The revised RTS can make a positive contribution to ensuring that rehabilitation is of high quality. Further research is needed to increase the level of evidence - especially regarding the intensity of therapy.

Current health policy reform efforts in Germany include introduction of a DRG (Diagnosis Related Group) based funding system in the hospital sector as well as integrated delivery of health care and disease management programs, developments that will directly affect the medical rehabilitation sector. Decreasing lengths of hospital stay induced by the DRG system will inter alia entail a shifting of cases and costs to subsequent sectors. Moreover, hospitals might not least seek compensation for shorter hospital stays by extending their scope to include rehabilitation and long-term care services. Introduction of the DRG system in acute-hospital care has resulted in major changes in respect of early rehabilitation. Existing specialized early rehabilitation facilities providing high-quality care face serious funding problems on account of the newly introduced early rehabilitation DRGs. For hospitals previously not involved in early rehabilitation on the other hand, incentives arise to set up new early rehabilitation structures although the need for these additional capacities obviously is questionable. Introduction of the DRG-based funding system has reinforced the discussion about applying a flat-rate system also in the rehabilitation sector. This form of remuneration however is inappropriate to medical rehabilitation concepts. On the other hand, a remuneration system incorporating cross-institutional per-diem fees and "treatment time" budgets might enable using essential advantages of flat-rate payment without having to expect repercussions for the quality of care. In the context of integrated care and disease management programs the issue at stake for rehabilitation primarily is to be able to contribute its specific competencies appropriately. Also, integrated health care is bound to result in stronger competition among the various health care sectors. If rehabilitation is set to face this competition, further research efforts will urgently have to be made along with ongoing development of clinical practice guidelines.

Schlüsselwörter • ▶ Leitlinien • ▶ stationäre Rehabilitation • ▶ Reha-Therapiestandards • ▶ Depression • ▶ evidenzbasierte Medizin Zusammenfassung ▼ Fragestellung: Im Auftrag der Deutschen Rentenversicherung wurden Reha-Therapiestandards (RTS) für die Indikationsgruppe Depressive Störungen entwickelt und in fachspezifi schen Rehabilitationseinrichtungen implementiert. Ziel der begleitenden Anwenderbefragung war die Bewertung von Qualitätsmerkmalen der RTS sowie den erwarteten Eff ekten der Implementierung. Es werden die Ergebnisse der befragten Rehabilitationseinrichtungen dargestellt. Material und Methoden: 89 Einrichtungen der Fachrichtung Psychosomatik/Psychotherapie erhielten Fragebögen sowie eine Rückmeldung, inwieweit ihre Versorgung bereits den Vorgaben der RTS entspricht, basierend auf den 2008 in ihrer Klinik durchgeführten Leistungen nach KTL 2007. Ergebnisse: Die Rücklaufquote betrug 47 %. Die Verständlichkeit der RTS wird überwiegend positiv bewertet. Der Mindestanteil zu behandelnder Rehabilitanden wird in den einzelnen evidenzbasierten Therapiemodulen (ETM) von 43 % bis 71 % als angemessen bewertet; die Mindestdauer je nach ETM von 31 % und 89 %. Häufi ge Gründe für das Nichterreichen der Anforderungen der RTS sind die unvollständige Verschlüsselung von Leistungen, die Erbringung nicht im ETM enthaltener Leistungen und Personalmangel. Diskussion: Die Anforderungen einzelner ETM werden als zu hoch angesehen und es wird z. T. eine Entindividualisierung des Therapieprozesses durch die RTS befürchtet. Es ist daher wichtig, den Umgang mit begründeten Abweichungen von den RTS transparent zu machen. Schlussfolgerung: Die grundsätzliche Sinnhaftkeit der RTS wird überwiegend bestätigt, gleichwohl besteht Skepsis hinsichtlich positiver Eff ekte der Implementierung. Die RTS sind aufgrund der Anwenderbefragung überarbeitet worden.Abstract ▼ Purpose: The German rehabilitation insurance fund has developed standards for the rehabilitation of depression (RTS) and implemented them in specialised rehabilitation centres. In a concurrent survey, the centres were asked to rate the quality of RTS and the expected eff ects of implementation. Results of the survey are described. Materials and Methods: 89 rehabilitation centres specialising in psychosomatic and psychotherapeutic treatment received questionnaires, as well as feedback information which allowed the centres to see to which degree the services they delivered in 2008 were already consistent with the requirements described in the RTS, as coded by the Classifi cation of Therapeutic Procedures (KTL 2007). Results: Return rate was 47 %. Most clinics rate the RTS as comprehensible. The minimum percentage of patients to be treated with each evidence-based therapy module (ETM) is rated as adequate by 43 % to 71 %; while the minimum duration per ETM is rated as adequate by 31 % to 89 %. Frequent reasons for not attaining the requirements of the RTS are the incomplete coding of services, delivery of services not contained in the ETM, and lack of staff . Discussion: The re...

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