Background: To date, no standardised indicators for quality of care in psoriasis have been published. Aims: Development and testing of evidence-based indicators of quality of care and guideline compliance in the treatment of psoriasis. Methods: Indicators of process and outcome quality were extracted and evaluated in a Delphi process according to international standards. The primary reference was the S3 German guideline for psoriasis treatment. The indicators were validated with data from two nationwide studies on psoriasis care involving 1,511 and 2,009 patients. Results: Eight quality indicators were defined: mean PASI, mean quality of life (Dermatology Life Quality Index; DLQI), proportion of patients with PASI >20, with DLQI >10, with previous systemic treatment, with PASI >20 and systemic treatment, with inpatient treatment, and number of work days lost. All indicators proved suitable for application, and were sensitive to change. Conclusions: Guideline-based indicators of quality of care are useful in the analysis of health care and the implementation of treatment guidelines in psoriasis.

1.
Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B: S3 guidelines for the therapy of psoriasis vulgaris (in German). J Dtsch Dermatol Ges 2006;4(suppl 2):S1–S126.
2.
Augustin M, Reich C, Schaefer I, Zschocke I, Rustenbach SJ: Entwicklung und Validierung eines neuen Instrumentes zur Erfassung patientendefinierten Nutzens in der Therapie der Akne. J Dtsch Dermatol Ges 2008;6:113–120.
3.
Stock J: Erste Erfahrungen mit Qualitätsindikatoren in Arztnetzen; in Stock J, Szecsenyi J (eds): Stichwort: Qualitätsindikatoren: Erste Erfahrungen in der Praxis. Bonn, KomPart, 2007, pp 277–300.
4.
Stock J, Broge B: ‘Qualitätsindikatoren der AOK für Arztnetze’ – erstes deutsches Indikatorensystem für die hausärztliche Versorgung; in Stock J, Szecsenyi J (eds): Stichwort: Qualitätsindikatoren: Erste Erfahrungen in der Praxis. Bonn, KomPart, 2007, pp 97–118.
5.
Stock J, Szecsenyi J: Mit Qualitätsindikatoren arbeiten – Resümee und Perspektiven; in Stock J, Szecsenyi J (eds): Stichwort: Qualitätsindikatoren: Erste Erfahrungen in der Praxis. Bonn, KomPart, 2007, pp 301–316.
6.
Huber F, Hess K: Qualitätsindikatoren für Managed Care in der Schweiz am Beispiel von MediX und EQUAM; in Stock J, Szecsenyi J (eds): Stichwort: Qualitätsindikatoren: Erste Erfahrungen in der Praxis. Bonn, KomPart, 2007, pp 71–96.
7.
Roski J: Qualitätsmessung in den USA: Erfahrungen und Konzepte in der ambulanten Versorgung; in Stock J, Szecsenyi J (eds): Stichwort: Qualitätsindikatoren: Erste Erfahrungen in der Praxis. Bonn, KomPart, 2007, pp 17–42.
8.
ÄZQ (Ärztliches Zentrum für Qualität in der Medizin). Beurteilung klinischer Messgrössen des Qualitätsmanagements – Qualitätskriterien und -indikatoren in der Gesundheitsversorgung. Konsensuspapier der Bundesärztekammer, der Kassenärztlichen Bundesvereinigung und der AWMF. Jena, Urban & Fischer, 2001.
9.
Szecsenyi J, Stock J: Einleitung: Wozu brauchen wir Qualitätsindikatoren im Gesundheitswesen? in Stock J, Szecsenyi J (eds): Stichwort: Qualitätsindikatoren: Erste Erfahrungen in der Praxis. Bonn, KomPart, 2007, pp 9–16.
10.
Leatherman S, McCarthy D: Public disclosure of health care performance reports: experience, evidence and issues for policy. Int J Qual Health Care 1999;11:93–98.
11.
Marshall MN, Shekelle PG, Leatherman S, Brook RH: The public release of performance data: what do we expect to gain? A review of the evidence. JAMA 2000;283:1866–1874.
12.
