Qualitatssicherung in der psychiatrischen klinik: Wie konnen die therapieergebnisse moglichst einfach erfasst werden?

Purpose: The German Social law requires quality assurance of inpatient treatment, i.e. of the quality of therapy, allowing the comparison of different hospitals. Methods: Since easy administrable assessment instruments are required, in this study (part of a greater survey on quality assurance at the Department of Psychiatry in Luebeck) a global self-rating by means of a visual analog scale (VAS) and the GAF (Global Assessment of Function) were compared with the ratings on the SCL-90-R scale in 386 psychiatric inpatients (mean age: 44.0 ± 15.2 years). Results: The comparison of the values on admission and at discharge yielded good correlations between the global VAS- value and the SCL-90-R symptom scores only at discharge. As parameter of therapeutic efficacy the difference of the scores on admission and at discharge was calculated. While the global self-rating (VAS) correlated well with the SCL-90-R scores, no relationship between the GAF-scores and the SCL- 90-R scores were found. Schizophrenics and patients suffering behaviour or personality disorders often showed discrepancies of the self- and the therapist rating. Conclusions: These discrepancies offer some hints for the identification of problematic patients. However, the global assessment of therapeutic efficacy often yield controversial results, if the limits of such scores are not considered.