The Quality of Outpatient Health Care: An Evaluation of Common Mental and Physical Conditions in Childhood and Adolescence (the QualiPäd Study).

Abstract

Most medical care for the approximately 14 million children and adolescents in Germany is provided on an outpatient basis, but data on the quality of care is lacking. We studied the quality of outpatient care for children and adolescents with common mental or physical conditions. In pediatric, general medical, and child/adolescent psychiatric practices in the German federal state of Hesse, patient records of children and adolescents diagnosed with attention deficit/hyperactivity disorder, depression, conduct disorder, asthma, atopic dermatitis, otitis media, or tonsillitis were randomly selected, and data were extracted for the calculation of quality indicators. The quality indicators had been generated before the start of the study with a modified RAND/UCLA method. The extracted data were used to determine the extent to which the quality indicators were fulfilled. Potential influencing factors were examined as well. Study registration: DRKS00022408. In the overall sample (1156 patients; 55.2% male, average age 8.9 years, 20 513 diagnostic/therapeutic episodes evaluated), 45.5% of quality indicators were met (mental disorders: 38.7%, physical diseases: 50.9%). The highest degree of adherence was found for tonsillitis (78.8%) and conduct disorders (72.5%), and the lowest for depressive disorders (21.2%) and asthma (34.0%). No consistent picture emerged with regard to the influencing factors examined. The quality of outpatient care for children and adolescents in Germany is-with limited comparability, because of methodological and health system factors-comparable to that in the USA and lower than that in Australia. Potential for improvement was identified for some disorders. The assessment of quality of care proved to be feasible; in future, this could be done routinely on the basis of electronic secondary data.