Augustin M, Krüger K, Radtke MA, Schwippl I, Reich K: Disease severity, quality of life and health care in plaque-type psoriasis: a multicenter prospective cross-sectional study in Germany. Dermatology 2008;216:366–372.
13.
Augustin M, Reich K, Reich C, Purwins S, Rustenbach SJ, Schäfer I, Radtke M: Quality of psoriasis care in Germany – results of the national study PsoHealth 2007. J Dtsch Dermatol Ges 2008;8:640–645.
14.
Fredriksson T, Pettersson U: Oral treatment of pustulosis palmo-plantaris with a new retinoid, Ro 10-9359. Dermatologica 1979;158:60–64.
15.
Finlay AY, Khan GK: Dermatology Life Quality Index (DLQI) – a simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210–216.
16.
Augustin M, Zschocke I, Lange S, Seidenglanz K, Amon U: Quality of life in skin diseases: methodological and practical comparison of different quality of life questionnaires in psoriasis and atopic dermatitis. Hautarzt 1999;50:715–722.
17.
Augustin M, Amon U, Braathen L, Bullinger M, Gieler U, Klein GF, Schultz-Amling W: Erfassung von Lebensqualität in der Dermatologie (Leitlinie). J Dtsch Dermatol Ges 2004;2:802–806.
18.
Augustin M, Lange S, Wenninger K, Seidenglanz K, Amon U, Zschocke I: Validation of a comprehensive Freiburg Life Quality Assessment (FLQA) core questionnaire and development of a threshold system. Eur J Dermatol 2004;14:107–113.
19.
Guyatt GH, Feeny DH, Patrick DL: Measuring health-related quality of life. Ann Intern Med 1993;118:622–629.
20.
Berger K, Ehlken B, Kugland B, Augustin M: Cost-of-illness in patients with moderate and severe chronic psoriasis vulgaris in Germany. J Dtsch Dermatol Ges 2005;3:511–518.
21.
Sohn S, Schoeffski O, Prinz J, Reich K, Schubert E, Waldorf K, Augustin M: Cost of moderate to severe plaque psoriasis in Germany: a multicenter cost-of-illness study. Dermatology 2006;212:137–144.
22.
Feldman SR: A quantitative definition of severe psoriasis for use in clinical trials. J Dermatolog Treat 2004;15:27–29.
23.
Garduno J, Bhosle MJ, Balkrishnan R, Feldman SR: Measures used in specifying psoriasis lesion(s), global disease and quality of life: a systematic review. J Dermatolog Treat 2007;18:223–242.
24.
Jacobson CC, Kimball AB: Rethinking the Psoriasis Area and Severity Index: the impact of area should be increased. Br J Dermatol 2004;151:381–387.
25.
Augustin M, Reich K, Radtke M, Dierks C: Lebensqualität, Empowerment und Compliance bei Psoriasis. Bremen, Unimed, 2006.
26.
Schmid-Ott G, Künsebeck HW, Jäger B, Sittig U, Hofste N, Ott R, Malewski P, Lamprecht F: Significance of the stigmatization experience of psoriasis patients: a 1-year follow-up of the illness and its psychosocial consequences in men and women. Acta Derm Venereol 2005;85:27–32.
27.
Finlay AY: Current severe psoriasis and the rule of tens. Br J Dermatol 2005;152:861–867.
28.
Hongbo Y, Thoma CL, Harrison MA, Salek MS, Finlay AY: Translating the science of quality of life into practice: what do Dermatology Life Quality Index scores mean? J Invest Dermatol 2005;125:659–664.
29.
Schöffski O, Augustin M, Prinz J, Rauner K, Schubert E, Sohn S, Reich K: Krankheitskosten und Lebensqualität bei Patienten mit mittelschwerer bis schwerer Psoriasis vulgaris in Deutschland: Eine multizentrische Studie. J Dtsch Dermatol Ges 2007;5:209–219.
30.
Augustin M, Reich K, Reusch M, Luger T, Franzke N, Schäfer I, Rustenbach SR, Radtke MA: Health Services Research in Psoriasis – The German Approach. Dermatology 2009;218:293–301.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.