Projektart: Gefördertes Projekt Verbundprojekt
Prädiktion, Verfahrensoptimierung, Kosten

Balance sheet from the collaborative activities to date: The increasing expansion of the rehabilitation science research infrastructure and the establishment of precise content-related and methodological standards under the leadership of the public universities provides the overarching framework of the RFNB's collaborative objectives. The framework topic "Rehabilitation Outcomes: Prediction, Process Optimization, Costs", the focus on the quality of rehabilitation outcomes, especially with regard to its transferability in terms of practical applicability, will continue to guide the activities of the RFNB in the coming years. Looking back on the first funding phase, the following interim balance can be drawn: - the increasingly efficient networking of research, supporting and provider institutions successfully took into account the need for external, cooperation-promoting structure formation in recent years; - the anchoring of interdisciplinary approaches increasingly enabled the assurance of qualitative standards at the research level. This progress can be directly derived from the framework conditions of the network's activities. The coordination of the scientific office in inter-institutional and interdisciplinary sub-projects and cross-project working groups has been a successful strategy to ensure: - immediate implementation of research results in health care practice, teaching and training (research-practice-transfer) and - long-term assurance of the research outcome of the network. Institutional structure of the network: The overall network is divided into two cooperating entities: - the scientific research network in the narrower sense and - the "Association for the Promotion of Rehabilitation in Lower Saxony and Bremen e. V." The scientific research network comprises the board of directors and the members, which include the representatives of the content-related (sub-) projects and cross-projects as well as the supporting institutions. This composition provides the institutional framework for the network participants: - Hannover Medical School, - Centre for Clinical Psychology and Rehabilitation at the University of Bremen, - Institute for Medical Psychology at the University of Hamburg (only 1st funding phase), - non-university rehabilitation facilities/clinics, - general practitioners as well as the - supporting institutions (German Pension Insurance, regional health insurance funds) . In this context, the special role of the two initiative groups from Bremen and Hanover in promoting the content of the network should be pointed out: the synergy effects from behavioral health science-oriented and medical epidemiology-oriented approaches contributed significantly to the contouring of the RFNB in recent years. For their part, the various research institutions contributed the perspectives of different disciplines, for example, from the field of organic medicine, psychological-behavioral medicine, psychosomatic-psychotherapeutic and health science. The inclusion of all German pension insurers in the region (Braunschweig, Hanover and Oldenburg/Bremen) in the activities of the network ensures, on the one hand, that research results are demand-oriented and, on the other hand, that they can be transferred to health care practice in a time-efficient manner. The "Verein zur Förderung der Rehabilitation in Niedersachsen und Bremen e. V." (Association for the Promotion of Rehabilitation in Lower Saxony and Bremen) provides the main support for the joint formulation and coordination of interests in the context of bringing together scientific institutions with the service and financial providers of rehabilitation. Representatives of the supporting institutions, the scientific association, the rehabilitation facilities as well as organizations and individuals interested in rehabilitation are united in this association. Further tasks of the association, also beyond the existing network, are the acquisition, association and integration of other institutions and people concerned with rehabilitation issues as well as the long-term support of the rehabilitation science research structures in the region. An expression of the good networking between the scientific research network and the support association is among other things the mutual statutory representation in both boards: the spokesperson of the RFNB in the board of the Association for the Promotion of Rehabilitation in Lower Saxony and Bremen e. V. and one representative each of the funding association and the German Pension Insurance of the region in the board of the RFNB. New rehabilitation science research structures in and after the 2nd funding phase: As an essential goal of the funding priority, it was achieved that new rehabilitation science research structures with university anchoring were created at the beginning of the 2nd funding phase. Initially, the initiative of the Deutsche Rentenversicherung Braunschweig-Hannover and the VRFNB succeeded in getting an endowed professorship at the MHH off the ground. Unfortunately, the appointment procedure could not be completed successfully. The German Pension Insurance Oldenburg-Bremen initiated an endowed professorship at