A Comparison of Different Methods of Social Medicine Assessments Used for the Selection of Patients for In-patient Rehabilitation (multi-center-study) (Project C-2)
Project management at the University of Würzburg:
The German rehabilitation system dictates a social medical assessment to precede the decision weather a patient is suitable for in-patient medical rehabilitation. Different assessment methods are established. The pension schemes’ Medical Services either intend assessment through inspection of patients’ records (through inspectors) including medical documents like comprehensive patient questionnaires and questionnaires filled out by patients’ GPs (assessment type A), or internal (assessment type B) or external medical experts (assessment type C) carry out personal medical assessments, or both kinds of assessments are implemented (inspection of records and medical assessment). Evidence-based knowledge of the effectiveness of the three types of assessments concerning the selection of patients with a need for rehabilitation (sensitivity, specifity) does not exist so far.
It was planned to compare procedures A, B and C to examine first, how the methods differ from each other and second, to which degree they correlate with the external criteria “patients’ subjective need for rehabilitation” and “patients’ objective need for rehabilitation assessed by social medical clinicians”. The chosen experimental design corresponds to a validation study for diagnostic instruments. It is the first randomised experimental design to be applied to social medical reviews of rehabilitation needs.
400 experimental subjects (patients who have requested rehabilitation) were assessed through inspection of records (assessment type A - as described above). They were then recruited to either one of the two randomised further social medical assessment types B (medical assessment by internal social medical experts) or C (medical assessment by external social medical experts). The judgements of internal and external experts were made independently from each other and from assessment A.
To estimate the subjective need for rehabilitation the IRES-questionnaire (Gerdes & Jäckel, 1995) was used. To make judgements about patients’ objective need for rehabilitation, special rating-instruments were designed. These include an item indicating “need for rehabilitation yes/no” along the most important social medical assessment-criteria. Patients who were positive in at least one of the assessments participated in the study. Patients of this group were examined at the time of the application for medical rehabilitation, at the beginning and at the end of rehabilitation, and after 3 and 12 months (follow-ups). Assessments by clinicians were taken at the beginning and at the end of the rehabilitation. Patients who were negative in all assessments were asked to fill in IRES 12 months after they had requested rehabilitation. The evaluation could be carried out in 2000 and 2001 at the Medical Services of the Bavarian LVAs and at the rehabilitation clinics as planned. At the beginning of the evaluation 534 patients were recruited, whereas 443 sets of data could be kept after rehabilitation. The results were correlated with the external criteria.
Between internal social medical experts and inspectors higher correspondence could be found than between external social medical experts and inspectors. External professionals rejected more requests than internal experts and inspectors. This can be explained as following: The main criteria for a need for rehabilitation have different degrees of importance to inspectors, internal and external experts. Correlations between judgements of inspectors and experts furthermore showed that internal and external social medical experts consider patients’ perspectives to a higher degree than inspectors do. A comparison of the different assessment methods and objective long-term success of the rehabilitation is to be expected.
Projekt period: from 10.1998 to 04.2002
Sonstige öffentliche Mittel ( LVA-Unterfranken ) ,Granting date: 26.08.1998