Roesner Martin, Beyer Joachim, Peter Dohm Christoph, Elsner Matthias, Groß Martin, Meyer Alfons, Mokrusch Thomas, Neunzig Hans-Peter, Thomas Randall, Winkler Christian, Rollnik Jens D
Klinikum Osnabrück, Klinik für Neurologie und neurologische Frührehabilitation.
Ludmillenstift Meppen.
Fortschr Neurol Psychiatr. 2019 Apr;87(4):246-254. doi: 10.1055/a-0849-9670. Epub 2019 Mar 13.
We analyzed the delivery of healthcare services among patients in neurological and neurosurgical early rehabilitation programmes in the German states of Lower Saxony and Bremen.
Patients´applications and admissions for neurological and neurosurgical early rehabilitation in Lower Saxony and Bremen were recorded during a period of two weeks both in November 2015 as well as 2016. The proportion of patients admitted to early rehabilitation within a six-week-period after disease onset was calculated. In addition, factors influencing the probability of admission were investigated.
Only 45 % of all patients transferred from a primary neurological / neurosurgical unit to an early rehabilitation facility in Lower Saxony / Bremen were successfully admitted. The probability of admission fell when patients were colonized with multi-drug resistant bacteria (21 % in comparison), in particular Methicillin-resistant Staphylococcus aureus (MRSA) with an admission rate of only 13 %. Deleterious effects were also observed in patients dependent on hemodialysis (20 %), or those with a primary diagnosis of polyneuropathy / Guillain-Barré-Syndrome (33 %) or hypoxic brain damage (37 %), as well as patients on mechanical ventilation (37 %). Patients had a higher probability of being admitted with the primary diagnoses of subarachnoid hemorrhage (52 %) or stroke (51 %). Age, Early Rehabilitation Index (ERI), monitoring, presence of tracheostomy, dysphagia, orientation or behavioral disturbances had no influence on the probability of admission, as well as other primary diagnoses or the number of admissions in one or more rehabilitation centers.
Over one-half of the patients applying for admission to neurological / neurosurgical early rehabilitation facilities in Lower Saxony and Bremen were not admitted. Apparently, the capacity of early rehabilitation treatment in these two German states is not optimal.
我们分析了德国下萨克森州和不来梅州神经科及神经外科早期康复项目患者的医疗服务提供情况。
记录了2015年11月和2016年两个为期两周的时间段内，下萨克森州和不来梅州神经科及神经外科早期康复患者的申请和入院情况。计算了疾病发作后六周内入院接受早期康复治疗的患者比例。此外，还调查了影响入院概率的因素。
从初级神经科/神经外科病房转至下萨克森州/不来梅州早期康复机构的所有患者中，仅有45%成功入院。当患者感染多重耐药菌时（相比之下为21%），入院概率下降，尤其是耐甲氧西林金黄色葡萄球菌（MRSA），入院率仅为13%。在依赖血液透析的患者（20%）、初诊为多发性神经病/吉兰-巴雷综合征（33%）或缺氧性脑损伤（37%）的患者以及接受机械通气的患者（37%）中也观察到了有害影响。初诊为蛛网膜下腔出血（52%）或中风（51%）的患者入院概率较高。年龄、早期康复指数（ERI）、监测、气管切开术的存在、吞咽困难、定向或行为障碍对入院概率没有影响，其他初诊情况或在一个或多个康复中心的入院次数也没有影响。
申请进入下萨克森州和不来梅州神经科/神经外科早期康复机构的患者中，超过一半未被收治。显然，这两个德国州的早期康复治疗能力并非最佳。
