title: Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study.
abstract: BACKGROUND
  In many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany.
  
  
  METHODS
  We analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals.
  
  
  RESULTS
  Of the 239,811 respondents 0.9% were nationals from Turkey, 0.8% had a nationality from a former Yugoslavian country, 0.9% held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9% were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95%-confidence interval [95%-CI]: 1.12-1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95%-CI: 1.45-1.80) for Turkish nationals and 1.68 (95%-CI: 1.52-1.85) for nationals from Former Yugoslavia.
  
  
  CONCLUSIONS
  Knowledge on health outcomes from the patients' point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process.
authors.affiliation: Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany. patrick.brzoska@uni-bielefeld.de.|Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Chemnitz, Germany. patrick.brzoska@uni-bielefeld.de.
authors.forename: P
authors.initials: P
authors.lastname: Brzoska
authors.affiliation: Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Sauzet
authors.affiliation: Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany.|Department of Public Health, Giresun University, Faculty of Medicine, Giresun, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Yilmaz-Aslan
authors.affiliation: German Statutory Pension Insurance Scheme, Social Medicine and Rehabilitation, Section Rehabilitation Research (Deutsche Rentenversicherung Bund, Geschäftsbereich Sozialmedizin und Rehabilitation, Bereich Reha-Wissenschaften), Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Widera
authors.affiliation: Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Razum
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000208:ethnology; D011174:Portugal; D012046:Rehabilitation; D016896:Treatment Outcome; D014421:Turkey / Q000208:ethnology
keywords: Effectiveness; Health services research; Inequity; Migrants; Rehabilitation