[Future Trends in Medical Rehabilitation in the Context of Multimorbidity - Part II: Structural Requirements to Manage an Appropriate Rehabilitative Healthcare]. / Die Zukunft der medizinisch-rehabilitativen Versorgung im Kontext der Multimorbidität ­ Teil II: Strukturelle Voraussetzungen und Anforderungen an das rehabilitative Versorgungssystem.

BACKGROUND: Rehabilitative health care is paying increasing attention to multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance. METHODS: Terms, requirements, design, configuration, challenges and supply of sociomedical rehabilitation were described in part I. A project group of the Medical Advisory Board of the Federal Rehabilitation Council describes manifold fields of actions to be taken in the rehabilitation of persons with multimorbidity. RESULTS: The actions proposed range from reviewing existing forms of management to identifying rehabilitative needs and initiating accurately fitting interventions, sensitizing and enlarging competences of involved personnel, considering multimorbidity in guidelines and further research on questions still open.

[Future Trends in Medical Rehabilitation in the Context of Multimorbidity - Part I: Definition of Terms, Issues and Challenges]. / Die Zukunft der medizinisch­rehabilitativen Versorgung im Kontext der Multimorbidität ­ Teil I: Begriffsbestimmung, Versorgungsfragen und Herausforderungen.

BACKGROUND: Rehabilitative health care is increasingly focusing its attention on multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance. METHODS: After defining the term "multimorbidity" in the context of rehabilitative health care, an exploratory overview of the prevalence and clinical implication of this condition as reported in the literature was drafted. Based on a case history, special attention was paid to general as well as special challenges regarding design, configuration and supply of sociomedical rehabilitative care. Consensus was achieved with the Health Advisory Board of the German Federal Rehabilitation Council. RESULTS: The proposed actions necessary for the healthcare of persons with multimorbidity include specific function-oriented individual assessment of needs via the distinctive allocation, selection and performance of rehabilitative procedures as well as post-rehabilitative care until the patient's reintegration into his social environment.

[Correction: Future Trends in Medical Rehabilitation in the Context of Multimorbidity - Part I: Definition of Terms, Issues and Challenges]. / Errata: Die Zukunft der medizinisch­rehabilitativen Versorgung im Kontext der Multimorbidität ­ Teil I: Begriffsbestimmung, Versorgungsfragen und Herausforderungen.

W. SEGER, W. CIBIS, A. DEVENTER, S. GROTKAMP, N. LüBKE, P.-W. SCHöNLE, M. SCHUBERT. DIE ZUKUNFT DER MEDIZINISCH-REHABILITATIVEN VERSORGUNG IM KONTEXT DER MULTIMORBIDITäT - TEIL I: BEGRIFFSBESTIMMUNG, VERSORGUNGSFRAGEN UND HERAUSFORDERUNGEN KüNSTLERISCHE THERAPEUTEN IM GESUNDHEITSWESEN. GESUNDHEITSWESEN 2016;: Bei diesem Beitrag fehlte ein Autor und die zugehörige Institutsangabe. Nachfolgend die ergänzten Autoren und Institute: AUTOREN:: W. Seger1, W. Cibis2, A. Deventer3, S. Grotkamp4, N. Lübke5, P.-W. Schönle6, M. Schmidt-Ohlemann7, M. Schubert2 INSTITUTE:: 1 MDK Niedersachsen, Hannover 2 Bundesarbeitsgemeinschaft für Rehabilitation (BAR), Frankfurt 3 Praxis für Physikalische und Rehabilitative Medizin, Hamburg 4 MDK Niedersachsen, SEG 1, Hannover 5 Kompetenz-Centrum Geriatrie (KCG), Hamburg 6 Maternus Kliniken, Bad Oeynhausen 7 Diakonie Bad Kreuznach, Rehabilitationsklinik, Bad Kreuznach.

[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation]. / Bedeutung der personbezogenen Faktoren der ICF für die Nutzung in der praktischen Sozialmedizin und Rehabilitation.

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

[Personal factors of the ICF]. / Personbezogene Faktoren der ICF.

