[The quality assurance programme of the statutory health insurance funds in medical rehabilitation: results and further developments].
OBJECTIVE
This study reports on the results of the quality assurance programme of the statutory health insurance funds in medical rehabilitation (QS Reha programme) and on the further development of the programme in 2007 to 2008. By October 2008, a total of 240 rehabilitation centres with 283 specialised departments were participating in the QS-Reha programme.


METHODS
To measure structural quality, the level of compliance with "basic criteria" (compiled beforehand with the help of experts) was determined. This was done by means of a questionnaire and subsequent telephone interviews with each institution. To determine patient satisfaction and measure outcome quality, a multicentric study with three measurement periods was carried out. Risk adjustment was conducted to compare clinics. The latest results presented here include the data from about 8,000 patients.


RESULTS
On average, the structural quality of the institutions can be described as good to very good (the rate of fulfillment is generally over 90%), but there are clear differences among the clinics. The patients are generally very satisfied with the personnel. The fraction of those not satisfied is about 10-15%. At the end of rehabilitation, medium high to high effects on the central dimensions of outcome can be determined for all the indications observed here. There are also significant deviations from the overall mean for 10-40% of the clinics after risk adjustment.


CONCLUSIONS
The preliminary results of the programme provide a comprehensive view of the quality of medical rehabilitation. Limitations exist concerning evidence-based structural quality criteria, methodological problems of patient-reported outcomes and the occurrence of non-responders and dropouts. The reworking of the QS Reha programme pursued the goal of improving the cost-benefit ratio of compiling data without impairing the methodological soundness of the programme. The new concept is scheduled to be implemented routinely beginning in 2009.
Farin
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Universitätsklinikum Freiburg, Abt. Qualitätsmanagement and Sozialmedizin. erik.farin@uniklinik-freiburg.de
Jäckel
W H
WH
Schalaster
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D005858:Germany; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires