ABSTRACT
BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.
Subject(s)
Ambulatory Care/standards , Psychotherapy/standards , Stroke Rehabilitation/standards , Stroke/therapy , Adult , Aged , Aged, 80 and over , Consensus , Female , Germany , Humans , Male , Middle Aged , Neuropsychology , Outcome and Process Assessment, Health Care , Pilot Projects , Quality Indicators, Health Care , Reproducibility of Results , Retrospective Studies , Stroke/physiopathology , Stroke/psychologyABSTRACT
SETTING: Data from tuberculosis (TB) cases in Germany who are continuously monitored for the purposes of epidemiological surveillance and disease control. OBJECTIVE: To examine the distribution of age, sex, place of birth, seasonality and recurrence of TB disease in different types of TB organ manifestations, with particular focus on lymph nodes and pleura. DESIGN: All TB cases reported to the Berlin State Office for Health and Social Affairs (LAGeSo) in Berlin, Germany, between 2001 and 2012 were analysed. RESULTS: Significant differences with regard to seasonal variation as well as age and sex distribution were seen when comparing pleural TB and TB of the extrathoracic lymph nodes, the predominant types of extra-pulmonary TB. EPTB was generally more prevalent in patients born outside Europe. In contrast to a previous study, an increase in recurrent TB was not observed in EPTB when compared to pulmonary TB cases. CONCLUSION: Significant differences in TB organ manifestation in association with season, sex and age suggest different pathophysiological mechanisms of disease development. Future studies might provide further insight into the mechanism of TB development and may therefore be of help in the prevention and treatment of EPTB.