Warum beurteilen Rehabilitanden die Rehaplanung und Zielorientierung weniger positiv als andere Aspekte der medizinischen Rehabilitation?1

PURPOSE: Patient satisfaction is one core dimension of quality assurance of the German statutory pension insurance. The scale “rehabilitation planning and goals” consistently produced substandard evaluations. The reasons for this effect were unknown. METHOD: This two-phased study integrated quantitative and qualitative research methods (“mixed-methods-design”). During the quantitative phase predictors for satisfaction on the scale “rehabilitation planning and goals” were identified using multiple regression models based on data from patients’ questionnaires. During the qualitative phase open-ended interviews concerning aspects of rehabilitation planning and goal orientation were analysed using the thematic coding approach to find differences between clinics rated below and above average. The items of the scale were analysed using content analysis approach. RESULTS: The quantitative data set contained 149527 patients from 548 clinics. Behavioural recommendations with regard to different areas of life, satisfaction with doctors as well as housing and accommodation turned out to be relevant predictors of satisfaction on the scale “rehabilitation planning and goals”. No substantial differences between clinics were found in the 40 open-ended patient interviews with regard to rehabilitation planning and goal setting. However, differences could be found concerning perceived continuity of care, doctors’ concern for the patient and organisational characteristics. Content analysis of the items revealed, that the scale considers rehabilitation goals and planning to lesser extent, but patient orientation and multidimensional goal orientation in the clinic. DISCUSSION: The content validity of the applied “rehabilitation planning and goals” scale has to be questioned. Differences concerning the satisfaction on the scale “rehabilitation planning and goals” do not refer to differences in regard to rehabilitation planning and goal orientation, but to general aspects of patient orientation: quality of the patient-doctor relationship and alignment of basic structural and organisational parameters to patient needs. CONCLUSIONS: Facilitating a patient-doctor relationship which is trustful and continuous and providing organisational processes related to patients’ needs might be a way to increase patient satisfaction substantially.