Anwendungsorientierte Konzeption zur internen Qualitätssteuerung der Klassifikationen KTL und ICF in der medizinischen Rehabilitation
In medical rehabilitation, the requirements of legislators and cost bearers for quality management are at a high level. The Deutsche Rentenversicherung (DRV) supports this with its quality assurance measures, as does the World Health Organization (WHO) with guidelines anent certified quality management systems. In this study, a concept was created to operate the Classification of Therapeutic Procedures (KTL) as a quality assurance instrument of the DRV and the International Classification of Functioning, Disability and Health (ICF) of the WHO. This concept was developed application-oriented under theoretical and empirical aspects. Collection of the empirical data was based on expert interviews using a semi-standardized interview guide and methodological evaluation was done by content-structuring qualitative content analysis. New pragmatic approaches were collected based on the knowledge of experts selected from various professional groups in medical rehabilitation. The concept of quality control developed in this study offers a guidance for permanent implementation in clinical practice connecting external quality measures with internal quality management. It focuses on communication and interdisciplinary exchange between the different disciplines within rehabilitation facilities. A structured approach of planning, analysis, management and control is crucial for implementing this concept of quality control. Additionally, both classifications (KTL and ICF) were analyzed regarding applicability, impact on patient care and benefits actually measurable in rehabilitation practice. In conclusion, the practicability of the KTL was only partially rated positively by the experts: Although these classifications may lead to a better standardization in prescription of medical care, they result in a loss of individuality in treatment. Concerning the ICF, improvements in setting therapy goals and a clearer communication within the rehabilitation team by using standardized ICF terms seemed beneficial, whereas time-consuming examinations on patient admissions according to ICF criteria were considered unfavorable. The expert’s judgement of the classifications influence on the quality of care in rehabilitation medicine was rather critical.
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