ABSTRACT
Medical rehabilitation is an important part of the German health care system in addition to medical and nursing care. For people with impairments, especially with chronic diseases, rehabilitation aims at emancipated participation in social life. The German pension insurance carries out rehabilitation mainly for gainfully employed people. To be entitled to these benefits legal and personal (medical) requirements must be fulfilled. The rehabilitation concepts of the German pension insurance are interdisciplinary, following the bio-psycho-social model of health and illness. Concepts of rehabilitation are presented exemplarily for musculoskeletal, oncologic, heart/circulation, metabolic/gastrointestinal, and neurological diseases as well as mental disorders. Elements of structure, process, and outcome quality are illustrated. Research topics in rehabilitation are presented.
Subject(s)
Chronic Disease/rehabilitation , National Health Programs , Rehabilitation, Vocational , Social Security , Cooperative Behavior , Disability Evaluation , Eligibility Determination , Germany , Humans , Interdisciplinary Communication , Patient Care Team , Quality Assurance, Health Care , Quality of Life , Rehabilitation Centers , Research , Self CareABSTRACT
The following guidelines were developed for the medical assessment services of the German pension fund. Starting from day-to-day practice, criteria and attributes to guide decisions for a systematisation of the sociomedical assessment of performance in diseases of the liver and the bile ducts were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent, e. g., for the assessment of applications for decreased earning capacity benefits. The guidelines summarise the typical manifestations of diseases of the liver and the bile ducts and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions, the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual. The guidelines followed from an extended procedure to attain a wide consensus in the setting of the German Pension Fund and an upgraded evidence base.
Subject(s)
Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/therapy , Delivery of Health Care/standards , Liver Diseases/diagnosis , Liver Diseases/therapy , Quality Assurance, Health Care/methods , Quality Assurance, Health Care/standards , Chronic Disease , Germany , Humans , Socioeconomic FactorsABSTRACT
The following guidelines were developed for the medical assessment services of the German Pension Insurance Federal Institution. Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in breast cancer were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent, e. g., for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of breast cancer and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions, the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.
Subject(s)
Breast Neoplasms/classification , Breast Neoplasms/diagnosis , Disability Evaluation , Health Status Indicators , Practice Guidelines as Topic , Social Medicine/methods , Work Capacity Evaluation , Breast Neoplasms/epidemiology , Breast Neoplasms/rehabilitation , Eligibility Determination/standards , Germany/epidemiology , Humans , Social Medicine/organization & administrationABSTRACT
The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemization of the sociomedical assessment of performance in inflammatory bowel disease (Crohn's disease, ulcerative colitis) were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent -- e. g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of inflammatory bowel disease and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.
Subject(s)
Disability Evaluation , Guidelines as Topic , Inflammatory Bowel Diseases/classification , Inflammatory Bowel Diseases/diagnosis , Severity of Illness Index , Work Capacity Evaluation , Adolescent , Adult , Aged , Germany , Humans , Inflammatory Bowel Diseases/rehabilitation , Male , Middle Aged , Social ClassABSTRACT
In recent years new avenues of medical rehabilitation have been made possible in order to allow a more flexible and better care for patients. This includes day care and outpatient treatment additional to inpatient services. A further new development are centers which provide "residential rehabilitation". It allows a continuous cooperation with physicians and therapists who send patients or take care of them after discharge. Cooperation with acute care hospitals is easier. Inpatient care, day care and outpatient care can be better integrated. The social network of the patient can easier be taken into account in treatment planning. Patients can be supported when going back to work. Contact with self-help groups can be arranged while the patient is still in treatment.
Subject(s)
Ambulatory Care/methods , Ambulatory Care/organization & administration , Home Care Services/organization & administration , Patient Care Team/organization & administration , Rehabilitation/methods , Rehabilitation/organization & administration , Germany , Residential Treatment/methods , Residential Treatment/organization & administrationABSTRACT
The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in chronic obstructive pulmonary diseases (COPD) and bronchial asthma were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e. g. for the assessment of applications for decreased earning capacity benefits. Part II outlines assessment of the individual's capacity, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.
Subject(s)
Asthma/diagnosis , Asthma/rehabilitation , Disability Evaluation , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/standards , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/rehabilitation , Asthma/classification , Germany , Humans , Patient Care Management/methods , Patient Care Management/standards , Practice Guidelines as Topic/standards , Pulmonary Disease, Chronic Obstructive/classification , Rehabilitation, Vocational/methods , Rehabilitation, Vocational/standards , Treatment OutcomeABSTRACT
To obtain a standardized method for performance capacity assessment in social medicine reference to a generally accepted model of performance capacity is necessary. Further, such a model enables description of the effects of chronic disease on performance capacity. This article describes how the term "performance capacity" can be reduced to operational basal parameters by a hierarchic breakdown, with the domain "physical performance capacity" having the most complex structure. Furthermore the construction of a graduation according to work-load taxonomies for every parameter is shown. The collection of data on the level of basal parameters is essential to assess the concrete performance capacity. To apply the model as a basis for estimating the effects of chronic disease, graduated disease features have to be created. The benefit of the procedure described lies in increased transparency of the decision process. Hence, performance capacity assessment will gain reliability and objectivity.
