C. Egen

People with Spinal Cord Injury in Germany

EPIDEMIOLOGY OF SPINAL CORD INJURY IN GERMANY In Germany, specific data reflecting the health and care situation on spinal cord injuries (SCIs) are very limited. The results of research primarily relate to diagnostic and therapeutic interventions. Routine data provided by the German Health Surveillance System do not give any information about new cases and their etiology. For that reason, neither the exact number of new cases per year nor the number of people affected by SCI in Germany is known. Furthermore, a nationwide registry like that in Australia or the United States, including all cases of SCI, does not exist. The extent of disability and rehabilitation needs in Germany is also unknown. AGerman working group is providing the first indications about the current situation. They have been collecting data from most SCI-specialized centers in Germany since 1976. From this database, we know that 34,000 new cases of SCI were registered between 1976 and 2002, corresponding to an annual incidence rate of approximately 1,200 to 1,500 cases per year. Most patients (70%) were male. The main identified causes of SCI were traffic accidents (31%) and disease (30%), eg, tumor of the spinal cord, certain types of disc herniation, or prenatal impairments like spina bifida. Thirteen percent of cases involved occupational accidents, and 7% involved swimming and sport accidents. Regarding the paralysis level, there were 37% tetraplegics and 63% paraplegics. Children were rarely affected (1%). Currently, Germany lists approximately 80,000 cases of a total of 81.1 million inhabitants. However, the significance of these figures is limited owing to the partial response of the specialized SCI centers in Germany. Recent data of the working group (1997–2010) indicate a strong increase in disease-related SCI and a slight decrease of accidental causes. Owing to an increase in age-related diseases in the population, an increase in disease-related SCI up to 50% is expected in the future. Moreover, an increasing percentage of women are expected owing to their higher life expectancy. The mean age of the entire population affected by SCI in 2010 was 60 years.

Early Workplace Intervention to Improve the Work Ability of Employees with Musculoskeletal Disorders in a German University Hospital-Results of a Pilot Study.

Health promotion is becoming increasingly important in work life. Healthcare workers seem to be at special risk, experiencing musculoskeletal disorders (MSD); their situation is strongly influenced by demographic changes. The aim of this study is to evaluate the feasibility and outcome of a worksite intervention. In a one-group pretest-posttest design, 118 employees of a hospital were recruited from 2010 to 2011. The raised parameters were satisfaction with the program, work ability (Work Ability Index), and sickness absence (provided by human resource management). Patient-reported questionnaire data was raised at baseline (t1) and after three months (t2). Sickness leave was evaluated in the period six months prior to and six months after the intervention. Means, frequencies, standardized effect sizes (SES), analysis of variance, and regression analysis were carried out. Participants were found to be highly satisfied. Work ability increased with moderate effects (SES = 0.34; p < 0.001) and prognosis of gainful employment (SES = −0.19; p ≤ 0.047) with small effects. Days of MSD-related sickness absence were reduced by 38.5% after six months. The worksite intervention program is transferable to a hospital setting and integration in occupational health management is recommended. The use of a control group is necessary to demonstrate the effectiveness.

Rehabilitation Services Provision and Payment.

Abstract Persons with spinal cord injury (SCI) experience disability and have significant need for rehabilitation. To deliver appropriate rehabilitation, interventions and programs suitable services must exist. A prerequisite for system improvement is a description of rehabilitation services. The aim of this paper was to develop a rehabilitation service framework for SCI. Additionally, principles and models of payment of rehabilitation services will be discussed. Health-related rehabilitation services should be available along the continuum of care and implemented at all levels of health care. The three most important types of services are acute, postacute, and long-term rehabilitation services. Health-related rehabilitation services for patients with SCI must be able to provide high-quality equipment and a well-trained, highly specialized and multiprofessional team of rehabilitation workers. The principles of payment for SCI rehabilitation services vary according to the organization of health care systems, which primarily depends on the sources of money (eg, from national health care systems, other health insurances, or out of pocket). Funding systems and payment criteria may influence service provision and justice in service delivery. It is important to analyze the provision of rehabilitation services and the related funding system using uniform assessment and evaluation tools.

Ein Weg aus dem Dickicht des Formulardschungels bei der Einleitung von Anschlussrehabilitation bzw. Anschlussheilverfahren

Many different claim forms are used when starting rehabilitation following inpatient treatment, resulting in high administrative overheads for hospital staff, financial institutions and government agencies as well as patient allocation inefficiencies. We describe the problems ensuing on multiple and incompatible claim forms. On the basis of a survey of extant forms, we describe the content of a unified claim form that can be accepted by all insurers and which is optimised for hospital use. A model procedure for the development of a nationwide unified claim form allows for the assessment of the tasks complexity and duration. Nevertheless, quality of care and efficiency considerations support a recommendation of standardisation of rehabilitation claim forms. On this basis the authors appeal to all relevant health-care players to enter into the enterprise of standardisation and to pursue this goal consistently.