title: [Feasibility and benefit of an active screening for rehab need and subsequent written advice to file an application for rehab treatment in AOK-insurants enrolled in the disease management program diabetes type 2 (PARTID-trial)].
abstract: OBJECTIVE
  Type 2 diabetes (DM II) is the world's most widespread metabolic disease. Numerous investigations have demonstrated that intensive, multimodal interventions can reduce the occurrence of DM-associated comobidities and mortality. Medical rehabilitation could offer such an alternative, albeit one with an obvious time limit. There is currently no active program in Germany designed to screen for pa-tients' need for rehab. Here, we investigated -whether screening for rehab need in DMII pa-tients accompanied by written advice to file an application for rehab treatment would generate a relevant number of rehab measures, whether -inpatient rehab results in improved mid-term prognoses, and which patients demonstrate a particular benefit from such a program.
  
  
  METHODS
  We screened 5 500 employed individuals aged 18-54 years for their need for rehab via an extensive questionnaire based on the "Lübeck Algorithm". The patients were registered in the DMP (disease management program) Diabetes mellitus Type 2 in the AOK Rheinland/-Hamburg health insurance division, and payed into DRV (German statutory pension insurance -scheme) Rheinland retirement insurance. Pa-tients needing rehab who presented no exclusion criteria (i. e., for a rehab intervention far from their place of residence) were randomized to a control or intervention group at a ratio of 3:1. Patients in the intervention group received a letter from the AOK advising them to fill out an application for rehab. A very short, simple application form was included in the mailing. 12 months after randomization we conducted a query to determine the effects of rehab. Our primary endpoint was a cardiovascular risk score specifically devised for diabetics. Multi-level models were applied to measure changes in cardiovascular risk.
  
  
  RESULTS
  850 patients (rate of return=16%) returned completed screening forms to us. After having excluded those with faulty diagnoses and/or those who had refused to participate, 829 patients remained. 94% of them presented a need for rehab according to specific criteria (39% with a simple and 55% with complex problem profiles). 266 patients stated in the questionnaire that a rehab program was impossible for them for personal reasons. Of those patients who remained, we randomized 299 to the intervention cohort and 102 to the control group. Almost 70% of the intervention group completed an application for rehab, and our follow-up revealed that most of them participated in a rehab intervention. Return rate after one year was 82%. Analysis on the intention-to-treat (ITT) principle revealed no significant effect on cardiovascular risk (p=0.68); however, per-protocol analysis demonstrated a significant effect in the intervention cohort (p=0.025). Males, and patients with an uncomplicated problem profile profited from the intervention.
  
  
  CONCLUSIONS
  We discovered that a proactive procedure leads to the identification of a highly relevant group of insured individuals, and that it is suited to generating a large number of medically -justified rehab applications. ITT analysis on the effi-cacy of inpatient rehabilitation for type 2 diabetes mellitus in terms of the cardiovascular 5-year risk, however, failed to display a significant statistical effect in this study population (insurees of generally lower socioeconomic status having no intention to apply for rehab treatment). Rehab treatment for type 2 diabetes does not seem to be universally effective. This of course does not apply to rehab in general, as patients usually participate in rehab of their own volition. More research is needed on this issue.
authors.affiliation: Institut für Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg.
authors.forename: O
authors.initials: O
authors.lastname: Mittag
authors.affiliation: Institut für Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg.
authors.forename: A
authors.initials: A
authors.lastname: Döbler
authors.affiliation: Klinik Niederrhein der DRV Rheinland, Bad Neuenahr-Ahrweiler.
authors.forename: H
authors.initials: H
authors.lastname: Pollmann
authors.affiliation: Institut für Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg.
authors.forename: E
authors.initials: E
authors.lastname: Farin-Glattacker
authors.affiliation: Akademisches Zentrum für Bevölkerungsmedizin und Versorgungsforschung, Universitätsklinikum Schleswig-Holstein (Campus Lübeck).
authors.forename: H
authors.initials: H
authors.lastname: Raspe
mesh_terms: D000293:Adolescent; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D004282:Documentation / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D020380:Needs Assessment; D015995:Prevalence; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult