[Outcome quality in rehabilitation of children and adolescents: results of project aiming at the development of a quality assurance programme]

Objectives: This study reports on the results of a project that was initiated by the German pension fund and the statutory health insurers and conducted in 2009 to 2010 with the goal of developing, arranging and testing instruments for quality assurance for the outcome (including patient satisfaction) in inpatient medical rehabilitation centres for children and adolescents.

Method: After a 6-month concept phase in which instruments were developed using value benefit analyses, expert consensus procedures, surveys of centres, and qualitative (cognitive interviews) and quantitative (psychometric tests) pre-studies, data were collected in 23 child and adolescent rehabilitation centres using the instruments that had been developed. The project was limited to the following 4 main diagnoses: obesity, bronchial asthma, atopic eczema, and hyperkinetic disorders as well as related disorders (ICD: F90-F94). Children and adolescents over the age of 12 years were interviewed themselves, for younger children, the parents were interviewed. It was decided to include 7 constructs that can be considered as indicators of the quality of the outcome or of patient satisfaction: generic and disease-specific quality of life, perceived change in health, body function parameters (e. g., blood pressure), disease-related self-management, satisfaction of the children/adolescents with rehabilitation, and parent satisfaction.

Results: With respect to quality of life, blood pressure, Munich fitness test and lung function parameters, low to medium effects were achieved; with respect to body mass index, SCORAD score and disease-related self-management, the effects were strong. The results can be summarised to the effect that rehabilitation generally achieves noticeable effects in the areas where the impairment is pronounced. In both the parent and the rehabilitation patient survey, there was a high level of satisfaction. The parents of rehab patients under the age of 12 years gave the centres an average assessment of 1.6 to 1.8; rehab patients over the age of 12 years gave the centres an average grade of 2.0 (1=very good to 5=very bad). The differences among the centres were very low after risk adjustment, especially for outcome quality.

Conclusions: The strengths of the instruments that were developed are that a scientifically demanding quality measurement was conducted (e. g., combination of indirect and direct measurement of change, several methodological approaches to measuring results, wide range of endpoints analysed, homogeneous comparison groups, elaborate risk adjustment process). There are limitations, especially with respect to the rather great effort needed and not particularly high power for the comparison of centres. The German pension fund and the statutory health insurers are now discussing on the basis of the results of the project the routine implementation of quality assurance in children/adolescent rehabilitation and concrete steps that can be taken to implement it in routine health care.