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DOI: 10.1055/s-2008-1042445
© Georg Thieme Verlag KG Stuttgart · New York
Patientenorientierung und ICF-Bezug als Herausforderungen für die Ergebnismessung in der Rehabilitation
Patient Orientation and Reference to the ICF as Challenges in Outcome Assessment in RehabilitationPublication History
Publication Date:
28 March 2008 (online)
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Zusammenfassung
Bei der Messung der Ergebnisse rehabilitativer Interventionen stellt sich eine Vielzahl von inhaltlichen und methodischen Fragen, von denen zwei herausgegriffen und vor dem Hintergrund aktueller Forschungsbefunde diskutiert werden: die Bedeutung der Patientenorientierung und der Bezug auf die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF). Bezüglich der Einbeziehung von Patienten in die Ergebnismessung werden die Erfassung von patientenseitigen Behandlungszielen, Erwartungen und Präferenzen, die Beteiligung der Patienten an der Entwicklung von Assessmentinstrumenten, die Erfassung von Patientenbewertungen des Behandlungsergebnisses und die Berücksichtigung der Subjektivität des Behandlers sowie der Patient-Behandler-Interaktion erörtert. Mit der ICF liegt ein terminologisches System vor, welches eine international einheitliche Klassifikation für die Beschreibung von Gesundheitszuständen darstellt und die Funktion einer gemeinsamen Sprache der in der medizinischen Rehabilitation tätigen Berufsgruppen übernehmen könnte. Es liegt deshalb nahe, eine Orientierung an der ICF auch in der Ergebnismessung vorzusehen. Damit kann die Patientenorientierung unterstützt werden, da die von der ICF verwendeten Kategorien - insbesondere auf den Domänen der Aktivitäten und der Teilhabe - alltagsnah und damit passend zur Lebenswelt der Patienten formuliert sind. Die aus dem hier gegebenen Überblick resultierenden Konsequenzen beziehen sich zum einen auf den zukünftigen Forschungsbedarf, zum anderen auf Hinweise zur Durchführung einer patientenorientierten, auf die ICF beziehbaren Ergebnismessung. Forschungsbedarf wird insbesondere deutlich hinsichtlich einer auf Patientenpräferenzen basierenden Ergebnismessung, bei der Bestimmung der vom Patienten wahrgenommenen Teilhabe-Relevanz als Kriterium der „patientenseitigen Signifikanz” (in Analogie zur „klinischen Signifikanz”), bei der Integration und Gewichtung von Patient- und Behandler-Erfolgsurteilen, bei der Berücksichtigung der subjektiven Konzepte der Behandler und der Kommunikationspräferenzen der Patienten sowie bei der Konzeption neuer, ICF-orientierter Assessmentinstrumente.
Abstract
Measuring the results of rehabilitation interventions presents a number of issues regarding content and method, two of which have been selected for discussion in view of the findings of current research - the significance of patient orientation and the relation to the International Classification of Functioning, Disability and Health, ICF. Compilation of patients’ treatment goals, expectations and preferences, patient participation in the development of assessment instruments, compilation of patients’ evaluations of treatment results and consideration of the subjectivity of the physician as well as interaction between patient and physician were discussed with respect to involving patients in measuring results. The ICF is a terminology system presenting a uniform international classification for describing health conditions that could assume the function of a common language for the members of various occupations involved in medical rehabilitation. Orienting the measurement of results to the ICF is an obvious next step. This can promote patient orientation, as the categories used by the ICF - in particular for the domains of activities and participation - are formulated in terms relevant to daily routine and are thus pertinent to the patients’ lifestyle. The consequences resulting from this overview concern future research needs on the one hand, and on the other hand tips for carrying out a patient-oriented, ICF-based measurement of results. The need for research becomes especially clear regarding the measurement of results based on patient preferences, the determination of the participation relevance perceived by the patient as a criterion for “patient significance” (analogous to “clinical significance”), the integration and weighting of patient and physician assessments of success, the consideration of physicians’ subjective concepts and pa-tients’ communication preferences, and the design of new, ICF-oriented assessment instruments.
Schlüsselwörter
Ergebnismessung - Patientenorientierung - ICF
Key words
Outcome assessment - patient orientation - ICF
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1 Das Konzept der „patientenorientierten Ergebnismessung” wird vom Autor im Rahmen eines vom Bundesministerium für Bildung und Forschung (BMBF) ab 2008 geförderten Forschungsprojekts mit dem Titel „Patientenorientierte Veränderungsmessung: Gesundheitsbewertungen und die Beurteilung der Teilhabe-Relevanz von Behandlungseffekten durch chronisch Kranke” erarbeitet. Einzelne Passagen des Projektantrags wurden modifiziert in die hier vorliegende Arbeit integriert.
Korrespondenzadresse
Dr. Erik Farin
Universitätsklinikum Freiburg
Abt. Qualitätsmanagement und Sozialmedizin
Breisacherstr. 62, Haus 4
79106 Freiburg
Email: erik.farin@uniklinik-freiburg.de