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Biomedical subjects

F Schliehe

Publications and source records attributed to F Schliehe.

At least 19 recordsLinked to original sources
PubMed2006

[The ICF classification system--a problem oriented inventory on behalf of the German Society of Rehabilitation Sciences].

With the International Classification of Functioning, Disability and Health, ICF and its adoption by the World Health Organization in May 2001, the concept of "functional health" reached a new dimension. Prepared and developed further over many years, the concept of a comprehensive and internationally consented classification system completed the shifting of paradigm in our notion of disease and disablement, bringing along far-reaching consequences for theory and practice in particular in rehabilitation. Symbolizing this paradigmatic shift, destigmatization, resource orientation, context factors, and participation are among the central notions of the concept. The ICF is a foundation for seeking international agreement across the bounds of disciplines and is amidst an intensive transfer and implementation process, also in Germany. Due to the multitude of actors and activities involved, it has become almost impossible even for those taking a strong interest in the matter to keep up with developments and fields of applications, let alone to achieve consensus in these respects. The German Society of Rehabilitation Sciences therefore initiated a problem-oriented stocktaking of the present situation. This article seeks to point out a number of important developments and trends in order to provide initial orientation and overview. The stocktaking is intended to contribute to further disseminating the ICF, at the same time however to outline several crucial fields of application and development. To be continued and deepened, this preliminary stocktaking underlines several core developments along with a number of conceptual issues still unresolved for the time being. Notwithstanding a high degree of acceptance of the concepts underlying the ICF, continued and, as far as possible, coordinated efforts toward implementation will be required at all levels.

Disability Evaluation↗
PubMed2004

[Criteria of quality of structure in rehabilitation units with inpatient treatment].

The structure of a rehabilitation unit is an important feature of the quality of care. Adequate and qualitatively good structures provide the basis for appropriate therapy offers and treatment and eventually, a better health for rehabilitants. The quality of structures is generally recorded without any evaluation of the aspects in particular. The definition of standards is the basis for such an evaluation. The project presented is aimed at the definition of relevant structural standards for rehab units with inpatient treatment for musculoskeletal, cardiac, neurological, gastroenterological, oncological, pneumological and dermatological diseases. Here, the distinction between basal criteria which have to be fulfilled by every rehab unit with inpatient treatment and criteria important for a well-aimed assignment of patients with specific needs ("assignment criteria") should be made. Apart from the documentation of structural attributes, the structural quality of a rehab unit can be described individually as well as in comparison with other units. Relevant structural criteria were defined in expert meetings by means of a modified Delphi-technique with five inquiries. Overall, 199 "basal criteria" and "assignment criteria" were defined. All criteria can be assigned to the two domains general structural characteristics (general characteristics and equipment of rooms; medical/technical equipment; therapy, education, care; staff) and process-related structures (conceptual frames; internal quality management; internal communication and personnel development). The structural standards are applicable to units for musculoskeletal, cardiac, neurological, oncological, gastroenterological, dermatological and pneumological rehabilitation financed by the two main providers of rehabilitation, the statutory pension insurance scheme and the statutory health insurance scheme for all other five indications. The definition of structural standards agreed by experts in a formal consensus process, provides comprehensive and concrete requirements for German rehab units with inpatient medical rehabilitation. If the two main providers of rehabilitation both use the standards this can be regarded as a hallmark on the path to a unitary programme for quality management. The results enable units to analyse their weak points not just on an individual basis but allow also for a comparison between units, along with contributing to optimizing the structural quality of rehab units.

Germany↗
PubMed2004

[New forms of remuneration and care delivery: their impact on rehabilitation].

Current health policy reform efforts in Germany include introduction of a DRG (Diagnosis Related Group) based funding system in the hospital sector as well as integrated delivery of health care and disease management programs, developments that will directly affect the medical rehabilitation sector. Decreasing lengths of hospital stay induced by the DRG system will inter alia entail a shifting of cases and costs to subsequent sectors. Moreover, hospitals might not least seek compensation for shorter hospital stays by extending their scope to include rehabilitation and long-term care services. Introduction of the DRG system in acute-hospital care has resulted in major changes in respect of early rehabilitation. Existing specialized early rehabilitation facilities providing high-quality care face serious funding problems on account of the newly introduced early rehabilitation DRGs. For hospitals previously not involved in early rehabilitation on the other hand, incentives arise to set up new early rehabilitation structures although the need for these additional capacities obviously is questionable. Introduction of the DRG-based funding system has reinforced the discussion about applying a flat-rate system also in the rehabilitation sector. This form of remuneration however is inappropriate to medical rehabilitation concepts. On the other hand, a remuneration system incorporating cross-institutional per-diem fees and "treatment time" budgets might enable using essential advantages of flat-rate payment without having to expect repercussions for the quality of care. In the context of integrated care and disease management programs the issue at stake for rehabilitation primarily is to be able to contribute its specific competencies appropriately. Also, integrated health care is bound to result in stronger competition among the various health care sectors. If rehabilitation is set to face this competition, further research efforts will urgently have to be made along with ongoing development of clinical practice guidelines.