PURPOSE: The presentation aims at illustrating the draft proposal of personal factors of the ICF for German-speaking regions which has been published in 2010 by the working group ICF of Faculty II "Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP. For this reason, each personal factor is illustrated by two examples. Thus, the benefit is intended to be convincing. METHODS: Applying a qualitative approach, the working group ICF consisting of members of various professions and institutions including a patients' representative selected for each item one example the factor serving as a facilitator and a second the factor serving as a barrier. RESULTS: The components of the personal factors, as proposed, are presented, each factor is accompanied by two examples. CONCLUSION: The presentation demonstrates the various possibilities of applying personal factors and intends to prove that the selection of items chosen makes sense. The process of a comprehensive discussion about the possible format of the component of personal factors in the ICF should lead to a further optimization of the proposal and the preparation of a discussion at an international level.

[Risks of prioritization in rehabilitation]. / Risiken der Priorisierung in der Rehabilitation.

Prioritization, on the one hand, is a necessity in everyday medical practice. On the other hand, a vivid controversy is taking place in particular as to how prioritization can be formalized in order to allocate resources in the German (statutory) health care system in the best possible manner. Some believe prioritization to be just a preliminary stage for rationing resources. Others point out that if human dignity, medical needs, and solidarity within society are taken into account properly, prioritization can contribute to an improvement of distributive justice and quality control in the health care system. With respect to the rehabilitation system this has already been discussed in the late 1990s, when the main rehabilitation carrier--the German statutory pension insurance scheme--had been forced by legislation to implement major cutbacks in rehabilitation spending. In this article, the authors analyze whether the German social code book IX (SGB IX), in force since 2001, has added new aspects to this debate, and consider the question of whether prioritization can be a useful approach in the rehabilitation system.

[Personal contextual factors of the ICF draft from the Working Group "ICF" of Specialty Group II of the Geman Society for Social Medicine and Prevention]. / Personbezogene Faktoren der ICF - Entwurf der AG "ICF" des Fachbereichs II der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

Personal contextual factors play an essential part in the ICF model in relation to patient-centred care. It is generally assumed that their classification must refer to the country-specific social and cultural setting and its particular linguistic terms. Therefore personal factors are not classified as yet by the WHO for general use. In Germany in 2006 a group of experts working on the medical advisory board of statutory health insurance published a proposal for a systematic classification of relevant personal factors to describe the background of an individual's life and living. This classification was now further analysed and thoroughly revised by a more comprehensive group of German specialists working in different health care insurances and institutions, authorised by the German Society for Social Medicine and Prevention (DGSMP), supported by German-speaking Swiss ICF specialists. This classification is published as work in progress intending to broaden and prepare the process of discussion for a consensus conference to be held in Germany in 2011.

[The term "Funktionale Gesundheit" (functional health) in the German edition of the ICF]. / Der Begriff "Funktionale Gesundheit" in der deutschsprachigen Fassung der ICF.

In the preface of the German edition of the INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) the term "functional health" (Funktionale Gesundheit) is introduced and defined. There is no direct equivalent expression in the original English Version of the ICF. The definition of "Funktionale Gesundheit" was thus strongly disputed among the translators and ICF experts involved in the German translation. In the following, the author suggests reconsidering the definition critically and proposes an alternative solution.

[Perspectives in rehabilitation. General position paper on future trends and challenges in rehabilitation by the Health Advisory Board of the German Federal Association for Rehabilitation]. / Perspektiven der Rehabilitation. Ein Positionspapier des Arztlichen Sachverständigenrates der Bundesarbeitsgemeinschaft f ü r Rehabilitation (BAR) zur Weiterentwicklung der Rehabilitation.

