[Are mental disorders given due consideration in the adjustment of stage of care according to the German Health Care Act? Assessment of cognitive impairment by medical expert record (MDK) and standardised methods of the research team].
Fifty-eight recipients of long-term care insurance benefits were interviewed during home visits by a research team. Fourty-eight percent of the interviewees achieved less than 22 points in the Mini-Mental State Examination (MMSE), clearly indicating cognitive impairment. Comparison of the authorized examination on the one hand and the findings of the research team on the other showed: neither CNS-specific diagnoses (77.8% sensitivity) nor CNS malfunction adequately recognised cognitive impairment. In 41% of the cognitively impaired, authorised examination found only minor or no functional CNS disorders. A comparison of the 'recognised' and 'not recognised' cognitively impaired and physically handicapped applicants found that a higher stage of care was allocated to the group with recognised dementia but that, in all MDK parameters, there was no judgmental difference in medical expert records between patients with unrecognised cognitive impairment and physically handicapped persons.
Zintl-Wiegand
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Zentralinstitut für Seelische Gesundheit, Psychiatrische Epidemiologie, Mannheim.
Krumm
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B
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000544:Alzheimer Disease / Q000145:classification / Q000175:diagnosis*; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D007353:Insurance, Long-Term Care / Q000331:legislation & jurisprudence*; D008297:Male; D008609:Mental Status Schedule / Q000592:standards*; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D020380:Needs Assessment / Q000331:legislation & jurisprudence; D009483:Neuropsychological Tests / Q000592:standards; D011594:Psychometrics / Q000706:statistics & numerical data; D012015:Reference Standards; D015203:Reproducibility of Results; D012943:Social Security / Q000331:legislation & jurisprudence