RESUMEN
Introduction: In the broad-based consortium project "Reha XI - Identifying rehabilitative requirements in medical service assessments: evaluation and implementation", a comprehensive analysis of the corresponding procedures was carried out by the medical services of the German Health Insurance Funds (MDK). On the basis of this analysis, a Good Practice Standard (GPS) for assessments was drawn up and scientifically evaluated. This article discusses the findings and applicability of the GPS as the basis for a nationwide standardized procedure in Germany as required by the Second Act to Strengthen Long-Term Care (PSG II) under Vol. XI Para. 18 (6) of the German Social Welfare Code. Method: The consortium project comprised four project phases: 1. Qualitative and quantitative situation analysis of the procedures for ascertaining rehabilitative needs in care assessments carried out by the MDK; 2. Development of a Good Practice Standard (GPS) in a structured, consensus-based procedure; 3. Scientific evaluation of the validity, reliability and practicability of the assessment procedure according to the GPS in the MDK's operational practice; 4. Survey of long-term care insurance funds with respect to the appropriateness of the rehabilitation recommendations drawn up by care assessors in line with the GPS for providing a qualified recommendation for the applicant. The evaluation carried out in the third project phase was subject to methodological limitations that may have given rise to distortions in the findings. Findings: On the basis of the situation analysis, 7 major thematic areas were identified in which improvements were implemented by applying the GPS. For the evaluation of the GPS, a total of 3 247 applicants were assessed in line with the GPS; in 6.3% of the applicants, an indication for medical rehabilitation was determined. The GPS procedure showed a high degree of reliability and practicability, but the values for the validity of the assessment procedure were highly unsatisfactory. The degree of acceptance by the long-term care insurance funds with respect to the recommendations for rehabilitation following the GPS procedure was high. Conclusion: The application of a general standard across all MDKs shows marked improvements in the quality of the assessment procedure and leads more frequently to the ascertainment of an indication for medical rehabilitation. The methodological problems and the unsatisfactory findings with respect to the validity of the assessors' decisions require further scientific scrutiny.
Asunto(s)
Programas Nacionales de Salud/normas , Evaluación de Necesidades/estadística & datos numéricos , Guías de Práctica Clínica como Asunto/normas , Garantía de la Calidad de Atención de Salud/normas , Rehabilitación/estadística & datos numéricos , Rehabilitación/normas , Atención a la Salud , Alemania , Programas Nacionales de Salud/estadística & datos numéricosRESUMEN
One of the Federal Joint Committee's duties is to assess benefit, need, and cost-effectiveness of diagnostic and therapeutic approaches. The aim is to decide whether they can be provided within the statutory health care system in Germany. The systematic assessment concerning low dose rate brachytherapy with permanent seed implantation for treatment of men with localized prostate cancer revealed that sufficient scientific evidence for its benefit compared to therapeutic alternatives is still missing. In 2009, the Federal Joint Committee recommended a randomized controlled trial in order to evaluate the different therapies. Based on a concept developed by the National Association of Statutory Health Insurance Funds urology and radiooncology experts and other protagonists are currently working on the steps to be taken for implementation of a preference-based randomized controlled trial to compare radical prostatectomy, percutaneous radiotherapy, low dose rate brachytherapy with permanent seed implantation, and active surveillance in the treatment of low or early intermediate risk prostate cancer.