[Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions]. / Ergebnisqualität medizinischer Rehabilitation: Zum Zusammenhang zwischen "Patient Reported Outcomes" (PROs) und geleisteten Sozialversicherungsbeiträgen.

Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary.

[Patient Questionnaire for Assessment of Rehabilitation Motivation (PAREMO-20) - psychometric evaluation and validation in a sample of cancer patients with different tumour sites]. / Patientenfragebogen zur Erfassung der Reha-Motivation (PAREMO-20) - Testtheoretische Uberprüfung und Validierung an einer Stichprobe von Krebspatienten unterschiedlicher Diagnosegruppen.

OBJECTIVES: A significant body of research suggests that patient motivation is related to better rehabilitation outcome with regard to psychosocial and physical well-being. Thus, patient motivation gains increasing attention with regard to the course of treatment and individual treatment planning in the practice and research in medical rehabilitation. This study aims to validate the PAREMO-20, a measure of rehabilitation motivation in a sample of cancer patients with different tumour sites. METHODS: 1193 cancer patients participated in a prospective study evaluating the medical and psychosocial effects of inpatient cancer rehabilitation. A set of various questionnaires was completed at the beginning and at the end of the rehabilitation measure as well as at one year follow-up (participation rate at follow-up: 78%). The PAREMO-20 was psychometrically examined on this sample. Validity was examined using a cancer-specific questionnaire for individual therapy goals, as well as the HADS-D and the SF-8. RESULTS: The original six factors were replicated. The factor solution emerging through PCA was tested with a confirmatory factor analysis. Maximum likelihood estimation of this model produced good fit statistics. Internal consistencies were high to satisfactory with Cronbach's Alpha=0.88 to Alpha=0.59. Psychological distress and physical impairments were positively associated with anxiety and depression, as well as with therapy goal dimensions. Moderate to high (negative) correlations were observed with health related quality of life, in particular with the mental-health dimension (r=-0.74, p=0.01). DISCUSSION: The PAREMO-20 is a reliable, valid and economic instrument, which can be recommended for use in clinical care.

[Outcome quality of psychosomatic rehabilitation: goal attainment scaling on the basis of a structured catalogue of therapy goals]. / Ergebnisqualität psychosomatischer Rehabilitation: Zielerreichungsskalierung auf der Basis einer strukturierten Therapiezielliste.

Within the scope of a multicenter study regarding the outcome quality of inpatient psychosomatic rehabilitation a structured catalogue of therapy goals (SZK, strukturierter Therapiezielkatalog) was developed. The catalogue contains 89 predetermined therapy goals as well as the option to formulate further goals in own words. The SZK is available both as a patient and as a therapist version. At the beginning of treatment up to five primary objectives are chosen from the list. At the end of treatment and at the 1-year follow-up the level of achievement of objectives is assessed. Moreover the SZK contains the option to mark goals as not relevant any more and to add goals which came up during the treatment and to evaluate them regarding the level of achievement. The study on hand asks for empirical identification of the target structure. Furthermore, reliability and validity of the calculated measures of goal attainment are analysed. As the most important finding the SZK turns out to be a practical and economical assessment instrument for goal-oriented evaluation.

[Quality assurance and total quality management in residential home care]. / Qualitätssicherung und Qualitätsmanagement in der stationären Altenpflege.

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

[Questioning of relatives--potentials for the internal quality management in institutions caring for the elderly]. / Angehörigenbefragungen - Potenziale für das interne Qualitätsmanagement in Altenpflegeeinrichtungen.

The German care quality assurance law ("Pflege-Qualitätssicherungs-Gesetz", PQsG) calls for internal quality management in residential care facilities. Empirical surveys with residents, their relatives and employees are essential to get transparency and to assess the quality of service. Within the scope of the present study more than 1400 relatives of residents of 31 residential care institutions were surveyed. Therefore in preliminary studies a questionnaire for the relatives was developed, which collects data concerning quality aspects on various aspects (for example care, staff, medical care, cooperation with relatives). On the average, relatives judged the quality of the institutions as good. The overall mean of 2.2 (scale values between 1.8 ["administration/management"] and 2.5 ["care"]) reveals a positive aspect, but there is substantial variation between institutions. Empirical surveys are important tools for internal quality management. Among other things, their results can be used as input for specific quality circle work and thus for continuous improvement. Used continually in the sense of a routine-monitoring system, surveys can also serve to evaluate quality management procedures.