Subject(s)
Chronic Disease/rehabilitation , Disability Evaluation , National Health Programs , Work Capacity Evaluation , Eligibility Determination/statistics & numerical data , Germany , Humans , Models, Statistical , Rehabilitation, Vocational/statistics & numerical data , Reproducibility of Results , Social Security/statistics & numerical dataABSTRACT
The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systematization of the sociomedical assessment of performance in chronic obstructive pulmonary diseases (COPD) and bronchial asthma were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e. g. for the assessment of applications for decreased earning capacity benefits. Part I of the guidelines gives information on the classification of chronic obstructive pulmonary diseases (COPD) and bronchial asthma and on the number of pensions due to limited earning capacity. The guidelines summarise typical manifestations of chronic obstructive pulmonary diseases (COPD) and bronchial asthma and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated.
Subject(s)
Asthma/diagnosis , Disability Evaluation , Pulmonary Disease, Chronic Obstructive/diagnosis , Adult , Asthma/classification , Asthma/rehabilitation , Blood Gas Analysis , Bronchoscopy , Diagnosis, Differential , Echocardiography , Echocardiography, Doppler , Electrocardiography , Eligibility Determination , Female , Germany , Humans , Male , Middle Aged , Plethysmography , Plethysmography, Impedance , Practice Guidelines as Topic , Pulmonary Disease, Chronic Obstructive/classification , Pulmonary Disease, Chronic Obstructive/rehabilitation , Respiratory Function Tests , Risk Factors , Social Security/legislation & jurisprudence , Spirometry , World Health OrganizationABSTRACT
In order to investigate whether the energy-equivalence principle is at least acceptable for exposures with a duration in the range of hours and in order to disclose the actual physiological responses to exposures which varied with respect to the time structure and the semantic quality of sounds, a series of tests was carried out where physiological costs associated with varying exposures were measured audiometrically. In a cross-over test design, 10 Subjects (Ss) participated in test series with 3 energetically equal sound exposures on different days. The exposures corresponded with a tolerable rating level of 85 dB / 8 h. In a first test series (TS I), the Ss were exposed to a prototype of industrial noise with a sound pressure level of 94 dB(A) / 1 h. In a second test series (TS II), the same type of noise was applied, but the exposure time of a reduced level of 91 dB(A) was increased to 2 hours. In a third test series (TS III), classical music was provided also for 2 h at a mean level of 91 dB(A). The physiological responses to the 3 exposures were recorded audiometrically via the temporary threshold shift TTS2, the restitution time t(0 dB), and the IRTTS-value. IRTTS is the integrated restitution temporary threshold shift which is calculated by the sum of all threshold shifts. It represents the total physiological costs the hearing must "pay" for the sound exposure. Physiological responses of the hearing to the industrial noise exposures in TS I and TS II, all in all, were identical in the 3 parameters. Maximum threshold shifts of approximately 25 dB occurred which did not dissipate completely until 2.5 h after the end of the exposure and IRTTS-values of about 800 dBmin were calculated. Therefore, at least for exposure times in the range of hours, the equilibration of intensity and duration of sound exposures according to the energy-equivalence principle seems to have no influence on the hearing. Classical music was associated with the least severe TTS of less than 10 dB which disappeared much more quickly. IRTTS added up to just about 100 dBmin and, in comparison with 800 dBmin as specific responses to industrial noise, amounted to only about 12%. The substantially lower physiological costs of classical music apparently indicate a decisive influence of the type of sound exposures. Making inferences from the results of the study, the conventional approach of rating sound exposures exclusively by the principle of energy equivalence can lead to gravely misleading assessments of their actual physiological costs.
Subject(s)
Auditory Threshold/physiology , Noise , Adult , Audiometry , Auditory Threshold/classification , Female , Humans , Male , MusicABSTRACT
The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in discopathy or associated diseases were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent -- e. g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of discopathy or associated diseases and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual. Guidelines for the sociomedical assessment of performance in coronary heart disease (CHD) have been published in Gesundheitswesen 2002, 64: 451-465.
Subject(s)
Disability Evaluation , Guidelines as Topic , Intervertebral Disc Displacement/classification , Work Capacity Evaluation , Cervical Vertebrae , Diagnosis, Differential , Eligibility Determination/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Germany , Humans , Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/rehabilitation , Lumbar Vertebrae , Neurologic Examination , Prognosis , Social Security/legislation & jurisprudenceABSTRACT
Using routine data collected in 2000 for the quality assurance programme of the German Pension Insurance subjective mental impairment and disorders documented in discharge letters of patients undergoing rehabilitation funded by the Federal Insurance Institute for Salaried Employees (BfA) (n = 19,272) were correlated with psychological treatment and inpatient somato-medical rehabilitation provided. The results show discrepancies between self-evaluation, original diagnosis and treatment received. The frequency of treatments varies between hospitals. The differences in treatment are attributed rather to a varying quality of implementation of the bio-psycho-social concept than to a lack of human resources.
Subject(s)
Mental Disorders/diagnosis , Patient Care Team , Psychophysiologic Disorders/rehabilitation , Somatoform Disorders/rehabilitation , Adolescent , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Documentation , Female , Germany , Humans , Male , Mental Disorders/psychology , Mental Disorders/rehabilitation , Middle Aged , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Quality Assurance, Health Care , Rehabilitation Centers , Somatoform Disorders/diagnosis , Somatoform Disorders/psychologyABSTRACT
The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in coronary heart disease (CHD) were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e.g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of CHD and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination and for diagnostic tests - especially of myocardial functioning - are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally inferences are drawn regarding the occupational capacity of the individual.