the Centre for Clinical Psychology and Rehabilitation of the University of Bremen, which was filled on 01.05.2004; this professorship (Prof. Dr. P. Hampel) will represent the subject "Rehabilitation Psychology" in teaching and research at the psychology course until April 2010. Since fall 2004, the German Pension Insurance Braunschweig-Hannover has financed a coordination office for applied rehabilitation research under the direction of Prof. C. Gutenbrunner and Dr. I. Ehlebracht-König, which will establish rehabilitation research at the MHH in teaching and research for five years - i.e. beyond the funding period. With these new rehabilitation science research structures at both university locations of the RFNB, its central tasks will be carried out even after the expiration of the current joint funding. Content-related tasks: For a well-founded decision by the cost bearers as to whether the application for a rehabilitation measure is sensible, expedient and medically necessary from the point of view of need, there is a need above all for scientifically sound statements on the prognosis of the endangered or reduced earning capacity and the individual rehabilitation success. The development of predictors, i.e. prognostically relevant parameters, identifies groups of people for whom - with quantifiable probability - incapacity to work is to be expected in the further course of the disease and - defined rehabilitation programs are particularly successful or have little or no effect. This is intended to provide the pension insurance institutions with a scientifically sound basis for making decisions about granting rehabilitation benefits to those applicants for whom there are satisfactory prospects of success. For this purpose, specific methodological approaches were developed in several subprojects as well as in the cross-projects "Methods and Statistical Consulting" and "Health Economic Evaluation". Within the RFNB, three relevant levels are focused on: - medical-somatic variables, - subjective dimensions, - maintenance and restoration of work and gainful employment. Process optimization: To ensure that both institutional care in general and specific treatments in particular can be designed effectively and in a time- and cost-efficient manner, the RFNB aims at process optimization with measures of external as well as internal quality assurance. Through scientific research into effectiveness, the RFNB can help to ensure that modified treatment procedures are only adopted in rehabilitation practice if they also prove to be effective in comparison with the previous procedures. Cost-benefit analyses (see below) can also play a role here. Patient training is already well established in medical rehabilitation for many clinical pictures. Standards on the type and content of these programs need to be formulated and implemented. In the case of newly developed procedures, scientific evaluation is particularly important in order to implement quality assurance in the sense of evidence-based medicine. Due to the assumed advantages of networking close to home, opportunities for day-care and outpatient rehabilitation should be increasingly examined. In the past, it has often been shown that the improvements achieved after rehabilitation are only stable to a limited extent. Against this background, aftercare concepts are becoming increasingly important. However, the review of these concepts is still pending in many areas. Within this orienting framework, the content-related subprojects focus on improving the quality of results of medical rehabilitation, especially with regard to maintaining and restoring the job integration of the rehabilitant. By increasing the focus of the content subprojects on case management, e.g., by considering or approaching meta-treatment plans across phases as well as institutions, the coordination of care services at the institutional interfaces of rehabilitation is to be improved in the long term. Costs: Successful rehabilitation measures have been shown to reduce follow-up costs resulting from chronic illnesses and disabilities. The well-calculated investment in efficient measures thus holds a considerable economic savings potential. In the RFNB, under the central coordination of the cross-project "Health Economics" (see below), the systematic collection of such cost-related data is undertaken, which enables a cross-project health economic evaluation. For example, inefficient treatment components can be identified and either eliminated or optimized in order to reduce care costs in this way. Thus, it is a concern of the RFNB to integrate economic methods into clinical questions as well as to analyze the results of this evaluation in the context of the rehabilitation system and social policy. Networking of the projects - form of cooperation: Characteristic for the RFNB is the structural and conceptual networking of the substantive subprojects with the cross-projects. On the one hand, the cross-projects ensure central coordination and quality assurance, but they also offer content-specific services and coordination services. In this way, the cross-projects provide the content-related projects with overarching competencies as well as the possibilities for central processing of methodological and economic