Quality assurance in psychiatric departments. How to assess therapy outcome in an easy way?

Purpose: The German Social law requires quality assurance of inpatient trea tment, i.e. of the quality of therapy, allowing the comparison of different hospitals. Methods: Since easy administrable assessment instruments are re quired, 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 vi sual analog scale (VAS) and the CAF (Global Assessment of Function) were co mpared 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 t herapeutic efficacy the difference of the scores on admission and at discha rge 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 pe rsonality disorders often showed discrepancies of the self- and the therapi st rating. Conclusions: These discrepancies offer some hints for the identi fication of problematic patients. However, the global assessment of therape utic efficacy often yield controversial results, if the limits of such scor es are not considered.