENSION INSURANCE HAS IMPLEMENTED A NEW METHOD OF QUALITY ASSURANCE FOR INPATIENT REHABILITATION OF CHILDREN AND ADOLESCENTS DIAGNOSED WITH BRONCHIAL ASTHMA, OBESITY, OR ATOPIC DERMATITIS: the so-called rehabilitation treatment standards (RTS). They aim at promoting a comprehensive and evidence-based care in rehabilitation. Furthermore, they are intended to make the therapeutic processes in medical rehabilitation as well as potential deficits more transparent. The development of RTS was composed of five phases during which current scientific evidence, expert knowledge, and patient expectations were included. Their core element is the specification of evidence-based treatment modules that describe a good rehabilitation standard for children diagnosed with bronchial asthma, obesity, or atopic dermatitis. Opportunities and limitations of the RTS as a tool for quality assurance are discussed. Significance for public healthThe German pension insurance's rehabilitation treatment standards (RTS) for inpatient rehabilitation of children and adolescents aim at contributing to a comprehensive and evidence-based care in paediatric rehabilitation. As a core element, they comprise evidence-based treatment modules that describe a good rehabilitation standard for children diagnosed with bronchial asthma, obesity, or atopic dermatitis. Although the RTS have been developed for the specific context of the German health care system, they may be referred to as a more general starting point regarding the development of health care and quality assurance standards in child/adolescent medical rehabilitative care.

[Use of standardized patients in the psycho-social subjects of medical studies--applicability of standardized patients in postgraduate psychotherapy training curricula?]. / Einsatz von Schauspielpatienten in den "Psych-"Fächern des Medizinstudiums--Verwendungsmöglichkeiten in der Psychotherapieausbildung?

Due to the successful use of standardized patients (SPs) in medical studies, possible fields of application for SPs in postgraduate psychotherapy training were examined on the basis of a systematic literature research (ranging from 1982 to 2011) on the use of SPs in the fields of psychotherapy, medical psychology, psychosomatic medicine, and psychiatry. The results show that SPs are used predominantly for teaching communication and counseling techniques, history taking, and assessment of psychopathology and are commonly used to portray patients with affective disorders, neurotic, stress and somatoform disorders and schizophrenia, as well as schizotypal and delusional disorders. The use of SPs is generally rated positively with regard to subjective learning effects, satisfaction, and authenticity. Hence, the results suggest that postgraduate psychotherapy training curricula might benefit from the implementation of SPs.

[Results of the pilot project of the Techniker-Krankenkasse "quality monitoring in outpatient psychotherapy" - a commentary by the project's scientific advisory board]. / Zu den Ergebnissen des Modellprojektes der Techniker-Krankenkasse zum Qualitätsmonitoring in der ambulanten Psychotherapie - eine Replik des wissenschaftlichen Beirats.

In order to objectify the discussion about a project of the TK, a German health insurance company, which aimed to analyse the effects of a specific quality monitoring system on psychotherapy outcomes, the scientific advisory board summarized the main results of the study. The main results were cited from the final report which confirms the confirmatory character of the study design that aimed to test the hypothesis of the superiority of the quality monitoring system compared to the system of peer review-based approval of therapies. The quality monitoring system represents a complex intervention which is composed of several single intervention elements. Thus, the study results allow only the conclusion that the overall complex interven-tion did not prove to be superior. Further studies are needed with regard to the effectiveness of single components. Finally, the issues of representativeness and selectivity of the study and the sample are discussed and their importance is -underlined by reference to the literature.

[The project of the Techniker-Krankenkasse: some comments on the results by the project's scientific advisory board]. / Das Modellprojekt der Techniker-Krankenkasse: Eine Kommentierung der Ergebnisse aus der Sicht des wissenschaftlichen Projektbeirates.

The Project of the Techniker Krankenkasse compared 2 systems of quality assurance in outpatient psychotherapy, the established peer review system based on qualitative individual case reports and a new model based on psychometric assessment and feed-back systems. In this publication the members of the project advisory board comment on the results and limitations of the study. 400 psychotherapists in private practice participated in a cluster-randomized comparison study, 200 were allocated to the intervention group, and 200 to the control group. In both groups assessments were performed at 3 points in time, one at the beginning of treatment, one at the end of treatment and one at follow-up 12 months post-treatment. No significant differences in psychotherapeutic outcome were observed in the 2 groups. The hypothesis of a better outcome associated with the psychometric assessment and benchmarking procedure was not confirmed.