Vorsatz N, Brüggemann S
Deutsche Rentenversicherung Bund.
Rehabilitation (Stuttg). 2011 Jun;50(3):168-77. doi: 10.1055/s-0031-1273727. Epub 2011 May 30.
Medical rehabilitation carried out by the German Pension Insurance aims at maintaining or restoring the ability to work taking into account individual problems of the insured population. To ensure high-quality rehabilitation the German Pension Insurance uses a variety of quality assurance instruments. It is indispensable that requirements from different instruments constitute a conclusive and hence reproducible overall concept. This article looks at the requirements imposed on work-related medical rehabilitation (MBOR) and from the standards for rehabilitative therapy.
In an expenditure analysis we evaluated the extent to which the requirements from our standards for rehabilitative therapy in chronic back pain and work-related medical rehabilitation are compatible with each other, and their impact on the quantity of treatment to be delivered. In a first step the instruments were compared qualitatively. Next, we looked at the resulting cumulative duration of treatment. Finally, using an orthopaedic rehabilitation centre on the underlying assumptions as an example, we analysed whether existing staffing levels are sufficient to fulfil the requirements.
MBOR and rehabilitation treatment standards both set requirements regarding vocational orientation; they, however, employ different methods and address different groups of rehabilitants. The duration of treatment for a rehabilitant who - owing to his work-related problems - is treated not only according to the rehabilitative treatment standards but also fulfilling the MBOR requirements profile increases on average from 10.4 to 14.2 h a week. Modelling of the staffing levels necessary to fulfil the requirements shows a possible shortage in the group of social workers only.
The requirements from MBOR and rehabilitative treatment standards are compatible with each other regarding systematics, target group and scope of work-related treatment and are consistent with specifications for structural quality, especially with staffing levels. Rehabilitants are not exposed to undue strains, and staffing levels in rehabilitation centres are adequate - with the possible exception of social workers for MBOR. In future development of quality specifications for rehabilitation it remains pre-eminent to ensure an interlocking of the different requirements, in order to provide the rehabilitation centres with a comprehensible frame for the provision of care.
德国法定养老保险所开展的医疗康复旨在考虑参保人群的个体问题，维持或恢复其工作能力。为确保高质量康复，德国法定养老保险采用了多种质量保证手段。不同手段的要求构成一个具有决定性且可重现的整体概念，这一点至关重要。本文探讨了对与工作相关的医疗康复（MBOR）的要求以及康复治疗标准的要求。
在一项支出分析中，我们评估了慢性背痛康复治疗标准和与工作相关的医疗康复要求彼此兼容的程度，以及它们对所需治疗量的影响。第一步是对这些手段进行定性比较。接下来，我们考察由此产生的累计治疗时长。最后，以一家骨科康复中心为例，依据基本假设分析现有人员配备水平是否足以满足要求。
MBOR和康复治疗标准都对职业导向提出了要求；然而，它们采用不同方法，针对不同的康复人群。由于与工作相关的问题，一名康复者不仅按照康复治疗标准接受治疗，还满足MBOR要求，其每周治疗时长平均从10.4小时增加到14.2小时。对满足要求所需人员配备水平的建模显示，仅在社会工作者群体中可能存在短缺。
MBOR和康复治疗标准在系统性、目标群体以及与工作相关治疗的范围方面彼此兼容，并且与结构质量规范一致，尤其是与人员配备水平一致。康复者不会承受过度压力，康复中心的人员配备水平充足——MBOR的社会工作者可能除外。在康复质量规范的未来发展中，确保不同要求相互关联仍然至关重要，以便为康复中心提供一个易于理解的护理提供框架。
