[Paediatric Rehabilitation by the German Pension Insurance - Status Quo and Future Developments]. / Kinder- und Jugendlichen-Rehabilitation ­ Stand und Perspektiven aus Sicht der Deutschen Rentenversicherung.

In Germany inpatient rehabilitation plays a major role for the treatment of children and adolescents with chronic health conditions. The German Pension Insurance carries out the rehabilitation of children and adolescents with high commitment. Paediatric rehabilitation enables children to go to kindergarten and school without interruption and participate in later professional life. The article specifies the basics of paediatric rehabilitation, describes the disease structure, defines the therapeutic care and explicates survey results.

Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study.

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.

[Outcome quality in rehabilitation of children and adolescents: results of project aiming at the development of a quality assurance programme]. / Ergebnisqualität in der Kinder-Jugend-Rehabilitation: Resultate eines Projekts zur Entwicklung eines Qualitätssicherungsverfahrens.

OBJECTIVES: This study reports on the results of a project that was initiated by the German pension fund and the statutory health insurers and conducted in 2009 to 2010 with the goal of developing, arranging and testing instruments for quality assurance for the outcome (including patient satisfaction) in inpatient medical rehabilitation centres for children and adolescents. METHOD: After a 6-month concept phase in which instruments were developed using value benefit analyses, expert consensus procedures, surveys of centres, and qualitative (cognitive interviews) and quantitative (psychometric tests) pre-studies, data were collected in 23 child and adolescent rehabilitation centres using the instruments that had been developed. The project was limited to the following 4 main diagnoses: obesity, bronchial asthma, atopic eczema, and hyperkinetic disorders as well as related disorders (ICD: F90-F94). Children and adolescents over the age of 12 years were interviewed themselves, for younger children, the parents were interviewed. It was decided to include 7 constructs that can be considered as indicators of the quality of the outcome or of patient satisfaction: generic and disease-specific quality of life, perceived change in health, body function parameters (e. g., blood pressure), disease-related self-management, satisfaction of the children/adolescents with rehabilitation, and parent satisfaction. RESULTS: With respect to quality of life, blood pressure, Munich fitness test and lung function parameters, low to medium effects were achieved; with respect to body mass index, SCORAD score and disease-related self-management, the effects were strong. The results can be summarised to the effect that rehabilitation generally achieves noticeable effects in the areas where the impairment is pronounced. In both the parent and the rehabilitation patient survey, there was a high level of satisfaction. The parents of rehab patients under the age of 12 years gave the centres an average assessment of 1.6 to 1.8; rehab patients over the age of 12 years gave the centres an average grade of 2.0 (1=very good to 5=very bad). The differences among the centres were very low after risk adjustment, especially for outcome quality. CONCLUSIONS: The strengths of the instruments that were developed are that a scientifically demanding quality measurement was conducted (e. g., combination of indirect and direct measurement of change, several methodological approaches to measuring results, wide range of endpoints analysed, homogeneous comparison groups, elaborate risk adjustment process). There are limitations, especially with respect to the rather great effort needed and not particularly high power for the comparison of centres. The German pension fund and the statutory health insurers are now discussing on the basis of the results of the project the routine implementation of quality assurance in children/adolescent rehabilitation and concrete steps that can be taken to implement it in routine health care.

[Quality assurance of rehabilitation by the German pension insurance: an overview]. / Ein aktueller Überblick zur Reha-Qualitätssicherung der Rentenversicherung.

The German pension insurance has in recent years developed a comprehensive programme for quality assurance in rehabilitation, and has implemented the programme into routine practice. Different aspects of rehabilitation are evaluated with differentiated instruments. Issues dealt with inter alia include the quality of rehabilitative care in a narrower sense, the structure and organisation of the rehabilitation centres, as well as quality from the patients' perspective. On the whole, positive results predominate. Big differences in quality however have been found between the rehabilitation centres. The data collections and data evaluations carried out make a continuous process of quality assurance reporting possible for use by rehabilitation centres and pension insurance agencies. This will enable targeted initiatives for quality improvement. The methods and procedures of quality assurance are enhanced at regular intervals, and the scope of quality assurance is extended. Thus, rehab quality assurance is also expanded to cover ambulant rehabilitation or rehabilitation of children and young people.

[Structure quality assurance in in-patient medical rehabilitation of children and adolescents]. / Sicherung der Strukturqualität in der stationären medizinischen Rehabilitation von Kindern und Jugendlichen.

BACKGROUND: So far, the routine programmes of the statutory pension and health insurance institutes for quality assurance in medical rehabilitation have not included facilities for children and adolescents. Thus, a conjoint project of the statutory pension and health insurance institutes to assess and to describe the structure quality of in-patient medical rehabilitation clinics for children and adolescents was initiated. The aim of the project was a survey and an analysis of the currently existing clinic structures and the development of criteria for an evaluation of the structure quality. The Institute of Medical Psychology, University of Hamburg and the Department of Quality Management and Social Medicine, University of Freiburg were engaged to conduct the project. METHOD: A questionnaire was developed in a multi-stage process with expert involvement which covers general information, characteristics of structure quality as well as structure affiliated process characteristics of clinics. The survey was planned as a cross-sectional study. Data collection was accomplished from 1.12.2004 - 15.3.2005. RESULTS: A total of n = 177 facility addresses were available. The return rate was 83.3 %. Eventually, n = 79 facilities were included in the analysis. In sum, the results underline the heterogeneity of services in the field of child and adolescent rehabilitation. CONCLUSIONS: The results allow an analysis of the current clinic structures as well as a first comparison of clinics on the basis of the assessed structure characteristics.