[Quality management in medical rehabilitation]

In the context of the quality assurance program of the German pension insurance institutions, instruments and procedures have been developed in the past few years in order to assess the quality of structure, process, and results of inpatient rehabilitation, as well as patient satisfaction. The routine implementation of these procedures aims at providing rehabilitation hospitals with fast information on shortcomings in their current practice, so that concepts of treatment and--in the long run--effects of rehabilitation can be systematically improved. When the "quality profiles" of rehabilitation hospitals are compared ("benchmarking"), paying institutions of rehabilitation could gain information on the cost-quality-ratio of particular hospitals as well as important leads for improving the steering processes of patients and hospitals. In the present article, results of a first "field-run" of the procedures for measuring patient satisfaction and quality of rehabilitation processes are reported. A comparative analysis of patient satisfaction in four orthopaedic/rheumatologic rehabilitation hospitals showed high degrees of overall satisfaction in all hospitals. In several subdimensions of patient satisfaction, however, significant differences between hospitals were found. Quality of rehabilitation processes--as assessed by a standardized peer-review--varied substantially between 36 hospitals. Problems of quality were found especially in some dimensions that must be considered as crucial for rehabilitation, e.g., in the history and diagnosis of disabilities, in the consideration of psycho-social problems, or in the assessment of occupational capacities.