I. Großimlinghaus

Entwicklungsprozess der DGPPN-Qualitätsindikatoren

BACKGROUND Valid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia). MATERIAL AND METHOD The DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators. RESULTS Four evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed. CONCLUSION It is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.ZusammenfassungHintergrundDie Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) entwickelte vier sektorenübergreifende Qualitätsindikatorensets für die häufigen psychischen Störungsbilder Alkoholabhängigkeit, Demenzen, Depression und Schizophrenie.Material und MethodenIn einem mehrstufigen, strukturierten Prozess nutzte die DGPPN für die Generierung von Qualitätsindikatoren zunächst Leitlinienempfehlungen mit hohem Evidenzgrad. Es folgten ergänzende Evidenzrecherchen, die Durchführung einer Indikatorensynopse, die Überprüfung der Indikatorengüte und eine Konsentierung aller Qualitätsindikatoren.ErgebnisseEs wurden vier diagnosespezifische und sektorenübergreifende Qualitätsindikatorensets mit Leitlinienbezug und breiter Evidenzgrundlage entwickelt und durch Experten konsentiert.SchlussfolgerungAuf der Basis von Leitlinienempfehlungen lassen sich Qualitätsindikatoren zur Versorgung von Menschen mit psychischen Störungen entwickeln. Die Pilottestung der DGPPN-Qualitätsindikatoren wird eine zentrale Rolle in der nächsten Zukunft einnehmen, um ihren Einsatz als mögliche Messinstrumente für Qualität in der deutschen psychiatrischen und psychotherapeutischen Versorgung zu evaluieren.SummaryBackgroundValid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia).Material and methodThe DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators.ResultsFour evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed.ConclusionIt is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.

European Psychiatric Association (EPA) guidance on the quality of eMental health interventions in the treatment of psychotic disorders

The main aim was to develop recommendations on eMental health interventions for the treatment of psychotic disorders. A systematic literature search on eMental health interventions was performed, and 24 articles about interventions in psychotic disorders were retrieved and systematically assessed for their quality. Studies were characterized by a large heterogeneity with regard to study type, sample sizes, interventions and outcome measures. Five graded recommendations were developed dealing with the feasibility of eMental health interventions, beneficial effects of psychoeducation, preliminary results of clinical efficacy, the need of moderation in peer support eMental health groups and the need to develop quality standards.

European Psychiatric Association (EPA) guidance on quality assurance in mental healthcare

PURPOSE To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance. METHODS We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding). RESULTS Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level). DISCUSSION There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels. CONCLUSION Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.

Developmental process of DGPPN quality indicators

BACKGROUND Valid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia). MATERIAL AND METHOD The DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators. RESULTS Four evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed. CONCLUSION It is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.ZusammenfassungHintergrundDie Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) entwickelte vier sektorenübergreifende Qualitätsindikatorensets für die häufigen psychischen Störungsbilder Alkoholabhängigkeit, Demenzen, Depression und Schizophrenie.Material und MethodenIn einem mehrstufigen, strukturierten Prozess nutzte die DGPPN für die Generierung von Qualitätsindikatoren zunächst Leitlinienempfehlungen mit hohem Evidenzgrad. Es folgten ergänzende Evidenzrecherchen, die Durchführung einer Indikatorensynopse, die Überprüfung der Indikatorengüte und eine Konsentierung aller Qualitätsindikatoren.ErgebnisseEs wurden vier diagnosespezifische und sektorenübergreifende Qualitätsindikatorensets mit Leitlinienbezug und breiter Evidenzgrundlage entwickelt und durch Experten konsentiert.SchlussfolgerungAuf der Basis von Leitlinienempfehlungen lassen sich Qualitätsindikatoren zur Versorgung von Menschen mit psychischen Störungen entwickeln. Die Pilottestung der DGPPN-Qualitätsindikatoren wird eine zentrale Rolle in der nächsten Zukunft einnehmen, um ihren Einsatz als mögliche Messinstrumente für Qualität in der deutschen psychiatrischen und psychotherapeutischen Versorgung zu evaluieren.SummaryBackgroundValid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia).Material and methodThe DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators.ResultsFour evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed.ConclusionIt is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.

A review of mental health recovery programs in selected industrialized countries

The concept of recovery has gained increasing attention and many mental health systems have taken steps to move towards more recovery oriented practice and service structures. This article represents a description of current recovery-oriented programs in participating countries including recovery measurement tools. Although there is growing acceptance that recovery needs to be one of the key domains of quality in mental health care, the implementation and delivery of recovery oriented services and corresponding evaluation strategies as an integral part of mental health care have been lacking.

