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Biomedical subjects

K Spyra

Publications and source records attributed to K Spyra.

10 recordsLinked to original sources
PubMed2006

[Rehabilitation as a subject of health services research].

Since the mid-1990s, the lack of proper development in health services research in the healthcare system of the Federal Republic of Germany has been repeatedly criticised by healthcare policy-makers and experts alike, whilst also being the subject of a number of reform initiatives. Rehabilitation sciences, which were established in Germany as an autonomous scientific discipline in the early 1990s, could benefit in terms of conception, methodology and organisation from these activities and the new interest bestowed on healthcare sector research. At the same time, the converse also holds true since from the very beginning health services research has played a particular role in the development of rehabilitation sciences-unlike the role it has played in the overall healthcare system. The complex nature of the areas of research covered by rehabilitation, together with the theoretical plurality and methodological diversity associated with it, may be ascribed to the fact that (up to the present) this sector has lacked a broader framework connecting together health research concerns and issues. This article presents a comprehensive overview of current concerns and issues as evidenced in publications of the past 15 years that make an explicit contribution to health services research. It highlights the rehabilitation system research undertaken in the past decade as a central plank of health services research. Furthermore, it also investigates the backdrop to health services research in rehabilitation in terms of its development, its research concerns, its methodology, its organisation and its infrastructural embeddedness.

Germany↗
PubMed1999

[Demographic and curative factors of need for rehabilitation--possibilities and limits of simple time series models].

Regarding rehabilitation demands, macro-analytical time-series models outline a method for the estimation of effective rehabilitation needs and for explaining the magnitude of the requirements. Their range is limited, in so far as they are unable to clarify the rehabilitation requirement regarding individual micro-level behavioural aspects. For the moment the rehabilitation requirements are hidden units in the models. Differing macro-dimensions have been gradually included in the analysis. The demographic parameters of the potential patients in need of rehabilitation are the fundamental starting point. Rehabilitation requirements are increasingly modelled by the magnitude of the curative requirements. These are characterised in the rehabilitation as "preliminary or follow up". Two examples of simple time-series models in rehabilitation--for the development of rehabilitation demand--illustrate empirically, which possibilities and boundaries are set in view of demographic and curative requirements by the interpretative range of the macro-concepts. What is methodically interesting with it, is how the analytical borders of such time-series models can experience a recognisable theoretical broadening, through a projection in real logistical facts--here in the interaction between prognosis and retrospection.

Coronary Disease↗
PubMed1999

[Concept and measurement of need for rehabilitation--framework for a multidimensional investigational approach].

As before the concept and content regarding the need for rehabilitation have still not been sufficiently clarified. In particular, an operationalization of the underlying parameters, as the basis for their measurement is absent. Some exemplary research concepts have been introduced and their methodological implications have been put out. Resulting from this, up till now, in the most developed model, determining the need for rehabilitation has been developed as a latent multi-dimensional variable. A framework, as a starting point for a multi-dimensional investigation regarding the need for rehabilitation has been introduced. According to this, the need for rehabilitation is a multidimensional, qualitative construct, that can not be directly observed and measured. The empirical investigation, which is based on this, limits the description of the need for rehabilitation to the various patterns of determinants, (description by a set of requirement factors and arranged factors) which result in different effects. Therefore different samples regarding the qualitative aspect do not mean the lesser or greater need for rehabilitation based on a continuum of measurement, but different qualitative forms which are visible in different effects.

Germany↗
PubMed1998

[Berlin-Brandenburg-Saxony Rehabilitation Research Group].

The principal subject of the Rehabilitation Research Network of Berlin, Brandenburg and Saxony (BBS) is "the theoretical and practical bases of the organisation and economics of rehabilitation". What is involved is a nation-wide analysis of the rehabilitation system, i.e. obtaining empirical information on the question as to what organisational forms are currently used to carry out rehabilitation and what results are achieved. This empirical stocktaking also includes economic aspects as far as possible. This study is to serve as a basis for developing, testing and implementing steps to rationalise steering mechanisms in the rehabilitation system. The first aspect to be studied is "national steering problems in institutionalised forms of rehabilitation". The focus is on projects on information management and performance and quality management in rehabilitation sciences as well as on the actual work of a number of bodies paying for rehabilitation (Bundesversicherungsanstalt für Angestellte, Landesversicherungsanstalten) as well as rehabilitation facilities (clinics etc.). The two other focuses of the study will examine "rehabilitative adjustment to remedies and technical aids/prostheses" and problems facing "family members in the context of rehabilitation". In studying these two areas, we are particularly interested in examining the interaction between institutionalised aspect of rehabilitation and informal factors both inside and outside the system. The BBS approach is supported by close co-operation with the regional pension insurance institutes (BfA, LVAs) with regard to both the data model and steps being taken. The principal instrument of co-operation is the "Gesellschaft für Rehabilitationswissenschaften e.V." (Society for Rehabilitation Sciences). In Berlin the BBS co-operates with Free University, the Technical University and the Robert Koch Institute and in Saxony with the universities in Dresden and Leipzig. Responsibility for scientific questions in the BBS lies with the Institute for Rehabilitation Sciences of Berlin's Humboldt University.

