[Quality of vocational education in speech therapy - development and implementation of a quality assurance programme]. / Therapeutenausbildung auf dem Prüfstand - Entwicklung und Umsetzung eines Verfahrens zur Qualitätssicherung der logopädischen Ausbildung.

The provision of high-quality health-services is only possible if it is based on vocational education of corresponding quality. To promote the quality of vocational education in speech therapy, a quality assurance programme was developed in a scientifically supervised multi-step process. The main goals of the quality assurance programme include: (i) external review of the quality of education by means of well-defined criteria, (ii) certification of schools that meet the requirements, and (iii) provision of feedback to schools about their results. A total of 208 quality indicators cover the essential aspects of vocational education in speech therapy, and apply to the structural, process and outcome quality. These indicators are based on a literature survey as well as on expert opinion, and are calibrated by data. The data are collected by using questionnaires (school management, teachers in speech therapy, students, consecutive patient sample) and are validated by specific document analyses and telephone audits. Each school receives an individual quality report of its achieved results benchmarked to other schools. Since the initial implementation in 2008, a total of 50 schools participated in the quality assurance programme and 41 achieved certification. Therefore, the defined set of quality criteria has been disseminated and utilized by about half of all German schools for vocational education in speech therapy. The evaluation of the data on quality collected across all schools highlights the strengths and weaknesses of vocational education as well as the demands for quality improvement.

[Can quality of life in psychotherapy be measured with clinician-ratings? A comparison of patient- and clinician-ratings using the SF-8]. / Zusammenhang zwischen Patienten- und Therapeuteneinschätzungen der Ergebnisqualität in der Rehabilitation von Patienten mit psychischen/psychosomatischen Erkrankungen am Beispiel des SF-8.

OBJECTIVE: Quality of life is a major criterion of the outcome of psychotherapeutic interventions. The concept of quality of life emphasizes patient self-ratings. However, they can be burdensome or inappropriate in some cases. Therefore we have compared self-ratings and clinician-ratings of quality of life. METHODS: Self- and clinician-ratings of the SF-8 (1-week recall version) were measured from consecutive samples of 1 812 inpatients from eleven psychotherapeutic clinics at admission and at discharge six weeks later. A physical summary score (PSS) and a mental summary score (MSS) were calculated. Pearson product-moment correlations were used. RESULTS: Self- and clinician-ratings of the PSS correlate r=0.48 at admission and r=0.58 at discharge, of the MSS r=0.46 and r=0.51, respectively. Concerning single items we find the highest correlation for item 4 (bodily pain: r=0.53 and r=0.55), the lowest for item 6 (social functioning: r=0.26 and r=0.30). Change scores of the PSS correlate r=0.20, of the MSS r=0.32. Correlations differ between diagnostic groups: Correlations are low for patients with either schizophrenia (F2), depressive episode (F32) or personality disorder (F60-62), comparatively higher for patients with dysthymia. Comparing correlations across the 11 clinics reveals substantial differences, for the MSS ranging from r=0.38 to r=0.58 at admission and r=0.27 to r=0.68 at discharge. CONCLUSION: Patient self-ratings of quality of life as a psychotherapeutic outcome measure using the SF-8 Health Survey could not be substituted by clinician-ratings, they should be used as complements.

[Structure quality assurance in in-patient medical rehabilitation of children and adolescents]. / Sicherung der Strukturqualität in der stationären medizinischen Rehabilitation von Kindern und Jugendlichen.

BACKGROUND: So far, the routine programmes of the statutory pension and health insurance institutes for quality assurance in medical rehabilitation have not included facilities for children and adolescents. Thus, a conjoint project of the statutory pension and health insurance institutes to assess and to describe the structure quality of in-patient medical rehabilitation clinics for children and adolescents was initiated. The aim of the project was a survey and an analysis of the currently existing clinic structures and the development of criteria for an evaluation of the structure quality. The Institute of Medical Psychology, University of Hamburg and the Department of Quality Management and Social Medicine, University of Freiburg were engaged to conduct the project. METHOD: A questionnaire was developed in a multi-stage process with expert involvement which covers general information, characteristics of structure quality as well as structure affiliated process characteristics of clinics. The survey was planned as a cross-sectional study. Data collection was accomplished from 1.12.2004 - 15.3.2005. RESULTS: A total of n = 177 facility addresses were available. The return rate was 83.3 %. Eventually, n = 79 facilities were included in the analysis. In sum, the results underline the heterogeneity of services in the field of child and adolescent rehabilitation. CONCLUSIONS: The results allow an analysis of the current clinic structures as well as a first comparison of clinics on the basis of the assessed structure characteristics.

[Quality assurance in the field of medical rehabilitation in Germany. State of the art and perspectives]. / Qualitätssicherung in der medizinischen Rehabilitation in Deutschland. Entwicklungsstand und Perspektiven.