[Individualized outcome measurement -- a comparison between prospective and retrospective problem marking in psychosomatic rehabilitation]. / Individuelle Ergebnismessung -- Vergleich zwischen prospektiven und retrospektiven Problemangaben in der psychosomatischen Rehabilitation.

This article reports on a questionnaire concerning individual problems in psychosomatic rehabilitation. A sample of 858 patients answered the questions at the beginning and on a one year catamnestic measurement. First, the frequency of occurrence of several symptoms was asked. Second, the rehabilitants were asked to indicate for each symptom if it was an important problem before treatment. This procedure of identifying problems was done at the beginning (prospective marking) and also at the one year follow up (retrospective marking). The questionnaire allows to compute eight subscales and one global scale regarding all items (classical approach). Frequency of occurrence decreased with an average effect size (ES) of 0.56 on the global scale. In the next step, measurement was individualized by regarding only items which were marked as relevant problem. By prospective marking, effect size was 1.32. By retrospective marking, no growth of effect size in comparison to the classical approach was found (ES = 0.56). The results indicate that the prospective approach of identifying problems is the better way of individualizing measurements. Moreover, the impact of individual problem definition on outcome was demonstrated.

[Development of a patient questionnaire for assessment of motivation for rehabilitation(PAREMO)]. / Entwicklung eines Patienten-fragebogens zur Erfassung der Reha-Motivation (PAREMO).

Following the assumption that the motivation to participate in a rehabilitation program is a multidimensional construct we surveyed experts to develop a first version of the patient questionnaire of rehabilitation motivation (PAREMO). In this article we describe the results of the pilot study with regard to the test-theoretical analysis of the questionnaire. Patients of cardiologic, orthopaedic and psychosomatic rehabilitation clinics were participants of this study. After several subsequent steps of analysis the PAREMO was reduced from an initial 150 items to 46 items. The questionnaire now contains a structure of six factors: 1. need for assistance and psychological burden of suffering, 2. restrictions in everyday life because of physical burden of suffering, 3. reactions of significant others to the illness, 4. readiness to change in terms of preventive behaviour, 5. hopelessness and scepticism, and 6. initiative and knowledge. These factors explain almost 50% of the total variance. Cronbach's Alphas range between 0.71 and 0.91 for the subscales, the corrected item total correlation means range between 0.45 and 0.65. The statistical results as well as the naming of the scales are preliminary to this date, they are being reanalysed in another study.

[Long-term outcomes of psychosomatic rehabilitation]. / Langfristige Ergebnisse Psychosomatischer Rehabilitation.

According to the latest state of research psychosomatic rehabilitation can be considered as effective and efficient. Several program-evaluation studies document process and outcomes of over 4000 psychosomatic patients in rehabilitation clinics so far. The majority of patients in all studies show positive therapy outcomes, which also can be demonstrated in follow-up investigations. Those positive results cover disease and disorder related aspects as well as cost relevant facets. This paper presents one of those program-evaluation studies which reports the outcomes of a one year and a five year follow-up respectively. It focuses on the outcomes of those subjects which participated in both inquiries. In addition to single criteria the construction of a multiple outcome criterion is discussed.

Single-Crystal Laser-Heated Pedestal-Growth Sapphire Fibers for Er:YAG Laser Power Delivery.

The Er:YAG laser-induced damage (LID) threshold and modal properties of single-crystal sapphire fibers grown by the laser-heated pedestal-growth method have been measured. The lowest loss (~0.4-dB/m) sapphire fibers produce little mode mixing and therefore deliver a near-single-mode output profile if the Er:YAG laser input beam profile is also nearly Gaussian. Normally, however, Er:YAG laser output beam profiles are multimode with numerous high-energy spikes. This leads not only to a multimode output from the fiber but also increased fiber loss that is due to higher-order mode coupling. The results of LID testing give a damage fluence of ~1.4 kJ/cm(2) for 300-mum core-only sapphire fibers at 2.94 mum.

Optical properties of single-crystal sapphire fibers.

Single-crystal sapphire fibers have been grown with the laser-heated pedestal-growth method with losses as low as 0.3 dB /m at 2.94 ?m. With the incorporation of a computer-controlled feedback system, fibers have been grown with less than +/-0.5 % diameter variation, or +/-1.5 ?m for a 300- ?m fiber. The losses in these fibers have been reduced further through a postgrowth anneal at 1000 degrees C in air, from 5.4 to 1.5 dB /m at 543 nm and from 0.4 -0.3 dB /m at 2.94 ?m. These fibers delivered 4.7 W at 10 Hz of Er:YAG laser power.

