Abel Rainer, Rehahn Kerstin
Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany.
Behandlungszentrum für Rückenmarkverletzte, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany.
Healthcare (Basel). 2024 Dec 13;12(24):2529. doi: 10.3390/healthcare12242529.
BACKGROUND/OBJECTIVES: Spinal cord injury (SCI) care in Germany was established after the Second World War, following Guttman's philosophy that post-SCI rehabilitation should not be separated from the acute treatment phase. Reimbursement is negotiated with only rudimentary eligibility requirements. Over time, however, more and more centers have emerged that offer "only" rehabilitation. Therefore, in 2014, the German-Speaking Paraplegic Society (DMGP) saw the need to establish a certification and grading process to protect existing centers and enable qualified reimbursement negotiations.
In a modified delpi process, key data reflecting the human resources and equipment of the units were collected, and, after lengthy consensus negotiations, a grading was proposed which recognizes four levels of performance. Level Ia-24/7 coverage for all SCI-related emergencies (including intensive care unit care and surgery)-to Level IIb (rehab only, no intensive care unit).
In 2019, the grading was accepted by the extended board of the DMGP, and all but one of the 27 SCI centers applied to be graded and certified according to a self-reported questionnaire (2020).
The development of the certification requirements and grading system was a complicated process, but it was possible to reach a solution which allowed its acceptance by all German SCI centers. Whether it will result in better care for the patients remains to be seen.
背景/目的：德国的脊髓损伤（SCI）护理是在第二次世界大战后，遵循古特曼的理念建立的，即SCI后的康复不应与急性治疗阶段分开。报销是在只有基本资格要求的情况下协商确定的。然而，随着时间的推移，越来越多的中心出现，它们“只”提供康复服务。因此，2014年，德语区截瘫患者协会（DMGP）认为有必要建立一个认证和分级程序，以保护现有中心，并促成有资质的报销谈判。
在一个经过改进的德尔菲过程中，收集了反映各单位人力资源和设备的关键数据，并经过长时间的共识谈判，提出了一个分级方案，该方案认可四个绩效水平。从Ia级（对所有与SCI相关的紧急情况提供全天候服务，包括重症监护病房护理和手术）到IIb级（仅提供康复服务，无重症监护病房）。
2019年，该分级方案被DMGP扩大委员会接受，27个SCI中心中除一个中心外，其余所有中心都根据一份自我报告问卷申请了分级和认证（2020年）。
认证要求和分级系统的制定是一个复杂的过程，但有可能达成一个能被所有德国SCI中心接受的解决方案。它是否会带来对患者更好的护理还有待观察。
