title: [Provision of assistive devices in amyotrophic lateral sclerosis. Analysis of 3 years case management in an internet-based supply network].
abstract: BACKGROUND
  The provision of assistive devices (PAD) is a key element of care in amyotrophic lateral sclerosis (ALS). Since 2011, assistive devices (AD) have been coordinated in an internet-supported care network at university-based ALS centers in Berlin, Bochum, Hannover and Jena. The digitization of PAD processes has facilitated the evaluation of real-life ALS care.
  
  
  OBJECTIVE
  Orthotics (OT), augmentative and alternative communication (AAC), supported treadmill (ST) and powered wheelchair (PW) were the PAD groups analyzed for delivery rates (proportion of delivered AD vs. medically indicated AD), rejection by patients and payers and latency of provision of care.
  
  
  RESULTS
  Between June 2011 and October 2014 a total of 1479 patients and 12,478 AD were coordinated, among which 3313 PAD were related to OT, AAC, ST or EM. The median delivery rate was 64.3 %. The mean rejection rate by patients was 9.8 % (OT 5.4 %, AAC 9.8 %, ST 10.2 % and PW 15.6 %). Marked differences were noted in the rejection rate by payers and in care provision latency: OT (16.2 %, 68 days, n = 734), AAC (30.4 %, 96 days, n = 392), ST (34.8 %, 113 days, n = 164) and PW (35.6 %, 129 days, n = 259). Analysis of rejection rates showed significant differences among insurers.
  
  
  CONCLUSIONS
  Only two thirds of the medically indicated AD reached the patients. Rejection rates by patients and payers and latency of provision of care were high. The PAD can substantially vary among health insurance companies. The establishment of consented criteria for PAD and their integration into treatment regimens and guidelines are crucial tasks for the future.
authors.affiliation: Ambulanz für ALS und andere Motoneuronerkrankungen, Neurologische Poliklinik, CharitéCentrum für Neurologie, Neurochirurgie und Psychiatrie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Funke
authors.forename: T
authors.initials: T
authors.lastname: Grehl
authors.forename: J
authors.initials: J
authors.lastname: Großkreutz
authors.forename: C
authors.initials: C
authors.lastname: Münch
authors.forename: B
authors.initials: B
authors.lastname: Walter
authors.forename: D
authors.initials: D
authors.lastname: Kettemann
authors.forename: C
authors.initials: C
authors.lastname: Karnapp
authors.forename: N
authors.initials: N
authors.lastname: Gajewski
authors.forename: R
authors.initials: R
authors.lastname: Meyer
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.forename: K M
authors.initials: KM
authors.lastname: Gruhn
authors.forename: T
authors.initials: T
authors.lastname: Prell
authors.forename: K
authors.initials: K
authors.lastname: Kollewe
authors.forename: S
authors.initials: S
authors.lastname: Abdulla
authors.forename: X
authors.initials: X
authors.lastname: Kobeleva
authors.forename: S
authors.initials: S
authors.lastname: Körner
authors.forename: S
authors.initials: S
authors.lastname: Petri
authors.forename: T
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology / Q000534:rehabilitation*; D019090:Case Management / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D015276:Health Care Rationing / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data* / Q000600:supply & distribution; D008137:Longitudinal Studies; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012656:Self-Help Devices / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D014600:Utilization Review