The Health Advisory Board of the German Federal Association for Rehabilitation (BAR) describes future trends and challenges in rehabilitation as deriving from the socio-demographic development in Germany and the structural characteristics of its Social and Health Care Insurance System. The focus is on elder employees to sustain and regenerate their capacity for employment, on people which are no longer employed to activate their autonomy and ability for self-support, and on rehabilitation as a holistic and integrative process extending through the social security and health insurances. There is an urgent need and a real chance to benefit from already existing scientific findings more frequently and to integrate them effectively into adequate further education and training programmes for professionals. Finally the conclusion summarises 8 theses to facilitate rehabilitation as an integral and essential part of the German social security and health sector. This paper was fully accredited by the members of the BAR Managing Board.

[Quality assurance in sociomedical evaluation]. / Qualitätssicherung in der sozialmedizinischen Begutachtung.

Presented is the work of the Quality Assurance in Sociomedical Evaluation Project Group and its findings so far. The Project Group has developed a quality assurance concept for the outcome quality of sociomedical evaluations with personal examination and for evaluations on the basis of medical records. The quality criteria proposed by the Project Group are divided into primary as well as particular criteria. The primary criteria are: plausibility and conclusiveness, reproducibility, neutrality; the particular criteria are: formal and content programming, medical-scientific foundations, understandability, completeness, transparency, and efficiency. Both, the primary and the particular criteria are operationalized through examination questions. To fulfill a primary quality criterion, all related examination questions have to be answered in the affirmative. The particular criteria are related using a scoring system. The quality assurance programme also provides for a peer-review procedure; however, the manual for this procedure has yet to be developed. Research projects will be needed to determine the methodological requirements that have to be fulfilled for the proposed peer review procedure. Prior to implementation of the programme with the financially responsible pension insurance agencies it will be necessary to estimate the amount of time and manpower involved.

[Aspects of expertise which are jointly valid for German sociomedicine and statutory health care]. / Trägerübergreifende Aspekte der Begutachtung nach dem SGB IX - Teil II: Fallbeispiel -

A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurance. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.

[Aspects of expertising which are jointly valid for German sociomedicine and statutory health care]. / Trägerübergreifende Aspekte der Begutachtung nach dem SGB IX--Teil I: Grundlagen.

A project group of the Medical Advisory Board of the German Federal Rehabilitation Council (BAR) developed fundamental joint principles on experts' opinions according to the social law code no. IX (SGB IX). The principles aim at medical experts working in different social organisations and statutory health care insurances. It was intended to create a "sociomedical language" which should be used as jointly as possible by experts in rehabilitation and social medicine and which is based on the ICF (International Classification of Functioning, Disability and Health, WHO 2001). Its stringent application will increase the utility of medical expertise across different institutions. The authors recommend to evaluate whether this model could provide a tool in the communication and cooperation between different sectors of the health system. Part I describes the theoretical model, Part II its application to a virtual individual case history.

[The ICD-10 and the Unified Diagnoses Code of the Pension Insurance. Guidelines for interpretation of the diagnostic codes within the legislative framework for pension insurance]. / Die ICD-10 und der Einheitliche Diagnosenschlüssel der Rentenversicherung. Hinweise zur Handhabung der Diagnosenverschlüsselung für den Bereich der gesetzlichen Rentenversicherung.

The "International Statistical Classification of Diseases and Related Health Problems", Tenth Revision (ICD-10), has to be used by all social security funds in Germany since Jan. 1, 2000. For purposes of the official statistical classification of causes of death, it has been used since 1998. There are a number of fundamental differences between the ICD-10 and the ninth revision. In particular, a considerably higher degree of specification and differentiation warrant a thorough look at the ICD-10 in numerous respects. The Unified diagnoses code of the statutory pension insurance is an extract from the ICD-10 referring specifically to diseases occurring in medical rehabilitation and early retirement contexts. Several new four- and five-digit codes were added for statutory pension insurance purposes, hence are not contained in the original ICD-10. This extract will only turn out a practical tool if the physician is well-qualified in his particular field and is familiar with the sometimes very complex differentiations within the systematical register in volume I of the ICD-10. The article provides an overview of the structure of the ICD-10; deals with major novelties and alterations as well as practical problems; uses various exemplary diagnoses to illustrate a systematical approach in possibly problematical encoding; and recalls several general rules for diagnoses encoding in social medicine.