Current appraisal of external quality assurance procedures in geriatric rehabilitation

Seven standardized external quality assurance (QA) Procedures are currently being applied in geriatric rehabilitation in Germany. Five of these procedures are case-based (Gernidas (R), GiB-DAT, KODAS, EVA-Reha (R), Evaluation Procedures of the Medical Review, Board of Saxony), and two are institution-based (Quality Seal for Geriatric Rehabilitation in Rhineland-Palatinate, Quality Seal for Geriatrics BAG KGE). The institution-based procedures focus on the quality dimensions "structure" and "process", whereas the case-based procedures mainly focus on the collection of administrative data, and to a limited extent on the quality dimensions "outcomes" and "patient satisfaction". The outcome quality parameters used in the case-based QA procedures are usually the "place of discharge" versus the "place of residence", the "improvement in coping with daily activities" (mostly based on the Barthel Index), and the "improvement in mobility and gait" (based on the Timed Up & Go). So far, outcomes to be specified at the beginning of rehabilitation measures have only been defined in few procedures, and only to a basic degree or on a trial basis. In the institution-based procedures, the data are mainly collected by external data collectors, whereas in the case-based procedures, they are collected by the service providers themselves. In most procedures, data processing and analysis are performed independently of the participating service providers but only partly independently of the agency responsible for the procedure and the whole group of service providers. In the case-based procedures, risk adjustment techniques are not routinely applied in comparisons between institutions. Attempts to implement standardised QA procedures in geriatric rehabilitation may,be based on existing procedures and should use this appraisal for developing them further, however taking more into account QA aspects specific to geriatrics.