Hollow-waveguide delivery systems for high-power, industrial CO(2) lasers.

Hollow-sapphire and metal-dielectric-coated hollow-glass waveguides have been used to deliver CO(2) laser power for industrial laser applications. The transmission, bending loss, and output-beam properties of these waveguides are described. The bore sizes of the hollow-sapphire waveguides were 1070 and 790 µm, and the hollow-glass waveguide had a bore of 700 µm. The waveguides ranged in length from 1.1 to 1.5 m. The sapphire waveguides were bent to 90°, and the hollow-glass waveguides were bent into a full 360° loop. We delivered a maximum of 1.8 kW through the 1070-µm-bore sapphire waveguide and 1.0 kW through the hollow-glass waveguide. All the hollow waveguides incorporated a water jacket to prevent overheating.

[Evaluation of psychosomatic treatment--results of a catamnestic study]. / Evaluation psychosomatischer Heilverfahren--Ergebnisse einer Katamnesestudie.

The authors report first results of a program evaluation (n = 560) in a psychoanalytically oriented psychosomatic clinic. Based on a naturalistic design, the study includes three points of measurement (beginning and end of treatment, 1-year follow-up) at which data were collected from patients and therapists. The article gives an overview of the general issues involved as well as of the methodological procedure and presents some catamnestic subjective and cost-relevant singular outcome criteria.

[Evaluation of change by patients and staff and specialist physicians in psychosomatic rehabilitation--a catamnestic comparison]. / Veränderungsbeurteilungen von Patienten und von Haus- und Fachärzten nach psychosomatischer Rehabilitation--Ein katamnestischer Vergleich.

Considering three single outcome criteria reflecting the change of a) physical state, b) general condition and c) ability to work catamnestic ratings of patients and of external doctors are compared. The ratings were assessed by questionnaires 12 months after the end of inpatient psychosomatic treatments ("direct measurement of change"). Mayor findings are: a) the judgements of both data sources indicated positive change or improvement for a majority of patients, b) the ratings of the external doctors were more favourable than the patients' self-ratings, c) moderate but statistically significant correlations between the ratings of the two groups of judges were to be observed. From a more methodological point of view it will be attempted to analyze the meaning of these correlations somewhat more in detail.

[Possibilities in clinical quality assurance founded on a basis documentation system and extended evaluation studies]. / Möglichkeiten klinikinterner Qualitätssicherung (QS) auf der Grundlage eines Basis-Dokumentations-Systems sowie erweiterter Evaluationsstudien.

Although the topic of quality control (QC) has been under discussion at least since the "Health Reform Legislation" (GRG) in almost all areas of the public health system, there is quite often a lack of models for practicability. Even for inpatient medical rehabilitation--at least concerning empirically founded QC-measures suitable methods and instruments have still to be developed. These must be relatively simple and economical to be integrated in the daily routine within a special clinic, if quality control should function. Starting from a broad concept of evaluation, the authors present a practical empirical QC-model for clinics, specifically for psychosomatic rehabilitation, which has been developed and proven for more than five years. To investigate the "programme" of the clinic, or particular program components (e.g. patients, treatments, outcome criteria) with systematically obtained data and analysis, is the main goal of this model. Where statements are replaced by empirically proven data. Aspects of process and outcome quality are considered to be a main task, and transparency is a necessary supposition. This model is particularly based on questionnaire procedures, is two-tracked, e.g. it is composed by continuous data collection ("treatment documentation") on the one hand and by time-restricted and defined studies for programme evaluation on the other. The treatment results represent the true target variable.

[Symptom portrayal and initial therapeutic relationship of female and male patients in the initial psychoanalytic interview]. / Symptomschilderungen und initiale Beziehungsangebote von weiblichen und männlichen Patienten in psychoanalytischen Erstinterviews.

The transcripts of psychoanalytic initial interviews are analyzed in using the "Structural Analysis of Social Behavior" (SASB) by L. S. Benjamin. This instrument was chosen to detect how male and female patients talk about their symptoms, and about previous treatments. The immediate interaction with the interviewer during the dialogue was also described by using SASB. On the basis of only the first patients' utterances after the initial request of the therapists (like "What brings you here?") we can distinguish female and male patients by the quality of the relations described (to the symptoms, the previous physicians, and to the therapist). The sex-specific readiness to establish relationships which becomes apparent in these descriptions can be related to the interview situation itself. In our further argumentation we interpret them as subtle messages to the interviewer. Finally we discuss their inherent potentials and risks for the psychotherapeutic cooperation.