Optimierung der Berufsgenossenschaftlichen Stationären Weiterbehandlung (BGSW) durch systematischen Einsatz von Assessmentinstrumenten

BACKGROUND: The managed inpatient rehabilitation of the statutory accident insurance (BGSW) is a standard treatment option after a major trauma of the lower extremities. There is no consensus yet in the literature concerning the utility and efficiency of inpatient rehabilitation of patients suffering from disability due to impairments of the locomotor system. There is a scarcity of evidence yet in terms of efficiency and cost-effectiveness of inpatient rehabilitation after major trauma. The aim of the current study is to develop and to evaluate an assessment-driven quality management system for optimising effects of inpatient rehabilitation of the BGSW in patients suffering from major trauma of the lower extremities. METHODS: From 768 patients admitted to the inpatient rehabilitation by the greatest regional statutory accident insurance (VBG), 493 (64.2%) suffered from a major trauma of the lower extremities. SF-36, WOMAC and EQ-5D were administered to this sample on admission (T1), at discharge (T2) from the inpatient rehabilitation, at the end of a scheduled prolongation (T2a) and at 6-months follow-up (T3). The treatment- and management-concept was optimized in three subsequent steps. We compared the effect sizes between cohorts treated during the subsequent optimizing steps. RESULTS: Concerning the whole study population, moderate to great effects were found between T1 and T2 across the dimensions of SF-36. PCS effects were significantly greater than MCS effects. There were moderate effects in EQ-5D and great ones as measured by WOMAC. The effects between T1 and T3 were greater as these between T1 and T2 in all parameters. There were significant differences between cohorts treated with different concepts representing subsequent steps in optimising process. CONCLUSIONS: The developed and implemented assessment-driven quality management system was practicable in patients undergoing inpatient rehabilitation programs of the statutory accident insurance (BGSW). The results support the hypothesised possibility and necessity of permanent assessment-driven optimising of rehabilitation processes. The implementation of optimised rehabilitation standards by further network partners would facilitate greater populations under evaluation and possibility of economic and subgroups analyses.