Qualitätssicherung in der medizinischen Rehabilitation

Parin, E.; Jäckel, W. H.

doi:10.1007/3-540-26634-8_34

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…anlau− fenden Disease−Management−Programme integriert" war (S. 40) [25]. [16,30]. Vergleichsweise einfach umsetzbar sind sicherlich Wei− terentwicklungen in Bezug auf die Messung der einzelnen Quali− tätsdimensionen.…”

Section: Externe Qualitätssicherungsprogrammeunclassified

Forschungsansätze zur Effizienzsicherung in der Rehabilitation - was ist getan und was ist notwendig?

Jäckel¹,

Glattacker²

2006

Phys Rehab Kur Med

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Section: Externe Qualitätssicherungsprogrammeunclassified

Forschungsansätze zur Effizienzsicherung in der Rehabilitation - was ist getan und was ist notwendig?

Jäckel¹,

Glattacker²

2006

Phys Rehab Kur Med

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“…Beispielsweise können Patienten mit bestimmten Diagnosen, Schweregraden oder psychosozialen Voraussetzungen -unabhängig davon, in welcher Klinik sie behandelt werden -von vornherein bessere Erfolgsaussichten haben als andere. Erkenntnisse über solche patientenbezogenen Prädiktoren von Reha-Effekten sind vor allem von Bedeutung, wenn Kliniken hinsichtlich ihrer Ergebnisqualität miteinander verglichen werden [7] oder wenn bei neuen "outcome-orientierten" Vergütungsformen (vgl. [25,29,57] effekthomogene Gruppen gebildet werden, deren Häufigkeiten im "Case mix" der Kliniken kontrolliert werden müssen, um zu verhindern, dass eine Klinik nur deshalb besser vergütet wird, weil sie einen höheren Anteil von Patienten mit besseren Erfolgsaussichten hatte.…”

Section: Originalarbeitunclassified

Eingangsbelastung der Patient(inn)en und Ergebnisqualität der Rehabilitation nach Schlaganfall

Gerdes

Baum²,

Greulich³

et al. 2003

Rehabilitation

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Rehabilitation after stroke has to face specific problems when treating patients with more or less severe disabilities in cognition and communication. Correspondingly, stroke rehabilitation takes a special position within the larger field of rehabilitation, and relatively little is known outside the neurological scientific community about the status of patients at admission, the case mix in the centres and the short- and medium-term effects of rehabilitation. The present study describes in some detail the initial status in unselected samples of consecutive patients (n = 768) from three neurological rehabilitation centres. The description shows a very inconsistent picture in all centres, ranging from patients with no neurological deficits to patients needing intensive care. Across the centres, we found remarkable differences in case mix. In order to measure the effects of rehabilitation after stroke, an instrument was developed that combines a physicians' questionnaire aiming at an assessment of the severely disabled cases with a patients' questionnaire for the less severe cases for which the physicians' questionnaire would show "ceiling effects" so that improvements could no longer be depicted. The application of the instrument showed that about 50 % of the sample were not capable of answering the patients' questionnaire. For the patients with neurological deficits, the functional parameters of the physicians' questionnaire showed significant improvements at discharge that can be interpreted as "strong" effects (effect sizes 1.0-1.3). For the patients with less severe deficits (and usually in later stages of the rehabilitation process), the patients' questionnaire showed "strong" improvements on the somatic and psychosocial scales both at discharge and 6 months later. On the functional scales, however, only small improvements were found. Finally, predictors could be identified that explain a large amount of the variance for length of stay (R(2) =.42) as well as for the effects of rehabilitation (R(2) =.74). When comparing effects across rehabilitation units with differences of case mix, these predictors should be statistically controlled in order to assure fair comparisons.

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“…[12,13]). Auf der Basis dieses Peer Reviews wurden auch für die Qualitätssicherungsprogramme der gesetzlichen Krankenkassen [14] und der Unfallversicherung [15] Peer-Review-Verfahren zur Bewertung des Rehabilitationsprozesses erarbeitet. Seit Ende 2002 liegt eine für den Bereich der Renten-und Krankenversicherung einheitliche Version des Peer Reviews vor, die zukünftig in den Qualitätssicherungsprogrammen beider Rehabilitationsträger eingesetzt werden soll.…”

Section: Introductionunclassified

Die Bewertung des Rehabilitationsprozesses mittels des Peer-Review-Verfahrens: Methodische Prüfung und Ergebnisse der Erhebungsrunde 2000/2001 in den somatischen Indikationsbereichen

Farin

Carl²,

Lichtenberg³

et al. 2003

Rehabilitation

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This paper reports the results of a peer review system that was implemented in the context of the quality assurance programme of the statutory German Pension Insurance scheme. The data reported refer to the 2000/2001 data collection period for medical rehabilitation in the somatic indications. Examination of inter-rater reliability for judgements of individual raters shows satisfactory results only in orthopaedics. In the quality assurance programme, rehabilitation centres are usually evaluated by the mean of 20 rater judgements. The reliability of this aggregated measure is satisfactory in all indications. The results of 561 rehabilitation centres show that those quality criteria are in particular need of improvement that refer to subjective concepts of patients (e. g., subjective theories of illness). Between peer review procedures in 1998 and 1999, the quality scores of rehabilitation centres had improved whereas between 1999 and 2000/2001, no further improvement can be shown. However, those rehabilitation centres with a low quality score in 1999 (lowest quartile of the distribution) underwent a positive development between 1999 and 2000/2001. Reasons for this trend and possibilities for improving interrater reliability of the peer review process as an element of the quality assurance programme of the German Pension Insurance scheme are discussed.

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Qualitätssicherung in der medizinischen Rehabilitation

Cited by 5 publications

References 8 publications

Forschungsansätze zur Effizienzsicherung in der Rehabilitation - was ist getan und was ist notwendig?

Forschungsansätze zur Effizienzsicherung in der Rehabilitation - was ist getan und was ist notwendig?

Eingangsbelastung der Patient(inn)en und Ergebnisqualität der Rehabilitation nach Schlaganfall

Die Bewertung des Rehabilitationsprozesses mittels des Peer-Review-Verfahrens: Methodische Prüfung und Ergebnisse der Erhebungsrunde 2000/2001 in den somatischen Indikationsbereichen

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