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Background: Patient centred and individually-tailored counselling of older people with a chronic condition who live at home is a useful intervention to support their independence., Aim: The paper presents the development and psychometric testing of the APN-BQ Instrument, to measure patient-centeredness., Method: To measure the quality of an in-home counselling intervention, a 23-item questionnaire was developed and tested with 206 people 80 years and older. Principal component analysis with Varimax Rotation was conducted (n = 206)., Results: Analysis revealed a four factor (fs = 0.91) model scoring in 19 items. All factors loaded > 0.45. Cronbach's alpha was 0.86. The utility and acceptance of the instrument was confirmed by the high response rate (100 %) and the fact that participants answered 98.8 % of all questions., Conclusions: The APN-BQ has shown to be a reliable Instrument with good content and construct validity. It is a tool for APNs to measure structure, process, and outcome quality of a patient-centred and individually-tailored counselling program, including the degree of patient participation, and patient empowerment.

The goal of Continuous medical education is to increase knowledge and skills of medical doctors to guarantee a high standard of medical care. According to the published literature on the effect of Continuous medical education interactive didactic methods seems to be more effective to reach the mentioned goal compared to lectures. These results are in accordance with the constructivist learning theory. The assessment of the learning needs, one of the fundamental elements of this theory, is a complex issue. A potential method to evaluate the needs is presented in the following paper.

This paper introduces the Zurich Intervention Planning and Evaluation Form (ZIPEF). The instrument covers (1) treatment problems, (2) interventions as to type, duration, and time expenditure, (3) treatment outcome and (4) causal factors. A total of 413 treatment problems were evaluated with the ZIPEF in a public child and adolescent psychiatric service. Depending on the target (e.g. symptoms, personality, relationship) the distribution of types of intervention differed. Time expenditures were significantly higher only for client-centred interventions than for parent counseling and similar for all other interventions. Treatment outcome and cooperation were independent from type of intervention. The main causal factor of treatment outcome for almost all types of interventions was cooperation followed by resources in some types of intervention. Complexity of the treatment problem tended to be another important determinant for treatment outcome. In summary, the ZIPEF can contribute to quality management in the area of intervention planning and evaluation of clienteles with mental health problems.

Within the quality assurance programme of nursing in a teaching hospital in Switzerland two steps are considered to be essential: the evaluation of standards by the authors themselves (self-evaluation) and the evaluation by peers from the hospital (peer review). These evaluations are part of a decentralized model of quality assurance. This paper describes the systematic control of the standards of care over a period of two years. In particular the author reviews the development of the instruments for self-evaluation and peer review; the education and allocation of peers: the selection of standards for the control process; finally the first results of the evaluations and the ensuing measures. The author goes on to describe her experience with the instruments of control. Conformity with a preestablished policy and continuity within the group of peers are considered to be important prerequisites for the quality of the evaluations. Development and control of mainly monodisciplinary standards are considered to be a transition and preparation for an eventually interdisciplinary quality assurance programme.

Follow-up of fracture treatment one year after surgery based on AO Documentation in a small, rural hospital in a region with many tourists is demanding. How many patients can be contacted and assessed at the one year follow-up? From 1.1.95 to 31.12.96 302 patients with 314 fractures were operated on and the results subsequently documented. 255 patients (84%) were assessed personally (221) or by an AO member or family doctor (34). 15 patients died before the appointment, 32 patients could not be contacted or their data was incomplete. To achieve this rate of follow-up, some internal organization in the hospital was necessary, as will be described in this paper. AO Documentation is an important tool for personal quality assurance, especially in small hospitals. Small hospitals might be interesting for the AO since their follow-up rate can be high due to a simple organization and a personal patient-doctor relationship.

Since the revision of the KVG (Art. 58) (Health Insurance Law) in 1995, systematic scientific monitoring is laid down by statute in order to ensure quality (Health Insurance Regulations; KVV Art. 77). In addition, the statistics law of 1992 prescribes the BFS statistics (with ICD coding) (model 1). Since 1983 the "Arbeitsgemeinschaft Schweizerischer Frauenkliniken" (ASF) (The Swiss Working Group of Obstetrical and Gynecological Institutions) has been maintaining a common set of statistics which amongst other things also serves for quality assurance purposes (model 2). In 1995 a number of surgical hospitals joined together under the title "Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie" (AQC) (Swiss Surgical Quality Assurance Working Group) and now also maintain similar common statistics (model 3). In this paper the three above-mentioned models are described with regard to their suitability for process quality assurance. Whilst the BFS statistics are unsuitable for this purpose, the two other methods of data collection largely fulfil the requirements for process quality assurance by using statistical models. The largest deficiency in the ASF and AQC statistics is the lack of comprehensive geographical coverage which in contrast is provided by the BFS statistics thanks to statutory requirements. However, all three models are unsuitable for the areas of structure and outcome quality assurance. Therefore other solutions must be sought for these purposes.

This paper describes the different stages of the implementation of a quality assurance programme in a teaching hospital (828 beds) in Switzerland. In this project, quality assurance is part of our concept of nursing care. The described stages represent the three first steps of the adapted model of quality assurance by Lang (1976): --Identification of values in nursing teams --Establishment of standards including criteria for structure, process and outcome --Quality measurement (Self-review and peer review) The following actions are considered important for a successful quality assurance programme: --decentralized procedure (bottom-up approach) --quality assurance by professional colleagues from within the hospital --peer reviewed quality assurance Although the nurses find the establishment of standards very difficult and need expert advice for this difficult task, the initiated programme can be considered successful.

The aim of quality assurance should be to ameliorate the medical treatment. Also it is automatically part of the medical profession. This paper defines the terms quality assurance and quality. Concepts existing in the USA and in Germany are partly just formed in Switzerland or work at the ASF (Arbeitsgemeinschaft Schweizerischer Frauenkliniken) successfully since 10 years. The quality assurance in hospitals and in the health system should be reached throughout Switzerland.