To a large extent, medical rehabilitation is an independent part of the German health system. Since the middle of the 1980s it has undergone a modification process oriented towards different objectives. Quality assurance programs and strengthened scientific rehabilitation research have been introduced with the aim of optimizing results and user orientation. The quality assurance programs have been routinely implemented for most of the rehabilitative areas of indication. Procedures and instruments for data collection, analysis, and feedback to the clinics involved have been developed with regard to the dimensions of the quality of structures, processes, and rehabilitative outcome. Current demands on the programs relate to the handling of the results in the involved clinics, a convergence of the quality assurance programs of the federal pension insurance with those of the health insurance organizations, and an evaluation of the procedure as a whole.

[Not Available]. / Zum Stand der Qualitätssicherung in der Rehabilitation Zur Entwicklung der medizinischen Rehabilitation in den 90er-Jahren : Zur Entwicklung der medizinischen Rehabilitation in den 90er-Jahren.

Since the 1990ies, the field of Medical Rehabilitation in Germany, which is a largely independent part of the German health care system, has undergone a modification process oriented towards various objectives. An optimized orientation towards both user related attributes and result related aspects has been the object of endeavors, manifested in the introduction of quality assurance programs and intensified rehabilitation-scientific research. The quality assurance program created by the medical rehabilitation section of the federal statutory pension insurance providers (the so-called 5-point program) forms a central component of this new orientation. The conceptualization of appropriate initiatives for the medical rehabilitation sections of the health insurance organizations, for providers of child rehabilitation, and the field of ambulatory rehabilitation will take place within the immediate future.

[Quality assurance in the field of psychosomatic rehabilitation]. / Qualitätssicherung in der Psychosomatischen Rehabilitation.

Since the mid 1990s, the statutory pension insurance agencies have developed and begun to implement a broad program for quality management in the field of medical rehabilitation. A total of 942 rehabilitation clinics from all areas of indication, including the field of psychosomatic rehabilitation, are currently participating in the program. In its first program point, the 5-point program deals with the collection and analysis of structural and conceptual aspects. Program point 2 deals with the documentation of therapy plans for the primary treatment groups; in program point 3, clinical documentations are used for a quality screening (peer review procedure), and in point four, patient satisfaction and treatment results will be evaluated by patient interviews. The analysis of inadequacies performed within these program points will be returned to the clinics by means of an information system. Thus, the clinics receive information on the conditions in their own clinics against the backdrop of results from clinics with similar structures. The quality problems which are identified, will be dealt with in the framework of quality circles (program point 5). This article describes and discusses the specifications of the quality assurance program for the field of psychosomatic rehabilitation.

[Strategies for classification of rehabilitation clinics based on structural equality]. / Strategien zur Taxonomie von Rehabilitationskliniken auf der Basis von Strukturgleichheit.

Comparison between clinics is a basic part of most quality assurance programmes. The classification of structurally similar clinics is a prerequisite for enabling comparisons between clinics according to quality criteria. As a part of the programme point 1 "structural quality" of the Pension insurance quality assurance programme in medical rehabilitation, a procedure was developed to classify clinics into structurally similar groups. For this purpose the data of the structure survey of the quality assurance programme was used. The first step was to check whether existing classification systems could be used, which made the need for a new classification procedure apparent. The 942 participating clinics were clustered according to a successive differentiation system employing only quality-neutral criteria, e.g., the indication group, the number of different indications, the part of AHB, number of beds, and the therapeutic focus. Further differentiation beyond indication group was necessary for the indications orthopaedics, cardiology, psychosomatics, addiction and neurology. The procedure is demonstrated using the indications orthopaedics and cardiology as examples.

[Assessing the quality of structures, concepts, and processes in prevention, health promotion, and education. Requirements and solutions]. / Die Beurteilung der Struktur-, Konzept- und Prozessqualität von Prävention und Gesundheitsförderung. Anforderungen und Lösungen.

The effectiveness of health promotion is determined by the foundation of evidence, the targeting of health problems, and the adaptation of interventions to specific social and organizational contexts. Methods for the implementation of these objectives must be able to balance interacting intervention goals, to account for the suitability of interventions for specific target groups and settings, and to integrate complex and divergent data. The core methodology underlying these conditions is peer review assessment. A quality assurance system based on this approach is presented: Two inventories elicit detailed self-descriptions characterizing either actors or activities within health promotion and education. Two assessment instruments instruct experts in reviewing these data according to primary and partial dimensions of quality. Thus, systematically structured and quantifiable quality profiles of organizational units or specific activities are produced. On this basis, comparative indicators for benchmarking purposes can be calculated. Quality profiles containing the strengths and weaknesses of organizations or activities, including indicators, benchmarks, and reviewers' recommendations, are communicated to participating organizations in order to stimulate continuous quality improvement by feedback. Moreover, the system offers a database of comparative indicators for monitoring and optimizing health promotion and education.