Stand der Qualitätssicherung in der Rehabilitation der gesetzlichen Rentenversicherung

[Satisfaction of Rehabilitation Patients on Social Media Websites and Online Rating Portals]

PURPOSE

Patients increasingly express themselves about their medical rehabilitation stay, evaluate health service providers with star ratings, and write reviews on the internet. So far, no results are available regarding online patient satisfaction for inpatient medical rehabilitation in Germany. For the first time, this study conducted a systematic analysis of rehabilitation patient satisfaction on social media websites and hospital rating portals.

METHODS

We collected reviews of medical rehabilitation on the portal Klinikbewertungen.de and the social network Facebook for 8 indication groups (orthopedics, psychosomatics/psychotherapy, oncology, cardiology, neurology, internal medicine, pulmonology/dermatology, gastroenterology) with a full data extraction over 3 survey years (October 2014-September 2017) and for rehabilitation clinics with main bed occupancy of retirement insurance (N=497). The star ratings, aggregated according to indication groups, were evaluated to determine patient satisfaction (Pearson's chi-square test, Fisher's exact test, Phi coefficient).

RESULTS

A total of 97.2% of the rehabilitation clinics were represented, with 24,806 ratings on Klinikbewertungen.de. The most frequently evaluated indication groups were orthopedics (38.5%) and psychosomatics/psychotherapy (27.1%). Facebook ratings (N=4,127) were collected for rehabilitation clinics with one department (38.6%) in order to ensure an indication group assignment. Almost the same number of ratings were determined on official (48.7%) and unofficial Facebook pages (51.3%), with no significant correlation between website management and overall satisfaction (p>0.05). On the Facebook pages of the rehabilitation clinics, 49.1% of the ratings were written by women (38.5% by men; 12.4% not assignable). Sociodemographic information on Klinikbewertungen.de was based solely on the status of the insured (89.1% of those with statutory insurance). Overall, 95.4% of the reviews were written by patients and 4.0% by relatives, with 77.5% of patients recommending the clinic to other users (relatives: 37.2%). Most patient ratings were positive. However, there were differences in overall satisfaction between the indication groups. Patients in oncology (77.9%) were more satisfied than those in neurology (59.0%).

CONCLUSIONS

Online ratings of inpatient medical rehabilitation were collected to a considerable extent. These were mostly positive. The results are comparable to standardized surveys. Despite restrictions in the use of social media data, the results indicated that the publicly available real-time online feedback from patients can provide useful information for the quality management of clinics as well as for patients in exercising their right to choose a rehabilitation clinic.

Die Bedeutung der Rehabilitation für die Versorgung chronisch Kranker

Das Gesundheitsversorgungssystem basiert auf drei Säulen: der Gesundheitsvorsorge, der Behandlung und der Rehabilitation, wobei letztere als medizinische Maßnahme (Leistungen der medizinischen Rehabilitation), berufsbezogene Maßnahme (Leistungen zur Teilhabe am Arbeitsleben) oder soziale Maßnahme (Leistungen zur Teilhabe am Leben in der Gemeinschaft) durchgeführt werden kann. Die Weltgesundheitsorganisation (WHO, www.who.org) bezeichnet die Rehabilitation von Personen mit Behinderungen als einen Prozess, der das Ziel verfolgt, den Betroffenen zu ermöglichen, ihr optimales physisches, sensorisches, intellektuelles, psychisches und soziales Funktionsniveau zu erreichen und aufrecht zu erhalten.

[Quality assurance and quality management in medical rehabilitation]

External quality assurance in medical rehabilitation is characterized by the programs of Germany's two largest providers of rehabilitation (the German pension insurance and the statutory health insurance). The programs were developed with considerable input from scientific institutes. Their strengths lie in measuring several relevant dimensions of quality, the comprehensive implementation for nearly all illnesses treated, integration of the patient perspective, and realization of prospective study designs with follow-up. Weaknesses include low relevance for patient allocation and compensation, the absence of systematic evaluations, and a lack of published patient information on the results of the quality measurements. Internal quality management in medical rehabilitation is regulated by sweeping legal guidelines. Since 2009, a statutory agreement has been in effect which includes a provision that all inpatient rehabilitation centers must be certified by October 2012. Areas for potential improvements in internal quality management processes include an improved theoretical basis, higher specificity for rehabilitation, and a more transparent, methodically improved structure of certification procedures.

[Quality assurance and guidelines in rehabilitation for musculoskeletal diseases]

Diseases of the musculoskeletal system are among the most common and most costly diseases in Germany. They are also associated with a considerable burden for those affected. As a result these disorders also dominate the utilization statistics with respect to medical rehabilitation measures paid for by the statutory pension insurance. In the last 10 years, quality assurance programs have been developed for rehabilitation--initiated and financed by the rehabilitation sponsors--that are characterized by a comprehensive, perspective, pronounced scientific basis, region-wide implementation, and strong patient orientation. The development of guidelines for rehabilitation began later than for acute medicine. In addition to the formulation of guidelines for rehabilitation by medical organizations and professional associations, the German pension insurance has developed so-called process guidelines containing framework requirements for the treatment of defined indication groups rather than support for decision-making in the rehabilitation of individual patients. By planned control of adherence to the process guidelines in the quality assurance programs of the pension insurers prompt implementation of the guidelines can be anticipated.