Meyer Thorsten, Kleineke Vera, Stamer Maren
Institute for Rehabilitation Medicine, Medical School, Martin-Luther-University Halle-Wittenberg Halle (Saale), Germany.
School of Public Health, Bielefeld University, Bielefeld, Germany.
Front Rehabil Sci. 2023 Mar 15;4:1114666. doi: 10.3389/fresc.2023.1114666. eCollection 2023.
Rehabilitation is a complex intervention that takes place in a complex setting. The MeeR project (characteristics of successful rehabilitation facilities) aims to identify complex conditions of successful rehabilitation outcomes.
A project with a sequential mixed-methods study design with a quantitative prestudy and a qualitative main study was applied. In the quantitative study, quality assurance data of the German Pension Insurance was used to (1) develop and compute a multifacet z-standardized outcome index based on patient-reported outcome data, (2) rank = 273 orthopedic rehabilitation facilities comprising = 112,895 patients and = 86 cardiac rehabilitation institutions comprising = 30,299 patients based on their outcome index score by means of a league table, and (3) adjust the ranking by basic patient characteristics (age, gender, diagnosis, weeks out of work prior to rehabilitation, application for pension). In the qualitative main study, = 6 rehabilitation facilities (orthopedic and cardiac rehabilitation centers) were recruited based on the results of the quantitative analysis: three facilities that ranked top 10% and three facilities that ranked lowest 10% of the adjusted league table. All six rehabilitation facilities were visited each for 1 week by two researchers. We conducted participant observations, expert interviews with medical and administrative leaders, group discussions with rehab team members, and group discussions with patients. Subsequently, a systematic comparison of the results of the upper and lower 10% facilities was conducted to identify those characteristics that distinguished those institutions from one another.
One of the three clusters of characteristics that distinguished the above and below 10% facilities related to teamwork or interdisciplinary cooperation: among others, the extent of interdisciplinary cooperation was higher in the rehabilitation facilities with a higher degree of success, the leading medical doctors were less dominant in these institutions, and there was also a more comprehensive representation of the team within team meetings, i.e., the quality and amount of interdisciplinary cooperation were higher in these institutions compared to rehabilitation facilities with a lower level of success.
This project provided qualitative evidence for the role of interdisciplinary cooperation and collaborative leadership and its different facets for patient-related successful rehabilitation in orthopedic and cardiac rehabilitation. It provides valuable insights into the fabric and structure of a rehabilitation institution and a variety of target points for team development and group-leading interventions.
康复是一种在复杂环境中进行的复杂干预措施。MeeR项目（成功康复设施的特征）旨在确定成功康复结果的复杂条件。
采用了一项具有序贯混合方法研究设计的项目，包括定量预研究和定性主要研究。在定量研究中，德国养老保险的质量保证数据被用于：（1）基于患者报告的结果数据开发并计算一个多方面的z标准化结果指数；（2）通过排行榜根据结果指数得分对273家骨科康复设施（涉及112,895名患者）和86家心脏康复机构（涉及30,299名患者）进行排名；（3）根据患者的基本特征（年龄、性别、诊断、康复前失业周数、养老金申请情况）调整排名。在定性主要研究中，根据定量分析结果招募了6家康复设施（骨科和心脏康复中心）：三家在调整后的排行榜中排名前10%的设施和三家排名后10%的设施。两位研究人员对所有六家康复设施各进行了为期1周的访问。我们进行了参与观察、对医疗和行政领导的专家访谈、与康复团队成员的小组讨论以及与患者的小组讨论。随后，对排名前10%和后10%的设施的结果进行了系统比较，以确定区分这些机构的特征。
区分排名前10%和后10%设施的三类特征之一与团队合作或跨学科合作有关：除其他外，在成功率较高的康复设施中跨学科合作的程度更高，这些机构中主导的医生不那么强势，并且在团队会议中团队的代表性也更全面，即与成功率较低的康复设施相比，这些机构中跨学科合作的质量和数量更高。
该项目为跨学科合作和协作领导的作用及其在骨科和心脏康复中与患者相关的成功康复的不同方面提供了定性证据。它为康复机构的结构和组织提供了有价值的见解，并为团队发展和团队领导干预提供了各种目标点。