EPA guidance on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD)

The aim of this EPA guidance was to develop recommendations on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). A systematic literature search was performed and 40 articles were retrieved and assessed with regard to study characteristics, applied technologies, therapeutic approaches, diagnostic ascertainment, efficacy, sustainability of clinical effects, practicability and acceptance, attrition rates, safety, clinician-supported vs. non-supported interventions and active vs. waiting-list controls. The reviewed studies showed a great heterogeneity concerning study type, study samples, interventions and outcome measures. Based on these findings, five graded recommendations dealing with symptom reduction, acceptability, type of administration, clinician support, self-efficacy and coping were developed.

Entwicklungsprozess der DGPPN-Qualitätsindikatoren@@@Developmental process of DGPPN quality indicators

BACKGROUND Valid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia). MATERIAL AND METHOD The DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators. RESULTS Four evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed. CONCLUSION It is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.ZusammenfassungHintergrundDie Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) entwickelte vier sektorenübergreifende Qualitätsindikatorensets für die häufigen psychischen Störungsbilder Alkoholabhängigkeit, Demenzen, Depression und Schizophrenie.Material und MethodenIn einem mehrstufigen, strukturierten Prozess nutzte die DGPPN für die Generierung von Qualitätsindikatoren zunächst Leitlinienempfehlungen mit hohem Evidenzgrad. Es folgten ergänzende Evidenzrecherchen, die Durchführung einer Indikatorensynopse, die Überprüfung der Indikatorengüte und eine Konsentierung aller Qualitätsindikatoren.ErgebnisseEs wurden vier diagnosespezifische und sektorenübergreifende Qualitätsindikatorensets mit Leitlinienbezug und breiter Evidenzgrundlage entwickelt und durch Experten konsentiert.SchlussfolgerungAuf der Basis von Leitlinienempfehlungen lassen sich Qualitätsindikatoren zur Versorgung von Menschen mit psychischen Störungen entwickeln. Die Pilottestung der DGPPN-Qualitätsindikatoren wird eine zentrale Rolle in der nächsten Zukunft einnehmen, um ihren Einsatz als mögliche Messinstrumente für Qualität in der deutschen psychiatrischen und psychotherapeutischen Versorgung zu evaluieren.SummaryBackgroundValid and feasible quality indicators can measure healthcare quality and show potential for improvement in care. The German Association for Psychiatry and Psychotherapy (DGPPN) has developed trans-sectoral quality indicator sets for four mental disorders with high prevalence (alcohol dependence, dementia, depression and schizophrenia).Material and methodThe DGPPN followed a structured multistage process and used guideline recommendations and the results of systematic evidence searches as the basis for the development of these quality indicators. This was followed by a structured consensus process for all quality indicators.ResultsFour evidence and consensus-based, diagnosis-specific and trans-sectoral quality indicator sets have been developed.ConclusionIt is possible to develop quality indicators on the basis of guideline recommendations. The implementation of the DGPPN quality indicators will play a crucial role in order to evaluate their utility and feasibility as quality measures for German mental healthcare.

Implementation of Quality Indicators in Routine Mental Health Care

Quality Indicators that are valid and feasible can measure the quality of care and thus have the potential to effectively improve healthcare. However implementation of quality indicator tools in routine mental health care in Europe is challenging. One reason for this is the sectoral structured health care system in many of the European countries. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has developed four sets of trans-sectoral Quality Indicators (QI) that are specifically designed for relevant mental disorders with a high prevalence in inpatient and outpatient mental health care (depression and schizophrenia). As an example, the implementation of the QIs in routine health care of nine psychiatric hospitals and outpatient facilities in the Rhineland [Northrhine-Westfalia-state] will be presented and compared to results of other European countries. The potential benefits for improving treatment quality by implementation of QIs in routine mental health care will be discussed.

Quality Assurance in German Mental Healthcare

Introduction One of the priorities in the German mental healthcare system pertains to the development and implementation of evidence-based quality assurance initiatives with the goal to measure quality and optimize the structures, processes and outcomes of mental healthcare services. Objectives To optimize the quality of mental healthcare by developing quality assurance tools including clinical practice guidelines and quality indicators. Aims To describe quality assurance initiatives in German mental healthcare. Methods Review of quality assurance initiatives and their current status. Results In national and regional initiatives, evidence- and consensus-based clinical practice guidelines and quality indicators are being developed. As examples, the cross-sectoral quality indicators of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the update process of the German clinical practice and disease management guideline on schizophrenia will be described. A discussion of the critical issues in psychiatric quality indicator and guideline development and implementation will be included. Conclusions Evidence- and consensus-based approaches are crucial to the development of relevant and valid instruments for quality assurance. One of the main challenges is the implementation of clinical practice guidelines and their evaluation by means of quality indicators as well as the establishment of a common framework of standardized quality indicators that address relevant quality aspects in mental healthcare.