Gunda Musekamp

Measurement invariance across chronic conditions: a systematic review and an empirical investigation of the Health Education Impact Questionnaire (heiQ™)

BackgroundTo examine whether lack of measurement invariance (MI) influences mean comparisons among different disease groups, this paper provides (1) a systematic review of MI in generic constructs across chronic conditions and (2) an empirical analysis of MI in the Health Education Impact Questionnaire (heiQ™).Methods(1) We searched for studies of MI among different chronic conditions in online databases. (2) Multigroup confirmatory factor analyses were used to study MI among five chronic conditions (orthopedic condition, rheumatism, asthma, COPD, cancer) in the heiQ™ with N = 1404 rehabilitation inpatients. Impact on latent and composite mean differences was examined.Results(1) A total of 30 relevant studies suggested that about one in three items lacked MI. However, only four studies examined impact on latent mean differences. Scale means were only affected in one of these three studies. (2) Across the eight heiQ™ scales, seven scales had items with lack of MI in at least one disease group. However, in only two heiQ™ scales were some latent or composite mean differences affected.ConclusionsLack of MI among disease groups is common and may have a relevant influence on mean comparisons when using generic instruments. Therefore, when comparing disease groups, tests of MI should be implemented. More studies of MI and according impact on mean differences in generic questionnaires are needed.

Individual prevention courses for occupational skin diseases: changes in and relationships between proximal and distal outcomes

To treat people with occupational contact dermatitis, the German Accident Prevention and Insurance Association in the Health and Welfare Services offers 2‐day individual prevention (IP) seminars.

Entwicklung von Verfahrensweisen und Instrumenten zur externen Qualitätssicherung in Einrichtungen der stationären Vorsorge und Rehabilitation für Mütter und Väter einschließlich Mutter-/Vater-Kind-Einrichtungen

OBJECTIVE There so far is no standardized program for external quality assurance in inpatient parent-child prevention and rehabilitation in Germany. Therefore, instruments and methods of external quality assurance were developed and evaluated on behalf of the federal-level health insurance institutions. METHODS On the level of structure quality, a modular questionnaire for assessing structural features of rehabilitation/prevention centers, basic and allocation criteria as well as a checklist for visitations were developed. Structural data were collected in a nationwide survey of parent-child prevention and rehabilitation centers. Process and outcome quality data were collected in n=38 centers. Process quality was assessed using multiple methods (process-related structural features, case-related routine documentation, and incident-related patient questionnaires). Outcome quality was measured via patient questionnaires (n=1 799 patients). We used a multi-level modelling approach by adjusting relevant confounders on institutional and patient levels. RESULTS The methods, instruments and analyzing procedures developed for measuring quality on the level of structure, processes and outcomes were adjusted in cooperation with all relevant stakeholders. Results are exemplarily presented for all quality assurance tools. For most of the risk-adjusted outcome parameters, we found no significant differences between institutions. CONCLUSIONS For the first time, a comprehensive, standardized and generally applicable set of methods and instruments for routine use in comparative quality measurement of inpatient parent-child prevention and rehabilitation is available. However, it should be considered that the very heterogeneous field of family-oriented measures can not be covered entirely by an external quality assurance program. Therefore, methods and instruments have to be adapted continuously to the specifics of this area of health care and to new developments.

Wirksamkeitsprüfung rheumatologischer Schulungen@@@Evaluation of effectiveness of education in rheumatology: Empfehlungen nach einem Wirkmodell der Patientenschulung@@@Recommendations according to a patient education model

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.ZusammenfassungPatientenschulungen in der Rheumatologie sollten evidenzbasiert sein. Laut Empfehlungen der European League Against Rheumatism (EULAR) sollten sich die Zielgrößen der Evaluation an den Zielen der jeweiligen Schulung orientieren. In Deutschland wurden für alle relevanten rheumatologischen Indikationen Schulungsziele beschrieben, Schulungsprogramme publiziert und evaluiert. Zur Wirksamkeitsprüfung sollten proximale und distale Zielgrößen herangezogen werden, die in unserem „Wirkmodell der Patientenschulung“ dargestellt werden. Proximale Zielgrößen sind Gesundheitskompetenzen (Wissen, Fertigkeiten, Einstellungen, Motivation) und Empowerment. Diese können direkt durch die Schulungselemente beeinflusst werden. Distale Zielgrößen sind Selbstmanagement (Gesundheitsverhalten, Adhärenz, Krankheitsbewältigung, Emotionsregulation), Morbidität, Funktionsfähigkeit, Lebensqualität und Teilhabe. Letztere werden durch proximale Zielgrößen und eine Reihe von person- und umweltbezogenen Faktoren beeinflusst. Ergebnisse einer Literaturrecherche fassen geeignete Messinstrumente zur Erfassung dieser Zielgrößen zusammen. Für distale Zielgrößen gibt es für einige rheumatologische Indikationen valide Fragebogeninstrumente in deutscher Sprache. Zur Erfassung proximaler Zielgrößen gibt es noch Entwicklungsbedarf. Wir empfehlen, bei der Evaluation von Patientenschulungen proximale und distale Zielgrößen nach dem Wirkmodell auszuwählen und die Wirkzusammenhänge zwischen den Zielgrößen zu überprüfen.AbstractPatient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.

Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education

BackgroundHeart failure (HF) patient education aims to foster patients’ self-management skills. These are assumed to bring about, in turn, improvements in distal outcomes such as quality of life. The purpose of this study was to test the hypothesis that change in self-reported self-management skills observed after participation in self-management education predicts changes in physical and mental quality of life and depressive symptoms up to one year thereafter.MethodsThe sample comprised 342 patients with chronic heart failure, treated in inpatient rehabilitation clinics, who received a heart failure self-management education program. Latent change modelling was used to analyze relationships between both short-term (during inpatient rehabilitation) and intermediate-term (after six months) changes in self-reported self-management skills and both intermediate-term and long-term (after twelve months) changes in physical and mental quality of life and depressive symptoms.ResultsShort-term changes in self-reported self-management skills predicted intermediate-term changes in mental quality of life and long-term changes in physical quality of life. Intermediate-term changes in self-reported self-management skills predicted long-term changes in all outcomes.ConclusionsThese findings support the assumption that improvements in self-management skills may foster improvements in distal outcomes.

Wirksamkeitsprüfung rheumatologischer Schulungen

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.ZusammenfassungPatientenschulungen in der Rheumatologie sollten evidenzbasiert sein. Laut Empfehlungen der European League Against Rheumatism (EULAR) sollten sich die Zielgrößen der Evaluation an den Zielen der jeweiligen Schulung orientieren. In Deutschland wurden für alle relevanten rheumatologischen Indikationen Schulungsziele beschrieben, Schulungsprogramme publiziert und evaluiert. Zur Wirksamkeitsprüfung sollten proximale und distale Zielgrößen herangezogen werden, die in unserem „Wirkmodell der Patientenschulung“ dargestellt werden. Proximale Zielgrößen sind Gesundheitskompetenzen (Wissen, Fertigkeiten, Einstellungen, Motivation) und Empowerment. Diese können direkt durch die Schulungselemente beeinflusst werden. Distale Zielgrößen sind Selbstmanagement (Gesundheitsverhalten, Adhärenz, Krankheitsbewältigung, Emotionsregulation), Morbidität, Funktionsfähigkeit, Lebensqualität und Teilhabe. Letztere werden durch proximale Zielgrößen und eine Reihe von person- und umweltbezogenen Faktoren beeinflusst. Ergebnisse einer Literaturrecherche fassen geeignete Messinstrumente zur Erfassung dieser Zielgrößen zusammen. Für distale Zielgrößen gibt es für einige rheumatologische Indikationen valide Fragebogeninstrumente in deutscher Sprache. Zur Erfassung proximaler Zielgrößen gibt es noch Entwicklungsbedarf. Wir empfehlen, bei der Evaluation von Patientenschulungen proximale und distale Zielgrößen nach dem Wirkmodell auszuwählen und die Wirkzusammenhänge zwischen den Zielgrößen zu überprüfen.AbstractPatient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.

[Evaluation of effectiveness of education in rheumatology : Recommendations according to a patient education model].

