Joachim Maier by chenmeixiu

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									   Rehabilitation/Case Management
   Support and Networking
   out of the Rehabilitation Clinic

Joachim Maier, Gisela Riedl (Füssen, Gemany)
Locations
Background
Starting point:
Accident/illness
                              Problems for the insured:
                              •Worsening health
                              •Financial losses
       Problem:               •Social isolation
       Complicated and long   •Loss of self-confidence, etc.
       processes
                              Problems for insurers:
                              •Sickness payments
                              •Medical and professional measures
Aim:                           for participation
Professional and social       •Compensation, etc.
integration
Definition

Rehabilitation / Case Management Support:

• Support of managing especially complex
  rehabilitation processes
• For seriously affected persons after serious accidents
  and with chronic illnesses
• On behalf of an insurance company
• By working out a concrete directional plan of action
  - with interdiscipliary medical emphasis
    and taking account of needs of the workplace
Target groups


Particularly complicated cases, e.g.:

•   Extended periods of inability to work
•   Interrupted careers
•   Unclear output profile
•   Courses of illness and effects of disability which are
    difficult to assess
    (e.g. neurological illnesses, brain damage,
    amputations, pain syndromes)
Case example

Paul, 44 year old truck driver, married with two
  children
Industrial accident: December 2003

Diagnosis: Comminuted fracture in the left foot
Results:   CRPS, talonavicular arthrosis,
                 chronic post-traumatic pain syndrome

What had been done to date:
•   Treatment as an in-patient and as an out-patient
•   Orthopaedic shoes
•   Operation to stiffen the talonavicular joint
•   Unsuccessful attempt to work
    Core services

     Main components of the concept are:
     • Situation analysis including establishing the potential
       for rehabilitation
     • Solution-orientated and interdisciplinary professional
       assessment
     • Unbiased recommendations
     • Professional and workplace-orientated therapy and
       training measures
     • Driving ability test, driver training

* Isernhagen Work System (USA)/Standardised, objective Evaluation of Functional (work-related) Performance
Targets

• Establishing what the patient can still do
• Identifying suitable types of therapy
• Managing suitable measures
• Keeping the job, opening new job prospects and/or
  securing professional training that has been started.
• Attaining / re-attaining personal mobility (driving,
  teaching to walk)
• Improving / speeding up processes with the aim of
  fast profesional and social re-integration
Case example

What does this mean for Paul?

Rehabilitation / Case Management Support:
Working out what is to be done and unbiased
recommendations within 5 days

Questions:
   1. Is it possible to reduce his pain?
   2. Can paul load a truck?
   3. Can Paul's job be kept for him?
    Network
                             Sponsor
Social insurance companies            Private insurance companies
        Employers                      Rehabilitation services

                             RCMS
 Integration                                     Company
 service                                         doctors
     Rehabilitation
     advisors
                                 Specialist
             Training             medical
          establishments          centres
                  part of                     Driving
              Traffic safety centre           schools
Process
   First analysis: Core team


                          Selecting
 Looking at                             First situation analysis
                          suitable
    initial
                          network          Directional plan
  findings
                          partners



Multidisciplinary exploration by:
    - Doctor                                 Further
    - Clinical social workers            examinations /
      rehabilitation advisors/CDMP     situation analysis
                                         in the network
    - Possibly (neuro) psychologists
Situation analysis

• Examinations in the necessary medical areas
• Care assessment
• Psycho-social exploration
• Evaluation of behaviour and motivation
• Clarification of general framework (social
  environment, family and professional situa-
  tion/perspectives)
• Establishing functional ability (IWS/EFL)
• Assessment of driving ability, driver training if
  required
Result

                Evaluation of the
                overall situation



         Setting out realistic plans of action



             Solution-orientated
              interdisciplinary
                 final report
Paul's case study
Recommendation: Carrying out pain therapy
Aim:           Improvement in foot statics, pain management,
                       driving test, clarifying what work he could do
   3 weeks' pain therapy in
   Enzensberg Clinic with practical truck driving test

Result:                Loading work not possible,
                       driving possible (with limitations)
Recommendation: Partial qualification as a service bus driver
  Qualification during a three-week stay in
  Enzensberg Clinic


      For 1½ years Paul has been working half days
                   as a bus driver
Evaluation

• Questions:        Fate after the measures and
                    patient satisfaction
• Study type:       Explorative cross-sectional study
• Methodology:      Written questionaire on a
                    standardised form
                    in Nov. 2005
• Overall result:   112 persons who had taken part
                    in the programme between January
                    2002 and August 2005
• Return:           62 questionnaires (return rate: 55%)
Sample

Sex                          46 (74%) men
Age on admission             38.6 years
Subject area                 54 (87%) orthopaedics /
                                       traumatology
                             4 (7%) neurology
                             4 (7%) internal/pain
Ability to work before the   50 (81%) working
incident                     12 (19%) in training
Ability to work before RCM 13 (21%) working
                           36 (58%) permanently off
                                    work
                           13 (21%) other
   Results
 After a stay in the Enzensberg Clinic and care from the RCM Support
 team 33% of the persons who had previously been unable to work
 had returned to work again within six months.
              100*

                80

                60
                            33                                             31
                40
                                           22              14
                20

                  0
                      Working/           Pensioned         Still        Unemployed
                      training/                           unable
                      re-training                        to work

* All numbers are percentages. Basis: 36 persons who were permanently unable to work when they were admitted to the clinic
   Results
    79% of the persons described the processes in rehabilitation /
    case management support as good or excellent
    Question: what is your opinion of what is offered and the processes in
           rehabilitation / case management support?
                              *
                       100

                         80

                         60
                                                    44
                         40                                    35

                                                                                         so-so
                         20
                                          11                                             good
                                                                                         excellent
                          0
* All numbers are percentages. basis: 62 patients who were questioned as part of an RCMS evaluation
 Unanswered to 100 percent No answer
   Results
    89% of the respondents described the measures offered to them as
    generally or clearly right

    Question: Would you say that the measures recommended to you in our
          clinic were the right ones?
                              *
                       100

                         80
                                                               58
                         60

                         40
                                                    31
                         20                                                            not really
                                           5                                           generally yes
                          0                                                            clearly yes

* All numbers are percentages. basis: 62 patients who were questioned as part of an RCMS evaluation
 Unanswered to 100 percent No answer
Conclusion

Support for the rehabilitation management
of the insurance companies by:

•   Case-related individual advice and care
•   Fast access to case-related information
•   Targeted cooperation and coordination of services
    in flexible, independent network

This means that the time for the process can be
compressed, continuous and with services which are
optimised for the individual case.
     Further Information




                 Rehabilitation / Case Management Support
     Dr.Gisela Riedl                                                           Joachim Maier
     Tel. +49 (0) 8362 - 124870 or 1119                                        Tel. +49 (0) 8362 - 121153
     Fax +49 (0) 8362 - 121110                                                 Fax +49 (0) 8362 - 121110
     gisela.riedl@fachklinik-enzensberg.de                                     joachim.maier@fachklinik-enzensberg.de

                                                             Enzensberg Clinic
Medical rehabilitation and conservative acute medicine • orthopaedics • traumatology • neurology • internal medicine • inter-disciplinary pain centre •
                                                    Rehabilitation/Case Management Support

                        Höhenstr. 56              87629 Hopfen am See / Füssen                                Germany

								
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