[Frequency of coercive measures as a quality indicator for psychiatric hospitals?]

Nervenarzt. 2019 Jan;90(1):35-39. doi: 10.1007/s00115-018-0611-4.
[Article in German]


Background: The percentage of patients subjected to coercive measures has been proposed as 1 of 10 quality indicators for psychiatric inpatient treatment by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN). Internationally, there are similar recommendations and corresponding reporting systems.

Methods: The registry of coercive measures of psychiatric hospitals in Baden-Württemberg that was established in 2015, yields the possibility to examine the appropriateness of this indicator, based on raw data of 108,863 cases in 2016. This study investigated how the indicator is influenced by patient variables and characteristics of hospital structure.

Results: The percentage of cases exposed to coercive measures was strongly (r = 0.6) correlated with the percentage of involuntarily treated cases. With respect to the latter, hospitals varied widely with a range from 0.7% up to 24.1%. Specialized wards serving patients outside the catchment area with a high number of coercive measures also had a strong influence on the results of a benchmarking comparison.

Conclusion: The indicator is a good instrument for longitudinal evaluation of an institution; however, due to a high number of known and unknown confounding factors, it is inappropriate for the purpose of comparing psychiatric hospitals.

Keywords: Benchmarking; Coercion; Hospitals, psychiatric; Quality indicator; Registries.

MeSH terms

  • Coercion*
  • Germany
  • Hospitals, Psychiatric* / standards
  • Hospitals, Psychiatric* / statistics & numerical data
  • Humans