Patient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.ZusammenfassungPatientenschulungen in der Rheumatologie sollten evidenzbasiert sein. Laut Empfehlungen der European League Against Rheumatism (EULAR) sollten sich die Zielgrößen der Evaluation an den Zielen der jeweiligen Schulung orientieren. In Deutschland wurden für alle relevanten rheumatologischen Indikationen Schulungsziele beschrieben, Schulungsprogramme publiziert und evaluiert. Zur Wirksamkeitsprüfung sollten proximale und distale Zielgrößen herangezogen werden, die in unserem „Wirkmodell der Patientenschulung“ dargestellt werden. Proximale Zielgrößen sind Gesundheitskompetenzen (Wissen, Fertigkeiten, Einstellungen, Motivation) und Empowerment. Diese können direkt durch die Schulungselemente beeinflusst werden. Distale Zielgrößen sind Selbstmanagement (Gesundheitsverhalten, Adhärenz, Krankheitsbewältigung, Emotionsregulation), Morbidität, Funktionsfähigkeit, Lebensqualität und Teilhabe. Letztere werden durch proximale Zielgrößen und eine Reihe von person- und umweltbezogenen Faktoren beeinflusst. Ergebnisse einer Literaturrecherche fassen geeignete Messinstrumente zur Erfassung dieser Zielgrößen zusammen. Für distale Zielgrößen gibt es für einige rheumatologische Indikationen valide Fragebogeninstrumente in deutscher Sprache. Zur Erfassung proximaler Zielgrößen gibt es noch Entwicklungsbedarf. Wir empfehlen, bei der Evaluation von Patientenschulungen proximale und distale Zielgrößen nach dem Wirkmodell auszuwählen und die Wirkzusammenhänge zwischen den Zielgrößen zu überprüfen.AbstractPatient education in rheumatology should be evidence-based. As recommended by the European League Against Rheumatism (EULAR) the outcomes of evaluation studies should be based on the goals of the education program. In Germany the goals of education programs have been described for all relevant rheumatological indications, various education programs have been published and evaluated. Our model of patient education outcomes distinguishes proximal and distal outcomes that should be used in effectiveness studies. Proximal goals include health literacy (e.g. knowledge, skills, attitudes and motivation) and empowerment. These can be directly influenced by the educational elements of a program. Distal outcomes include self-management behavior (e.g. health behavior, adherence, coping and emotion regulation), morbidity, functioning, quality of life and participation. The latter can be influenced by proximal outcomes and moderated by a number of personal and environmental factors. The results of a literature search summarize appropriate measurements for these outcomes. For distal outcomes, valid instruments exist in the German language for some rheumatological indications. To assess proximal goals there are still developmental needs. We recommend choosing proximal and distal outcomes for evaluation according to the model of patient education outcomes and to test the relationships between these outcomes.

Externe Qualitätssicherung in Mutter-/Vater-Kind-Einrichtungen: Entwicklung von Instrumenten im Bereich Strukturqualität

AIM OF THE STUDY As required by German law, inpatient institutions offering prevention and rehabilitation measures for mothers, fathers and children are obliged to implement external quality assurance measures. In 2 pilot projects funded by the German federal association of health insurance funds, external quality assurance procedures for in-hospital prevention and rehabilitation of mothers and fathers were analyzed with the aim of developing a set of instruments for the description of structural characteristics in this area of health care and to evaluate its appropriateness. Concerning structure-related quality, the project included a) designing and evaluating a questionnaire, b) the definition of assessment criteria for subsequent comparative data analyses, and c) the description and documentation of the current state in the field of rehabilitation and prevention for mothers, fathers and children. METHOD To document structural quality comprehensively, a modular questionnaire was developed and tested in a survey of 115 inpatient prevention and rehabilitation institutions for mothers, fathers and children. Involving an expert panel, preliminary basic and selection criteria were defined in order to assure a conducive assessment with regard to structural attributes. RESULTS The majority of institutions had provider agreements for both prevention and rehabilitation. Measures for mothers/fathers with children were predominant; only 7 institutions exclusively treated mothers and fathers. Institution sizes varied strongly. Major indications included psychosomatics, dermatology, and pneumology. Overall, structural conditions of the institutions showed a high standard. Potential for development was found with regard to some aspects of the conceptual framework of institutional practice and the implementation of the International Classification of Functioning, Disability and Health (ICF) in diagnostics. In this article, the degrees of fulfillment with relation to the structural dimensions are presented, referring to the analysis of the preliminary basic criteria. CONCLUSIONS The developed modular questionnaire tapping structural features of inpatient mother/father-child institutions has proven to be a useful instrument to describe the structural quality in future routine practice of quality assurance. In addition, the data can be used for the definition of the final set of criteria.

Translation and psychometric testing of the German version of the Health Education Impact Questionnaire (heiQ)

This journal suppl. contain abstracts presented at the 19th Annual Conference of the International Society for Quality of Life Research

Outcome Assessment in External Quality Assurance Programs for Family-Oriented Medical Rehabilitation in Germany

INTRODUCTION In-patient medical rehabilitation and prevention programs for mothers, fathers, and children (mother-/father-/child rehabilitation) are a distinctive feature of the German social security system. It aims at defi cits in functioning disability, and health problems associated with family life and family-related interaction. All providers of medical rehabilitation in Germany are legally obligated to participate in comparative quality assurance programs. For mother/father/child rehabilitation, such a program was developed, being commissioned and fi nanced by the head organizations of the German statutory health insurance funds.