[Clinic comparisons as an instrument for quality assurance in the treatment of patients with mental disorders: the significance of risk adjustment].
It is becoming increasingly more relevant for health care providers to also participate in external quality assurance measures. A few systematic approaches that also integrate outcome quality and include a comparison of different clinics have only recently been developed for the area of the treatment of patients with mental disorders. In this context, a key issue is the appropriate consideration of confounders, i.e., of unevenly distributed patient characteristics that are causally related to the treatment results. Using a sample of consecutive patients from four psychotherapeutic clinics, we exemplarily examined the significance of the confounders for the comparison of the clinics with regard to short-term outcome. The results show that an adjustment is principally advisable and is generally associated with a reduction of the differences in treatment results. The discussion asserts that the use of regression weights, which were ascertained using an independent, representative sample, allows for a more valid risk adjustment. Finally, reference will be made to the relevance of giving consideration to varying resource usage in the assessment of the risk-adjusted clinic comparisons.
Schulz
Holger
H
Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf. schulz@uke.uni-hamburg.de
Barghaan
Dina
D
Watzke
Birgit
B
Koch
Uwe
U
Harfst
Timo
T
D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D011618:Psychotic Disorders / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000592:standards*; D012917:Social Adjustment; D016896:Treatment Outcome