Quality measurement of out-patient neuropsychological therapy after stroke in Germany: definition of indicators and retrospective pilot study.

BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.

[Computer assisted training of attention and concentration with healthy children]. / Computergestütztes Aufmerksamkeits- und Konzentrationstraining bei gesunden Kindern.

The intention of this study was to analyze in how far a computer assisted training for brain damaged adults can be used for the practice with children. Healthy children of different ages were trained with this attention and concentration programme. The results should help to adapt the training programme for the use in brain damaged children. Age-groups differed significantly in level of performance. Data showed that in comparison to Kindergarten-children, first-grade children showed a higher benefit from the training. Implications for modifications of the training-programme are discussed. Other parameter of performance (reaction-time, errors) in relation to school age provide clues to the distribution of structure of difficulty in the programmes. A questionnaire assessing motivation before and during the training, intelligibility of the task, feasibility of the computer and adequacy of the test in children showed that sustained motivation can be achieved provided the training is used in an adaptive way. Thereby demotivating with too easy tasks as well as frustration caused by difficult tasks can be avoided. In general, there was good acceptance of the computerised cognitive training. The presence of a therapist during every training session proved to be necessary in children under the age of 6 years.