[Data sources for continual quality improvement in medical rehabilitation- the QS-Reha procedure of the statutory health insurance funds and the Eva-Reha documentation system of MDK Rhineland-palatinate].
Rehabilitation centers in Germany with a care supply contract according to section 111 Social Code Book Five - statutory health insurance (SGB V) are legally obligated to implement an internal quality management and to participate in comprehensive measures of external quality assurance which particularly aim at improving outcome quality ( section 135a SGB V). The legislator has left it to the central associations of health insurance funds and to the relevant umbrella organisations of care providers to develop these measures as well as the basic requirements on internal quality management in order to reach a joint agreement about it (cf. section 137d [1] and [1a] SGB V). The corresponding agreement was concluded on April 1, 2004. Whereas configuration of the internal quality management to a large extend lies in the discretion of the individual rehabilitation center, although it has to be geared to the objectives and principles set out in the agreement under section 137d SGB V, participation in the external quality assurance procedures of the central associations of health insurance funds (QS-Reha procedure) is obligatory for all rehabilitation centers with a care supply contract according to section 111 or 111a. The QS-Reha procedure comprises a survey of the central quality dimensions (structural, process and outcome quality as well as patient satisfaction) and permits related quality comparisons, which are utilized by the health insurance funds for quality oriented patient allocation and remuneration. The QS-Reha procedure had been developed to implement the legal requirements for external quality assurance in the field of medical rehabilitation ( section 135a in conjunction with section 137d SGB V) as well as to create a basis for quality focussed remuneration and patients allocation, whereas the Eva-Reha database had been developed by the Medical Service of Health Insurances in Rheinland-Pfalz for single case documentation with the objective of utilizing these data for internal quality management and, beyond this, also for various aspects of quality development across centers. The results generated in the framework of external quality assurance and internal management have to be integrated in the concept of internal quality management as they account for important sources of information with respect to the analysis of strengths or weaknesses of the facility. Irrespective of their origin quality relevant results should be integrated into a benchmarking system providing information to the operational and medical management of a rehabilitation center on the effectiveness and efficiency of the medical rehabilitation services provided. Up-to-date data, such as those generated by the Eva-Reha database, or sample survey data as those from the QS-Reha procedure can equally be used for such a benchmarking system and complement each another in a meaningful way. In this paper the main features of the QS-Reha procedure and the Eva-Reha database are described, with the objective of pointing out the particular perspectives of their data structure and results for continuous improvement in the framework of internal quality management.
Bassler
M
M
Medizinischer Dienst der Krankenversicherung (MDK) Rheinland-Pfalz, Alzey. markus.bassler@mdk-rlp.de
Nosper
M
M
Follert
P
P
Böwering
L
L
Polak
U
U
D019985:Benchmarking / Q000331:legislation & jurisprudence; D016208:Databases, Factual / Q000331:legislation & jurisprudence*; D004282:Documentation / Q000379:methods* / Q000592:standards; D005858:Germany; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000331:legislation & jurisprudence*; D012047:Rehabilitation Centers / Q000331:legislation & jurisprudence* / Q000592:standards / Q000706:statistics & numerical data; D017749:Total Quality Management / Q000331:legislation & jurisprudence