Budgets↗
PubMed2003

[The significance of clinical guidelines for rehabilitation].

Clinical practice guidelines are relevant to all parties involved in the health system. For rehabilitation under the German pension insurance scheme, there are two main aspects: the integration of rehabilitation into the curative guidelines in terms of "local tailoring" on the one hand and the development of guidelines for rehabilitative processes, demand-oriented control of rehabilitation access, and rehabilitative aftercare on the other hand. The elaboration of effective standards is aimed at avoiding over-provision, under-provision or misdirected provision of care and, simultaneously, at ensuring that quality assured treatment is offered to the rehabilitees. Also, it is intended to increasingly implement evidence-based medicine in a sector of the health system in which research has so far been underrepresented. Implementation of guidelines in the rehabilitative sector will allow to disseminate existing knowledge in targeted manner, to systematically fill the gaps and to broaden the knowledge base as a whole. Furthermore, guidelines can facilitate integration of the different sectors in health care provision by operationalising the interfaces both with curative medicine and primary prevention. Throughout the process of guideline development for rehabilitation the specific characteristics of this sector must be kept in mind. Since therapeutic interventions are multidisciplinary and multimodal in nature guidelines have to be comprehensible and applicable for all members of the multiprofessional team. Corresponding to the relative paucity in rehabilitation research there is no sufficient evidence base for numerous therapeutic interventions. Accordingly, guidelines in rehabilitation will--initially--consist of a mixture of evidence- and consensus-based recommendations. Also, the specific goal of rehabilitation under the German pension insurance scheme, namely maintenance or recovery of the capacity at work, has to be borne in mind. There are many initiatives by the providers of rehabilitation as well as the scientific medical societies to develop and implement rehabilitative clinical practice guidelines, e. g. the guidelines programme of the BfA (Federal Insurance Institute for Salaried Employees), which is aimed at developing rehabilitation process guidelines for selected indications, the guidelines activities of the VDR (Federation of German Pension Insurance Institutes), and the input of the "Guidelines" commission of the DGRW (German Society of Rehabilitation Science). It is hoped that in the years to come the parties involved in German health care provision will be open to the advantages of clinical practice guidelines. Rehabilitation under the German pension insurance scheme, with respect to its experience with quality assurance, its responsibilities for structure and concept and a growing acceptance on the part of care providers, already holds a well-founded starting position.

Combined Modality Therapy↗
PubMed2001

[Challenges in social medicine counseling and expert assessment].

The services of expert testimony and professional consultation in sociomedicine are considerably challenged. It is not so much the question of maintaining their traditional functions but of developing them in order to maintain at least the status quo. These challenges consist for example of the lack of a scientific basis for the complex function of allocation, piloting and control of medical resources. Some new approaches are offered by the ICIDH, by new instruments of medical assessment and by quality management including "evidence-based medicine". Furthermore the services of expert testimony must bridge the gap between patients and social services in a way which is satisfactory for the population. Nevertheless, these services must maintain strict independence.

Evidence-Based Medicine↗
PubMed1999

[Current developments in ambulatory rehabilitation].

Up to now, the majority of rehabilitative measures in Germany has been performed in inpatient programmes. In the past 10 years discussions have increased about extending a flexible scheme involving outpatient, inpatient and partially inpatient rehabilitation benefits. Some concepts in outpatient rehabilitation were already developed as well by the Federal Rehabilitation Council as by various rehabilitation providers. Concept requirements include the principles of holism, interdisciplinarity, goal-oriented rehabilitation and team-work of rehabilitation staff. The arguments in favour of extended outpatient rehabilitation are being faced with many questions and uncertainty about future needs, differential indication criteria and effectiveness. In order to answer these questions pilot projects accompanied by scientists are being conducted for different indication fields. Preliminary findings of the scientific studies indicate that the inpatient rehabilitation model gains more acceptance than the partially inpatient type. The studies on the whole show that partially inpatient populations differ from inpatient ones on various variables. Considering these limitations in comparability, there is a tendency for partially inpatient rehabilitation to yield similar results as inpatient measures. Additionally, it is important to accurately identify the indication.

Ambulatory Care↗
PubMed1999

[Need for rehabilitation and application behavior].

