Outcome quality of in-patient cardiac rehabilitation in elderly patients--identification of relevant parameters.

BACKGROUND: Outcome quality management requires the consecutive registration of defined variables. The aim was to identify relevant parameters in order to objectively assess the in-patient rehabilitation outcome. METHODS: From February 2009 to June 2010 1253 patients (70.9 ± 7.0 years, 78.1% men) at 12 rehabilitation clinics were enrolled. Items concerning sociodemographic data, the impairment group (surgery, conservative/interventional treatment), cardiovascular risk factors, structural and functional parameters and subjective health were tested in respect of their measurability, sensitivity to change and their propensity to be influenced by rehabilitation. RESULTS: The majority of patients (61.1%) were referred for rehabilitation after cardiac surgery, 38.9% after conservative or interventional treatment for an acute coronary syndrome. Functionally relevant comorbidities were seen in 49.2% (diabetes mellitus, stroke, peripheral artery disease, chronic obstructive lung disease). In three key areas 13 parameters were identified as being sensitive to change and subject to modification by rehabilitation: cardiovascular risk factors (blood pressure, low-density lipoprotein cholesterol, triglycerides), exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure, angina pectoris) and subjective health (IRES-24 (indicators of rehabilitation status): pain, somatic health, psychological well-being and depression as well as anxiety on the Hospital Anxiety and Depression Scale). CONCLUSION: The outcome of in-patient rehabilitation in elderly patients can be comprehensively assessed by the identification of appropriate key areas, that is, cardiovascular risk factors, exercise capacity and subjective health. This may well serve as a benchmark for internal and external quality management.

[Capacitive requirement for acute in-patient care of patients with psychosomatic diseases in bavaria]. / Bettenbedarf für die vollstationäre Versorgung von Patienten mit psychosomatischen Erkrankungen in Bayern - Zusammenfassung des Ergebnisberichtes der Projektgruppe "Akutstationäre Versorgung von Patienten mit psychosomatischen Erkrankungen in Bayern".

Estimations of the requirement for acute in-patient care of patients with psychosomatic diseases in Bavaria have to rely on respective data on their incidence and prevalence as valid requirement data are missing. The required capacity of in-patient beds depends on several, inconsistently figured parameters: hospitalization rate, length of stay, occupancy rate. Based on conservative assumptions the hospitalization rate was calculated to be at least 1.3 admissions per 1000 and for adequate treatment the average length of stay should not be limited to less than 50 days. In order to avoid unnecessary delay of treatment a realistic occupancy rate has to be 90 %. Thus the minimal capacity for in-patient care is assessed to be 2453 beds. At present patients with psychosomatic diseases in Bavaria receive in-patient treatment in psychosomatic departments of general hospitals, hospitals and rehab clinics of psychosomatic and psychotherapeutic medicine, and in hospitals of psychiatry and psychotherapy, in each with a different focus. When the expertise was drafted these acute care and rehab hospitals provided some 2500 beds - with only 76 beds in general hospitals. For quality assessment of the available beds for in-patient care and future planning minimal standards of structural quality have to be consented. At present it is not possible to make a clear and substantial distinction between the treatment for patients with psychosomatic diseases in acute-care hospitals and in psychosomatic rehab clinics respectively. Thus, the necessary in-patient rehab capacity can only be assessed roughly. The existing pluralism of the in-patient care providing system for patients with psychosomatic diseases is considered to be appropriate for different needs of this patient group. In the future excellent care for this patient group will acknowledge options for a more flexible and interconnected care-providing system. This is a publication of the complete expertise by the project group "Acute In-patient Care for Patients with Psychosomatic Diseases in Bavaria" which has been handed to the Bavarian Ministry of Social Affairs in December 1999.