Kalwitzki T, Huter K, Runte R, Breuninger K, Janatzek S, Gronemeyer S, Gansweid B, Rothgang H
SOCIUM - Forschungszentrum Ungleichheit und Sozialpolitik, Universität Bremen, Bremen.
MDS, Essen.
Gesundheitswesen. 2017 Mar;79(3):e26-e38. doi: 10.1055/s-0042-103745. Epub 2016 May 2.
In the broad-based consortium project "Reha XI - Identifying rehabilitative requirements in medical service assessments: evaluation and implementation", a comprehensive analysis of the corresponding procedures was carried out by the medical services of the German Health Insurance Funds (MDK). On the basis of this analysis, a Good Practice Standard (GPS) for assessments was drawn up and scientifically evaluated. This article discusses the findings and applicability of the GPS as the basis for a nationwide standardized procedure in Germany as required by the Second Act to Strengthen Long-Term Care (PSG II) under Vol. XI Para. 18 (6) of the German Social Welfare Code. The consortium project comprised four project phases: 1. Qualitative and quantitative situation analysis of the procedures for ascertaining rehabilitative needs in care assessments carried out by the MDK; 2. Development of a Good Practice Standard (GPS) in a structured, consensus-based procedure; 3. Scientific evaluation of the validity, reliability and practicability of the assessment procedure according to the GPS in the MDK's operational practice; 4. Survey of long-term care insurance funds with respect to the appropriateness of the rehabilitation recommendations drawn up by care assessors in line with the GPS for providing a qualified recommendation for the applicant. The evaluation carried out in the third project phase was subject to methodological limitations that may have given rise to distortions in the findings. On the basis of the situation analysis, 7 major thematic areas were identified in which improvements were implemented by applying the GPS. For the evaluation of the GPS, a total of 3 247 applicants were assessed in line with the GPS; in 6.3% of the applicants, an indication for medical rehabilitation was determined. The GPS procedure showed a high degree of reliability and practicability, but the values for the validity of the assessment procedure were highly unsatisfactory. The degree of acceptance by the long-term care insurance funds with respect to the recommendations for rehabilitation following the GPS procedure was high. The application of a general standard across all MDKs shows marked improvements in the quality of the assessment procedure and leads more frequently to the ascertainment of an indication for medical rehabilitation. The methodological problems and the unsatisfactory findings with respect to the validity of the assessors' decisions require further scientific scrutiny.
在基础广泛的联合项目“康复XI - 确定医疗服务评估中的康复需求：评估与实施”中，德国健康保险基金医疗服务机构（MDK）对相应程序进行了全面分析。基于此分析，制定了评估的良好实践标准（GPS）并进行了科学评估。本文讨论了GPS的研究结果及其适用性，它是德国《社会福利法典》第十一卷第18条第（6）款规定的《加强长期护理第二法案》（PSG II）所要求的德国全国标准化程序的基础。该联合项目包括四个项目阶段：1. 对MDK进行护理评估时确定康复需求的程序进行定性和定量情况分析；2. 通过结构化的、基于共识的程序制定良好实践标准（GPS）；3. 在MDK的实际操作中，根据GPS对评估程序的有效性、可靠性和实用性进行科学评估；4. 就护理评估员根据GPS为申请人制定的康复建议是否合适，对长期护理保险基金进行调查。在第三个项目阶段进行的评估存在方法上的局限性，这可能导致研究结果出现偏差。基于情况分析，确定了7个主要主题领域，并通过应用GPS进行了改进。为了评估GPS，共根据GPS对3247名申请人进行了评估；在6.3%的申请人中，确定了医疗康复的指征。GPS程序显示出高度的可靠性和实用性，但评估程序有效性的值非常不理想。长期护理保险基金对遵循GPS程序的康复建议的接受程度很高。在所有MDK中应用通用标准显示出评估程序质量有显著提高，并且更频繁地导致确定医疗康复的指征。评估员决策有效性方面的方法问题和不理想的研究结果需要进一步的科学审查。