The need for rehabilitation is not absolute and given quality. Determination of the need for rehabilitation depends on various criteria, e.g., the case history and certain legally standardized medical prerequisites. Both the regulation of rehabilitation expenditures and different types of personal excess coverage may be interpreted as efforts on the part of social policy to introduce additional controls (i.e., alongside the medical prerequisites) of the need for rehabilitation. Since rehabilitation benefits are only granted in case the insured has applied for, the demand for personal excess coverage might cause a certain selection of financially powerful rehabilitees. Recent cost-cutting legislation, which inter alia included strict budgeting of rehabilitation expenditures and increased personal excess coverage, had entailed a considerable decline in the number of applications for rehabilitation in 1996 and 1997. Several pension insurance funds started questioning their insured to examine the general interest in using rehabilitation services. The results show a strong need for rehabilitation in the group of the older insured (aged 40 and over), however, only 35% to 40% of the insured in subjective need for rehabilitation intend to file an application for rehabilitation and an even smaller number of insured actually apply for rehabilitation. Major impediments to applying for rehabilitation mentioned are job uncertainty as well as the increased personal excess coverage under the recent austerity legislation.

Adult↗
PubMed1998

[Current status and progress in scientific rehabilitation research].

When compared to the entire field of health research, to the significance and role of rehabilitation in the health care system, to future developments in demand and to international developments, the field of rehabilitation in Germany has formerly suffered from a considerable deficit in research regarding both structure and content. The German Federal Ministry of Research and the German Statutory Pension Insurance have now established a common focus in research. This decision reflects not only a new political attitude toward the promotion of research but also represents the initiation of attempts to overcome existing research deficits permanently by means of an extensive programme for the promotion of research. In addition to the construction of a scientific infrastructure, the funders most importantly expect results that will contribute to the further optimisation of effectiveness and efficiency in rehabilitation services. An improved scientific foundation of rehabilitative practice will also assist the field of rehabilitation in finding greater socio-political recognition as an interdisciplinary field. In order to achieve the demanding goals of this promotion of research, the promoters will accompany the programme with efficient scientific management and quality assurance. The statutory pension insurance institutes will systematically analyse the expected research results and offer recommendations and suggestions for realisation in dialogue with scientific experts and specialist practitioners.

Forecasting↗
PubMed1998

[The quality assurance program of mandatory social security in the realm of medical rehabilitation. Concept, status of implementation and prospects].

The quality improvement programme aims at the comparison of clinics in charge of the statutory pension insurance. The programme has been implemented successively in 1994, supported by researchers and teams of experts on specific subjects. Instruments and procedures have been developed to all programme items including a clinic comparing and information system, thus permitting routine use in practice. Performing regular clinic-comparisons analysing structural quality (equipment, staff, clinical concept, management), procedural quality (recording of rehabilitation process), and outcome quality (success of the rehabilitation estimated by physician and patient) of rehabilitation facilities shall initiate quality competition and stimulate a constant improvement of quality. significant basis, therefore, is a clinic-comparing information and reporting system. The developed instruments and procedures are available for all institutes providing rehabilitation.

Germany↗
PubMed1997

[Consequences of the need for cost control in rehabilitation].

Beginning 1997, considerable cost-cutting constraints have become effective which are entirely founded by fiscal reasons. The resulting restrictions will not remain without consequences for care and supply of patients with chronic diseases and handicaps as well as for the entire rehabilitation system itself. The expected cuts are so serious that they will also affect further rehabilitation prospects and objectives. The extent of the austerity measures-especially the extent of budget capping-is running counter to the factual development of needs.

Cost Control↗
PubMed1997

[Rehabilitation from the economic viewpoint in relation to the legal social security insurance].

Rehabilitation increasingly focuses on patients' chronic diseases and a restricted efficiency in job and everyday life. In Germany, the specialized rehabilitation system has been adapted to this development and produced particular successful, holistic, and interdisciplinary concepts which involve medical, occupational, and social benefits. Medical rehabilitation as a field discipline and treatment method has been advanced continuously and can not be compared with acute or curative care. During recent years rehabilitation expenses increased constantly; however, the cost increase corresponds to the rise of the actual need. The share of all rehabilitation expenses (rehabilitation providers, types of benefit) in health care benefits is between 6% and 7% and consequently considerably lower than hospital charges, for example. Economy in rehabilitation, as it now is especially intended through a restrictive rehabilitation benefit budgeting for the statutory pension insurance, will not reduce health care expenses in all. On the one hand, it is to be expected that benefits for pensions and care will rise in the medium term. On the other hand, economy in rehabilitation will produce additional expenses in other health care sectors without being more effective. Since the need for rehabilitation benefits will further increase due to demographic development, new priorities should be set in favor of patients with chronic diseases.

Aged↗