The German pension insurance has in recent years developed a comprehensive programme for quality assurance in rehabilitation, and has implemented the programme into routine practice. Different aspects of rehabilitation are evaluated with differentiated instruments. Issues dealt with inter alia include the quality of rehabilitative care in a narrower sense, the structure and organisation of the rehabilitation centres, as well as quality from the patients' perspective. On the whole, positive results predominate. Big differences in quality however have been found between the rehabilitation centres. The data collections and data evaluations carried out make a continuous process of quality assurance reporting possible for use by rehabilitation centres and pension insurance agencies. This will enable targeted initiatives for quality improvement. The methods and procedures of quality assurance are enhanced at regular intervals, and the scope of quality assurance is extended. Thus, rehab quality assurance is also expanded to cover ambulant rehabilitation or rehabilitation of children and young people.

Using routine data collected in 2000 for the quality assurance programme of the German Pension Insurance subjective mental impairment and disorders documented in discharge letters of patients undergoing rehabilitation funded by the Federal Insurance Institute for Salaried Employees (BfA) (n = 19,272) were correlated with psychological treatment and inpatient somato-medical rehabilitation provided. The results show discrepancies between self-evaluation, original diagnosis and treatment received. The frequency of treatments varies between hospitals. The differences in treatment are attributed rather to a varying quality of implementation of the bio-psycho-social concept than to a lack of human resources.

It appears to be necessary to implement clinical practice guidelines in all evaluated therapeutic modules but "endurance training" and "motivation". An evidence based clinical practice guideline for the rehabilitation of cardiac patients should detail the kind and extent of procedure(s) required. It should also inform about the lack of evidence for variations in treatment with respect to age, gender, or indication. To facilitate monitoring of the degree of implementation of the guideline precise instructions for the documentation using the KTL should be developed and implemented. As a next step towards an evidence based, empirically proven and acceptable guideline this project's results will be discussed with experts from science and clinical practice.

Aktuelle Strategien der Deutschen Rentenversicherung in der Qualitätssicherung der medizinischen Rehabilitation Die Reha-Qualitätssicherung der Rentenversicherung unterstützt die Transparenz des Leistungsgeschehens in den Reha-Einrichtungen, die Optimierung der Rehabilitation und die Initiierung eines qualitätsorientierten Wettbewerbs. Dafür werden u.a. die Qualität der rehabilitativen Versorgung, der Struktur und der Organisation und die Qualität aus Rehabilitandensicht einbezogen. Bei insgesamt positiven Ergebissen, zeigen sich erhebliche Unterschiede zwischen den Reha-Einrichtungen. Dies anzugleichen ist auch ein Ziel der evidenzbasierten Therapievorgaben, die in indikationsspezifischen Leitlinien gebündelt werden. Die Reha-Qualitätssicherung wird auf weitere Bereiche wie z.B. die ambulante Rehabilitation oder die Rehabilitation von Kindern und Jungendlichen ausgedehnt Current strategies of the German Pension Insurance in the quality management in medical rehabilitation The quality management of the German Pension Insurance concerning the medical rehabilitation system is aimed at greater transparency, optimizing the rehabilitative care and initiating a quality oriented competition. To this end, the quality of the rehabilitative care, of the structure and organization as well as the quality from the point of view of the patients are taken into consideration. Overall, the results are positiv, there are, however, remarkable differences between the clinics. The purpose of evidence-based recommendations in form of indication-specific guidelines is to improve the quality where necessary. The quality management is extended to further areas such as outpatient rehabilitation and the rehabilitation of children and adolescents. Reha-Qualitätssicherung durch die Rentenversicherung Die Reha-Qualitätssicherung der Rentenversicherung ist durch einige wesentliche Grundprinzipien gekennzeichnet. Als Grundlage der Reha-Qualitätssicherung wird eine umfassende Transparenz der Leistungserbringung durch eine möglichst vollständige Originalarbeit Original paper Schlüsselwörter Deutsche Rentenversicherung-medizinische Rehabilitation-Qualitätsbewertung-Qualitätssicherung-Rehabilitationseinrichtungen

In 1998, the German Federal Ministry of Education and Research (BMBF) and the German pension insurance scheme established a funding programme for research in rehabilitation. This "Rehabilitation Sciences" research funding programme comprises eight regional research networks for eight years in two periods (1998-2002, 2001-2005). In our paper we review the findings of the first funding period in five of the research fields: patient education, need for and access to rehabilitation, vocational training in medical rehabilitation to enhance return to work, comorbid mental disorders in patients with somatic diseases, and gender differences. Several activities aimed at transferring research findings into practice are outlined. Finally, the impact of the funding programme is summarized and perspectives for further funding are given.