[Peer review: a method for the analysis of the quality of processing in-patient rehabilitation methods]

In order to evaluate the process quality of inpatient rehabilitation we established a peer-review system. In our approach, measurement of process quality is based on the report written by rehabilitation doctors at discharge of their patients. First of all, a list of 52 criteria relevant to process quality was defined by experienced clinicians using the Delphi technique. These criteria may be divided into six dimensions: anamnesis, diagnostic interventions, goals of therapy and therapy, judgement on vocational abilities, recommendations for further treatment and epicrisis. Thereafter, the experts in a manual defined specific requirements for each of the 52 criteria. In a pilot study, we were able to demonstrate reliability and practicability of the peer review system. Using this approach shortcomings in present rehabilitation practice may be detected. Nearly 400 reports from 20 rehabilitation hospitals were reviewed by thoroughly trained peers. Most frequently shortcomings were found in the description of patient's disabilities and in the definition of specific rehabilitation goals. Furthermore, this procedure enables comparison of process quality in different rehabilitation hospitals. In our pilot study we found marked differences in the process quality of the 20 rehabilitation hospitals.