Center for Stroke Research, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Zentrum für ambulante Neuropsychologie und Verhaltenstherapie (Center for out-patient neuropsychology and behavioral therapy), Schleiermacherstraße 24, 10961, Berlin, Germany.
BMC Neurol. 2021 Feb 17;21(1):76. doi: 10.1186/s12883-021-02092-0.
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.
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 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).
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.
与医院环境相比，目前针对门诊医疗和治疗护理质量的定义、衡量和改进工作甚少。我们开发了一套指标来衡量卒中后门诊神经心理治疗的质量。
这些指标涵盖了门诊神经心理工作的核心和跨学科方面，例如在有需要时将患者转介到社会护理。质量指标的选择是与门诊治疗师的共识小组共同完成的，并得到了证据、有效性、可靠性以及与护理质量的相关性和可变性的支持。该指标集在回顾性队列研究中进一步进行了测试。2017 年 11 月至 2018 年 4 月，从五个诊所的门诊临床记录中收集了 104 名患者的匿名数据。利用探索性分析估计了过程质量和结果质量之间的关联。
结果确定了过程护理质量存在更大变异性的领域，并表明注意力训练（目前指南推荐）达到质量目标的总体比例最低（仅 44%的病例达到）。其次是治疗开始前时间<1 个月（63%达到）和在有需要时将患者转介到社会护理（65%达到）。我们还观察到，整体质量和让家属参与治疗与更高的专业康复率相关（p 值=0.03）。然而，需要转介到社会护理与成功专业康复的机会减少相关（p 值=0.009）。
总之，我们描述了一套最初的质量指标，涵盖了门诊神经心理治疗的不同方面和足够的护理变异性。初步数据进一步表明，达到规定的质量目标可能确实对结果有相关影响。
