University of Lübeck, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562, Lübeck, Germany.
BMC Health Serv Res. 2022 Mar 15;22(1):342. doi: 10.1186/s12913-022-07482-9.
German social law offers services from various providers and agencies for people with chronic disease or disability. Claiming services requires a high level of information and communication. Dealing with a multitude of actors, such as pension insurance agencies, job centers, employers, physicians, and psychotherapists, and coordinating between and with these actors can delay or prevent the utilization of necessary measures like medical or vocational rehabilitation. We developed a case management intervention for people at high risk of receiving a disability pension to address these challenges.
METHODS/DESIGN: Our randomized controlled trial tests the effectiveness of the multi-component AktiFAME strategy (Active access, counseling, and case management for people at high risk of permanent work disability). This strategy is comprised of four modules: screening and postal contact, telephone counseling, an initial one-on-one interview, and case management. The randomized controlled trial is complemented by an observational study that exclusively involves the individuals participating in case management and accompanies the implementation of the case management intervention. We enroll 9000 individuals aged 18 to 65 years who were identified as being at increased risk for receiving a disability pension based on administrative data from the German Pension Insurance North but who have not yet applied for rehabilitation. Half of the individuals are randomly assigned to the intervention group and the other half to the control group. The intervention group is contacted and informed about a case management intervention, whereas the control group is not. The primary outcome of the randomized controlled trial is the utilization of rehabilitation services from the German Pension Insurance North (medical or vocational rehabilitation). Data on rehabilitation will be provided by the German Pension Insurance North 1 year after random allocation. Secondary and tertiary outcomes cover additional administrative data (e.g., employment and welfare benefits) and a range of patient-reported outcome measures.
This randomized controlled trial is designed to determine the effectiveness of a newly implemented multi-component strategy to promote participation and rehabilitation coverage among individuals at high risk of receiving a disability pension.
German Clinical Trials Register (DRKS00024648, April 27, 2021).
德国社会法为患有慢性疾病或残疾的人提供各种服务，来自不同的提供者和机构。申请服务需要较高的信息和沟通水平。与众多参与者（如养老保险机构、就业中心、雇主、医生和心理治疗师）打交道，并协调这些参与者之间的关系，可能会导致延迟或阻止必要措施（如医疗或职业康复）的利用。我们为处于领取残疾养老金高风险的人群开发了一种病例管理干预措施，以应对这些挑战。
方法/设计：我们的随机对照试验测试了 AktiFAME 多组分策略（针对永久性工作残疾高风险人群的积极获取、咨询和病例管理）的有效性。该策略由四个模块组成：筛选和邮寄联系、电话咨询、一次一对一访谈和病例管理。随机对照试验辅以一项观察性研究，该研究仅涉及参与病例管理的个体，并伴随病例管理干预的实施。我们招募了 9000 名年龄在 18 至 65 岁之间的个体，这些个体是根据德国北方养老保险的行政数据确定的处于领取残疾养老金高风险的人群，但尚未申请康复。将这些个体随机分为干预组和对照组各 4500 名。干预组会被联系并被告知病例管理干预，而对照组则不会。随机对照试验的主要结局是德国北方养老保险（医疗或职业康复）康复服务的利用。康复数据将在随机分配后 1 年由德国北方养老保险提供。次要和三级结局包括额外的行政数据（例如就业和福利）和一系列患者报告的结果测量。
本随机对照试验旨在确定新实施的多组分策略在促进领取残疾养老金高风险人群参与和康复覆盖方面的有效性。
德国临床试验注册处（DRKS00024648，2021 年 4 月 27 日）。
