[Can routine data on in-patient rehabilitation of musculoskeletal diseases replace the physicians' judgement in quality management? --an investigation on 12,014 observations].
The acceptance of quality management is strongly influenced by the additional work-load necessary to obtain data. "Quality management questionnaire? Do we really need it? In rehabilitation, we must deliver a long and detailed discharge report anyway...". This frequent comment from the physician side has prompted us to investigate whether compilation of quality-management questionnaires really provides new information, or if a prediction model (for example similar to that predicting early retirement based on routine data in a discharge report) could be used to replace the physician judgement. If the prediction accuracy of the model is sufficiently high, the compilation of quality-management questionnaires might become obsolete, sparing the paperwork load of the physician. A central issue in the quality-management system of the LVA Baden-Wuerttemberg (a regional pension insurance institute) is the mutual agreement on a certain rehabilitation goal by patient and physician at the beginning of therapy. At the end of the rehabilitation program, the achievement of the goal is discussed with the patient in a discharge interview. In addition, patient and physician fill out a structured questionnaire with specification on three rehabilitation dimensions (WHO standard ICF: Body function and structure, activity, and participation). However, the results of multivariate modelling of 10 routinely observed parameters on more than 12,000 observations in patients with musculoskeletal diseases demonstrate that the agreement between the prediction model and the physician judgement of rehabilitation success is far away from optimal values. Thus, in this case the physician judgement can not be replaced by a forecast model solely based on routine data. Accordingly, the evaluation of rehabilitation success within the framework of a quality-management system based on currently valid standards must directly rely on the physician judgement.
Muche
Rainer
R
Abteilung Biometrie und Medizinische Dokumentation, Universität Ulm, Ulm. rainer.muche@medizin.uni-ulm.de
Kaluscha
Rainer
R
Jacobi
Eckart
E
D005858:Germany; D006801:Humans; D007297:Inpatients; D007600:Judgment; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D010820:Physicians; D011785:Quality Assurance, Health Care; D012046:Rehabilitation / Q000592:standards*