Spyra K, Köhn S, Ammelburg N, Schmidt C, Missel P, Lindenmeyer J
Charité – Universitätsmedizin Berlin, Lehrstuhl für Versorgungssystemforschung und Grundlagen der Qualitätssicherung in der Rehabilitation, Luisenstraße 13A, 10117 Berlin.
Rehabilitation (Stuttg). 2011 Oct;50(5):298-307. doi: 10.1055/s-0031-1285918. Epub 2011 Oct 5.
Due to the introduction of lump sum reimbursement systems for acute-care settings (DRGs), patient classification systems have been developed in Germany during the last 15 years to adapt a case-based lump sum system to the field of medical rehabilitation. The concept of Rehabilitee-Management-Categories (RMK), developed by the Charité - Universitätsmedizin Berlin, classifies rehabilitees primarily by their relevant impairments of activity and participation, as these factors mainly determine treatment needs and resources required in rehabilitation. It can, inter alia, be used to optimize the demand-related allocation of treatment services in the rehabilitation centres as well as lead to more transparency in the allocation process. RMK results are reported on the example of inpatient rehabilitation of alcohol dependence.
Utilizing internationally established assessments, an RMK-assessment was developed that allows the assessment of rehab treatment needs of patients undergoing alcohol dependence rehabilitation. The RMK-assessment was completed by n=731 rehabilitees. Latent class analysis was applied to find groups of cases. To facilitate the RMK-patient classification a software-based algorithm was developed and implemented in 12 rehabilitation centres (implementation study). To validate the results of the first study phase, the data collected during implementation (n=1,533) was again analyzed using latent class analysis. Combined standardized and qualitative user surveys were conducted at the end of the implementation study.
On the basis of 15 needs-related patient characteristics, 4 comparable case groups (AL-1 to AL-4) each were identified in 2 independent samples, groups that differed significantly in their degree of dependence-related, psychological and social impairment. The user survey confirmed the basic clinical plausibility of the 4 different case groups as well as the feasibility of the instruments applied in a rehabilitation setting.
The RMK-concept offers a new approach for a demand-related patient classification in medical rehabilitation. The RMK-instruments allow a standardized initial assessment of impairment and treatment needs in alcohol rehabilitation and can hence be used for objective comparisons between rehabilitation centres. The results of the RMK-assessment provide relevant information about demand-related treatment requirements, which is a matter of great interest in the context of limited resources. Appropriate treatment requirements for the 4 RMK-case groups will be defined and verified in the next step of the RMK-concept. A financial evaluation of the RMK is possible in principal, will however require more extensive development, not least in order to model and evaluate the health-economic implications involved.
由于急性护理环境中引入了总额预付报销系统（诊断相关分组），在过去15年里德国开发了患者分类系统，以使基于病例的总额预付系统适用于医学康复领域。柏林夏里特大学医学中心开发的康复者管理类别（RMK）概念主要根据康复者的活动和参与相关损伤对其进行分类，因为这些因素主要决定康复中的治疗需求和所需资源。它尤其可用于优化康复中心治疗服务与需求相关的分配，并提高分配过程的透明度。以酒精依赖住院康复为例报告了RMK的结果。
利用国际公认的评估方法，开发了一种RMK评估方法，用于评估酒精依赖康复患者的康复治疗需求。731名康复者完成了RMK评估。应用潜在类别分析来找出病例组。为便于进行RMK患者分类，开发了一种基于软件的算法并在12个康复中心实施（实施研究）。为验证第一研究阶段的结果，使用潜在类别分析再次分析了实施期间收集的数据（n = 1533）。在实施研究结束时进行了标准化和定性相结合的用户调查。
基于15个与需求相关的患者特征，在2个独立样本中分别确定了4个可比病例组（AL-1至AL-4），这些组在依赖相关、心理和社会损伤程度上有显著差异。用户调查证实了4个不同病例组的基本临床合理性以及在康复环境中应用的工具的可行性。
RMK概念为医学康复中与需求相关的患者分类提供了一种新方法。RMK工具允许对酒精康复中的损伤和治疗需求进行标准化初步评估，因此可用于康复中心之间的客观比较。RMK评估结果提供了与需求相关的治疗要求的相关信息，这在资源有限的情况下是一个非常重要的问题。在RMK概念的下一步将定义并验证4个RMK病例组的适当治疗要求。对RMK进行财务评估原则上是可行的，但需要更广泛的开发，尤其是为了对所涉及的健康经济影响进行建模和评估。
