Knecht Stefan, Studer Bettina
St. Mauritius Therapieklinik, Strümper Straße 111, 40670, Meerbusch, Deutschland.
Institut für Klinische Neurowissenschaften, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Nervenarzt. 2019 Apr;90(4):371-378. doi: 10.1007/s00115-018-0641-y.
Neurorehabilitation comprises medical and functional treatment. If patients in the post-hospital phase need acute medical interventions but these cannot be provided by the rehabilitation center, patients must be referred to suitable acute care hospitals; however, such referrals incur additional costs, are fraught with medical risks and delay further rehabilitation. We evaluated how integrating non-neurological medical specialties and a hospital unit into a neurorehabilitation center affects the rate of acute hospital referrals. The special situation in North-Rhine Westfalia, which was the last state in Germany to grant restricted hospital certification to neurorehabilitation centers, enabled a longitudinal assessment over 10 years. We analyzed the referral rate at one of the first hospitals in the state, which in addition to rehabilitation treatment (according to § 40 of the Social Security Code V, SGB V) now also provide hospital treatment (according to § 39 SGB V) and have reorganized in preparation for integrated treatment structures. In the center investigated (St. Mauritius Therapy Hospital Meerbusch) the average patient age increased between 2007 and 2017 from 69 years to 72 years and the proportion of severely ill patients on admission by 70%. Starting in 2012 integrated structures were established in a stepwise fashion with the inclusion of specialists in intensive care, cardiology and neurosurgery, extension of the diagnostic and interventional spectrum and establishment of a 24/7 emergency team with back-up from a new intensive care and mechanical ventilation unit. As a result referrals to hospitals dropped by more than 50% in all categories of disease severity despite the increase in age and morbidity. In view of the savings in costs of hospital treatment, reduced risks due to transfer and less interruption of rehabilitation, it is concluded that the efficacy of patient treatment is improved by discipline and sector integrated neurorehabilitation compared to isolated structures.
神经康复包括医学治疗和功能治疗。如果处于出院后阶段的患者需要急性医疗干预，但康复中心无法提供，那么患者必须被转诊至合适的急症医院；然而，此类转诊会产生额外费用，充满医疗风险，并会延误进一步的康复治疗。我们评估了将非神经医学专科和一个医院科室整合到神经康复中心如何影响急性医院转诊率。北莱茵 - 威斯特法伦州的特殊情况使其成为德国最后一个授予神经康复中心有限医院认证的州，这使得能够进行长达10年的纵向评估。我们分析了该州首批医院之一的转诊率，该医院除了提供康复治疗（根据德国社会法典第五卷第40条，SGB V）外，现在还提供医院治疗（根据SGB V第39条），并且已经为综合治疗结构进行了重组。在所调查的中心（梅尔布施圣毛里求斯治疗医院），2007年至2017年间患者的平均年龄从69岁增加到72岁，入院时重症患者的比例增加了70%。从2012年开始逐步建立综合结构，纳入重症监护、心脏病学和神经外科专家，扩大诊断和干预范围，并建立了一支全天候应急团队，由一个新的重症监护和机械通气科室提供支持。结果，尽管年龄和发病率有所增加，但所有疾病严重程度类别的医院转诊率下降了50%以上。鉴于医院治疗成本的节省、因转诊导致的风险降低以及康复中断减少，得出的结论是，与孤立的结构相比，通过学科和部门整合的神经康复提高了患者治疗的效果。
