Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

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Within the scope of a multicenter study regarding the outcome quality of inpatient psychosomatic rehabilitation a structured catalogue of therapy goals (SZK, strukturierter Therapiezielkatalog) was developed. The catalogue contains 89 predetermined therapy goals as well as the option to formulate further goals in own words. The SZK is available both as a patient and as a therapist version. At the beginning of treatment up to five primary objectives are chosen from the list. At the end of treatment and at the 1-year follow-up the level of achievement of objectives is assessed. Moreover the SZK contains the option to mark goals as not relevant any more and to add goals which came up during the treatment and to evaluate them regarding the level of achievement. The study on hand asks for empirical identification of the target structure. Furthermore, reliability and validity of the calculated measures of goal attainment are analysed. As the most important finding the SZK turns out to be a practical and economical assessment instrument for goal-oriented evaluation.

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Not each premature discontinuation is a psychotherapeutic failure. Warning signals for looming premature discontinuation are low ratings of therapy success while psychotherapeutic treatment.

Zusammenfassung. In der Pilotstudie QS-PSY-BAY wurde durch 217 Therapeuten eine Methode zur einrichtungs- und fachrichtungsübergreifenden Qualitätssicherung in der ambulanten psychotherapeutischen Versorgung an 1.696 Patienten erfolgreich erprobt. Es kam eine einheitliche elektronische Dokumentation zur Erfassung und Rückmeldung von Behandlungsparametern und des Behandlungserfolges zum Einsatz. Der individuelle Therapieverlauf wurde im Kontext anonymisierter Vergleichsgruppen mit gleicher Hauptdiagnose grafisch dargestellt. Der Studiendatensatz lässt sich zur Beantwortung von Fragen der Versorgungsforschung nutzen. Die Patienten weisen zu Therapiebeginn im Durchschnitt eine deutliche Beeinträchtigung ihres gesundheitlichen Befindens auf. Jeder zweite Patient wird aufgrund einer depressiven Störung behandelt. Die Prä-Post-Effektgröße der abgeschlossenen Therapien erreicht einen Wert von 1,57 und ist in der Ein-Jahres-Katamnese stabil. Bei Berücksichtigung des Drop-Outs nach Intent-To-Treat-Methodik beträgt die konservativ korrigierte Effektgröße 0,97. Damit haben die im Projekt evaluierten Behandlungen eine ausgezeichnete Ergebnisqualität, was die Bedeutung der ambulanten Psychotherapie für die Gesundheitsversorgung in Zeiten einer allgemeinen Zunahme psychischer Erkrankungen unterstreicht.

Background: In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction.Methods: In a naturalistic longitudinal study, we examined a disorder heterogeneous sample of N = 584 outpatients who were either treated with cognitive-behavioral, psychodynamic, or psychoanalytic therapy. Depression, anxiety, stress, and somatization were assessed with the Patient Health Questionnaire (PHQ). Annual amounts of inpatient costs, outpatient costs, medication costs, days of hospitalization, work disability days, utilization of psychotherapy, and utilization of pharmacotherapy 1 year before therapy and 1 year after therapy were provided by health care insurances. Symptom and cost reduction were analyzed using t-tests. Associations between symptom and cost reduction were examined using partial correlations and hierarchical linear models.Results: Patients who terminated therapy regularly showed the largest symptom reduction (d = 0.981–1.22). Patients who dropped out due to an unproblematic reason and patients who terminated early due to a quality-relevant reason showed significant but small effects of symptom reductions (e.g., depression: d = 0.429 vs. d = 0.366). For patients with a regular end and those dropping out due to a quality-relevant reason, we observed a significant reduction of work disability (diff in % of pre-test value = 56.3 vs. 42.9%) and hospitalization days (52.8 vs. 35.0%). Annual inpatient costs decreased in the group with a regular therapy end (31.5%). Furthermore, reduction of symptoms on the one side and reduction of work disability days and psychotherapy utilization on the other side were significant correlated (r = 0.091–0.135).Conclusion: Health care costs and symptoms were reduced in each of the three groups. The average symptom and cost reduction of patients with a quality-relevant dropout suggested that not each dropout might be seen as therapy failure.

This is the first study to evaluate a quality assurance and feedback tool with regard to its practical feasibility in routine care and within the German health insurance system. This paper summarizes the evaluators' perspective on issues regarding the representativeness of the sample, consequences for therapy length and central assumptions and concepts of the project. The evaluation team comments on the paper "Pilot project of the Techniker-Krankenkasse - A comment from the perspective of the academic advisory council".