questions. During the first funding phase, the cross-project Q2 supported the research infrastructure of the Lower Saxony/Bremen network by means of an Internet service. The communication modules developed in this context offer an excellent opportunity to ensure the connection of the spatially separated individual projects by means of innovative technology. An electronic helpdesk for the support of methodological-statistical problems provides a close link between the methodological center and the individual projects. The Method Center performs its quality assurance function by means of computer-assisted mini-audits and study protocols. The aim of this is to provide continuous support for the individual projects of the network instead of only processing requests on an ad hoc basis. It is also planned to carry out cross-project and, if necessary, cross-network evaluations, which will increase the efficiency of data analysis. In summary, an added value for the network is expected in two respects: the quality of results of the individual projects will be improved by continuous involvement of the Method Center, and additional results will be contributed by additional evaluations and the continued involvement in the cross-network "Methods Working Group". By centralizing the rehabilitation economic competence in cross-project Q3 Health Economic Evaluation in Rehabilitation, all projects of the RFNB will have access to the health economic methodology. It is ensured that the economic evaluation in the projects of the RFNB follows the recommendations of the AG Reha-Ökonomie and thus also complies with international guidelines for health economic evaluation. The organizational combination of the economic evaluation in Q3 ensures that - as far as possible - a uniform conception of the rehabilitation economic evaluation is implemented in the projects of the RFNB, with uniform definitions of costs and benefits, uniform survey instruments (parameters, survey dates and periods) as well as uniform definition and determination of the evaluation components. In addition, synergy effects are realized by including patient-related service data by the health insurance companies in the evaluation and aggregation of health economic parameters. As a result of the good cooperation with the Association for the Promotion of Rehabilitation in Lower Saxony and Bremen e. V. and the rehabilitation facilities in the region, a desired substantial increase in the number of externally funded projects associated with the RFNB can be expected in the 2nd funding phase. They are also supervised by the cross-sectional projects and strengthen the data generating basis of the network. Project overview: (projects of the first funding phase are marked with (*)) Cross-sectional projects Project Q1 Quality management and scientific office Project Q2 (1st and 2nd funding phase) Method- Statistical consulting in the RFNB - Research Information System Rehabilitation Project Q3 (1st and 2nd funding phase) Method- Statistical consulting in the RFNB - Research Information System Rehabilitation (1st and 2nd funding phase). Funding phase) Health economic evaluation in rehabilitation Cost-effectiveness and cost-benefitAnalyses Project area A Project A1 (*) Evaluation of a training program for patients with ankylosing spondylitis Project A2 (*) Effects of patient training in adult asthmatics in the context of outpatient and inpatient rehabilitation Project A2a Development and evaluation of a patient training program for children and adolescents with epilepsy and their parents Parents Project Area B Project B1 (*) Long-term socio-medical prognosis and utilization of rehabilitation services for patients with chronic polyarthritis Project B1a Review of a structured inpatient follow-up concept for rheumatic illnesses in medical rehabilitation Project B2 Interfaces of day-care orthopedic-rheumatological rehabilitation - networking with occupational rehabilitation and aftercare Project B4 Prediction of failed disease management and the need for rehabilitation in chronic complex tinnituscomplex tinnitus Project Area C Project C1 (*) An integrative outpatient treatment concept for mothers with psychosomatic illnesses and preschool children Project C1a Validation of illness-specific assessment procedures for pneumological rehabilitation Project C2 (*) Quality of life as an evaluation criterion in the rehabilitation of chronically ill children Project C3 (*) Intensive- and minimal training for parents of chronically ill children (up to preschool age) Implementation of research results: Because of the central importance of transferring the results into practice, the funding agencies have initiated a special implementation phase in which the transfer was initiated with the end of the first funding phase, as well as being supported organizationally and accompanied scientifically if necessary. The four thematic areas of patient training, access to rehabilitation, vocational orientation in medical rehabilitation and aftercare were highlighted. The RFNB is represented in this implementation phase with the Project A1c: Evaluation der modellhaften Einführung von Patientenschulungsprogrammen für die rheumatologische und pneumologische Rehabilitation (Laufzeit 01.02.2005 - 31.07.2007).