[Regional quality assurance in medical rehabilitation. The Schleswig-Holstein Medical Rehabilitation Quality Community--main study and empirical findings from orthopaedic clinics].

The "Quality Community Medical Rehabilitation" (QGmR) is a voluntary association of several rehabilitation clinics in Schleswig-Holstein. The QGmR is closely oriented along the quality assurance programme of the national pension insurance scheme. As local initiative its emphasis lies in patient outcomes. The patients of the QGmR were interviewed twice (pre-post: before and four months after rehabilitation), and all patients were included consecutively during a defined period of time. After a pilot phase the main study of the QGmR was accomplished between 2002 and 2004. Twenty Schleswig-Holstein rehabilitation clinics with six diagnostic groups and a total of 3094 patients participated (2026 at both points of measurement). The majority of the patients interviewed were orthopaedic patients, and the smallest number were patients with heart disease and neurologic conditions. Most patients showed clearly health-related impairments before rehabilitation compared with population-referred data, four months after rehabilitation patients showed significant improvements in all health-related parameters. In addition to health improvement the patients showed a high satisfaction with all areas of the rehabilitation treatment and processes they were asked to judge (administration, therapy, care) independent of diagnostic group or rehabilitation clinic. But, also independent of diagnostic group and clinic, there were clear deficits in the field of post-rehabilitative treatment. Some of the results varied according to diagnostic group and clinic. The results of a comparison between the clinics showed some differences to the effect that some clinics were better than others, but these differences were not very large although statistically significant in a few cases. Nevertheless the "best" can be determined, which could motivate the clinics to participate in regular quality assurance working groups.