Cost-Benefit Analysis↗
PubMed1998

[Rehabilitation management categories. A new approach to case mix in medical rehabilitation].

Creating typical treatment case groups in medical rehabilitation, in short: Rehabilitee Management Categories (RMKs, Rehabilitanden-Management-Kategorien), is a key issue for quality assurance within the frame of modern concepts of Total Quality Management (TQM), not least utilizing current organization and management concepts (Managed Care). So far, the problem of creating highly homogeneous case groups has remained unsolved on the basis of the present methodological framework. Critical prerequisites for any further scientific work on this problem are being established in the field of medical rehabilitation with the help of the Classification of Therapeutic Services (CTS) as well as development of instruments documenting therapy plans for typical rehabilitation case groups, process-relevant quality features and definitions of therapy goals as a basis for quality screening under the Pension Insurance quality assurance programme in medical rehabilitation. These developments have clearly contributed to expanding the theoretical foundations as well as the prerequisites for empirical grounding of Rehabilitee Management Categories in medical rehabilitation under the Pension Insurance scheme. A project for determination of rehabilitation case groups which is based on these developments, is due to start at the Humboldt University and Technical University, Berlin in the near future within a rehab promotion initiative of the German Pension Insurance system in cooperation with the Federal Ministry of Research and Technology. Conceptually, the determination of Rehabilitee Management Categories by far exceeds all previous approaches as (1) it will be generated by an iterative process of empirical service descriptions and theoretical consensus building among experts, (2) not only static parameters but also process-related details will be recorded, and (3) quality requirements will be defined for the rehabilitation process and outcome. As a result, rehabilitation-relevant case groups are to be created, which will include a definition of process- and outcome-oriented quality standards. Unlike previous case group concepts, the new approach encompasses quality management issues as an integral part of its development. Since this concept for determination of Rehabilitee Management Categories incorporates the definition of quality standards, i.e., guidelines, prerequisites will be created for integrating these standards into quality management concepts, as well as service management across the interfaces of the German service delivery system (Managed Care).

Diagnosis-Related Groups↗
PubMed1997

[Assessment of long-term needs and expenditures development for rehabilitation services of the BfA with reference to the growth and occupational rehabilitation regulation (WFG)].

Based on a Prognos Model projection (1998 to 2040), the number of medical and occupational rehabilitation service treatments required will increase by about 70,000 between 1998 and 2015, reaching 500,000. Thereafter, the situation improves and the number drops to between 370,000 and 430,000. The WFG law provides a 2.7 billion DM budget for the entire time period which results in a growing deficit, reaching 1.7 billion DM by 2015, and enabling the provision of only 50% of the treatments required in the western states, if it is assumed that a reduction of treatment in the eastern states is precluded. This service deficit makes an increase in early retirements probable, thereby, generating costs on balance which exceed any potential savings in the areas of rehabilitation. It is, therefore, necessary to adapt the WFG law to the demands of real needs so that the BfA may continue to fulfill its legal obligation, "rehabilitation before retirement" to the accustomed and necessary extent.

Aged↗
PubMed1997

[Cost-benefit evaluation of medical rehabilitation by social security pensions and effects of the growth and occupational rehabilitation regulation (WFG)].

The retirement insurers, within the scope of their responsibility for health care, have already adopted the standard that calls for quality control, cost-efficiency, and outcome-focusing. For a start, the BfA (Federal Insurance Agency for Salaried Employees) has compiled a pilot evaluation presented here, based solely on its own costs and returns on costs. This evaluation demonstrates that rehabilitation "pays off". With regard to the WFG, this means that cost-saving in rehabilitation generates significant cost increases through loss of premium payments and necessary early-retirement outlays. The analysis presented shows that future investment in rehabilitation is required to ensure positive returns for the RV.

Aged↗
PubMed1988

[Where one dies].

Explore the source record for details and available documents.

Germany, East↗
PubMedDate not supplied

[Perimortal management--humanistic assignment and responsibility. Attempt at status determination].

The scientific research and practical use of all questions concerning life demands interdisciplinary cooperation. This is the result of neglection of death and dying and new social and medical developments as there are institutionalisation of dying and scientific-technical progress. The foundation of the working group "perimortal medicine" in 1983 in the Association for clinical medicine gives the possibility to discuss theoretical and practical questions concerning the end of life, death and dying. It seems to be important, that also bereavement and sympathy belongs to the topics. The results will help to develop the quality of care for the dying and the survivors.

Aged↗