Measurement of healthcare quality in atopic dermatitis - development and application of a set of quality indicators.

BACKGROUND: Quality indicators are essential tools for the assessment of health care, in particular for guideline-based procedures. OBJECTIVE: Development of a set of indicators for the evaluation of process and outcomes quality in atopic dermatitis (AD) care. Application of the indicators to a cross-sectional study and creation of a global process quality index. METHODS: An expert committee consisting of 10 members of the German guideline group on AD condensed potential quality indicators to a final set of 5 outcomes quality and 12 process quality indicators using a Delphi panel. The outcomes quality and 7 resp. 8 process quality indicators were retrospectively applied to a nationwide study on 1678 patients with atopic dermatitis (AtopicHealth). Each individual process quality indicator score was then summed up to a global index (ranges from 0 [no quality achieved] to 100 [full quality achieved]) displaying the quality of health care. RESULTS: In total, the global process quality index revealed a median value of 62.5 and did not or only slightly correlate to outcomes quality indicators like the median SCORing Atopic Dermatitis (SCORAD; rp = 0.08), Dermatology Life Quality Index (DLQI; rp = 0.256) and Patient Benefit Index (PBI; rp = -0.151). CONCLUSION: Process quality of AD care is moderate to good. The healthcare process quality index does not substantially correlate to the health status of AD patients measured by 5 different outcomes quality indicators. Further research should include the investigation of reliability, responsiveness and feasibility of the proposed quality indicators for AD.

Prevalence of skin lesions and need for treatment in a cohort of 90 880 workers.

BACKGROUND: Healthcare planning requires robust data on the prevalence and need for care of dermatological diseases. To date, no systematic data in population-based samples are available for Germany. OBJECTIVES: Determination of the prevalence of skin lesions and of the need for care based on dermatological examinations in working adults in Germany. METHODS: From 2004 to 2009, workers aged between 16 and 70years from different branches of industry throughout Germany underwent a single dermatological whole-body examination on the occasion of company screening for skin cancer. The data were recorded electronically and evaluated descriptively. In addition to the clinical findings, case history data on previous skin diseases were documented and the need for further clarification or treatment was determined on the basis of the dermatologist's assessment. RESULTS: Data from n=90 880 persons from a total of 312 companies were evaluated. Of the pigmented skin lesions, dermal naevi were found in 25·1% of the cohort, and 16·7% displayed more than 40 each. The most frequent inflammatory skin diseases were acne vulgaris (3·9%), psoriasis (2·0%), rosacea (2·3%) and atopic eczema (1·3%). Examination of the case histories showed that the most frequent condition was allergic sensitizations (41·1%); of these, pollen accounted for the biggest group (21·4%), followed by contact allergens (8·0%). In total, 26·8% of the cohort exhibited a dermatological finding in need of treatment or further clarification. CONCLUSIONS: Dermatological lesions and diseases requiring clarification are frequent and indicate a high demand for treatment in the adult population.