[The Rehabilitation Guideline Program of the BfA]

Since 1998, the German Federal Pension Insurance for Salaried Employees (BfA) has funded several research projects aimed at developing clinical practice guidelines for medical rehabilitation. Using a standardized protocol, therapeutic processes for individual disorders were evaluated as to whether they were evidence-based. The projects covered about half of all rehabilitation cases handled by the BfA. Effective therapeutic procedures were identified in a systematic literature review. Clusters of therapies--so called evidence-based therapeutic modules (ETM)--were formed, outlining the frame of an ideal rehabilitation. A target/actual comparison was carried out to determine the need to develop rehabilitation guidelines. Routine data of the Classification of Therapeutic Performances derived from discharge letters were compared with the ETM, allowing comparison of the actual provision of treatment with the scientifically-defined target. The variance in therapies between the ETM on one hand, and among rehabilitation centers on the other hand, made the necessity for the development of rehabilitation clinical practice guidelines clear. The ETM were finalized after a written survey including all professions and a subsequent multi-professional expert workshop. The guidelines are now integrated into the BfA's quality assurance system. The process of implementation is accompanied by research teams.

By developing clinical practice guidelines specific to rehabilitation, the pension insurance is the only sector of the German health system in which quality evaluation is carried out on the basis of clinical practice guidelines. This will improve the treatment of chronically ill patients on a scientific and quality-assured basis.