Das Aachener Modell zur Qualitätssicherung und Dokumentation : die Entwicklung und Evaluation von Instrumenten zur Erfassung und Sicherung der Prozessqualität in der beruflichen Rehabilitation

摘要

The quality and quality assurance has gained more importance during the last years by the resource shortage in the health care system. The medical rehabilitation implemented quality management systems already years ago, but also in the vocational rehabilitation efforts are made to obtain a functioning quality assurance. In parallel the quality assurance was anchored in the SGB IX and legal default was done. The conversion of these defaults in the vocational rehabilitation take place mostly by the implementation of the quality management systems of the medical rehablitation, whereby the quality of the results is defined by abort and switching ratios. An instrument of the quality assurance, which originates from the medical rehablitation and was tranfert into the vocational rehablitation, is the individual support and integration plan (IFIP). Hofmann and Schulze clear deficiencies of the IFIPs in 2003.The goal of this work is to develop a quality management system particularly for the vocational rehablitation. The Aachener quality assurance system for documentationand evaluation (QuasiDok) was ICF based and designed corresponding to legal defaults. It is built modular. In its center stands the company target of the facilities of the vocational rehablitation (mostly this is the holistic integration of LB). Around this center circle aspects, which affect this goal. For a holistic view and a comprehensive documentation these aspects must be seized and made measurable. The development and evaluation of three instruments (modules) are represented in this work. The first instrument is the „Profilmodul”, which is supposed to document the individuell rehablitation process by means of standardized categories. To meet objective and valide statements, the psychometric quality criteria must be fullfilled. For ProMo resulted very high values of interrater correlation (.56 -.76) on the first scales, which capture disziplinary problems and key qualifications. To assess the validity, following assumption is made: Objectively different achievers must also differ in their ProMo judgements. An objective difference is, when either the training is successfully locked or an achiever has dropped out of the training prematurely. There could be measured significant differences between the two groups, whereby the evaluations, if they were made solely by teachers, were only sicnificantly different on the scales of the key qualifications and disziplinary problems. If the professional services are involved in the assessment, all scales are judged significantly different for successful ones and drop outs. The internship modul („Praktikumsmodul”) documents the internship process transparent on the basis of standardized criteria. The teachers take the module to the internship attendancies and assess the individual items on the basis of discussions with the internship donator. The internship module was developed compatibly to the ProMo, i.e. the first three scales of the PraMos are designed equaly to the PrMo. The correlation between the first three scales oft he PrMo and the PraMos value for Kendalls Tau between .47 - .58 and between. 62 - .74 for Spearmans Rho. For the verification of the validity of the internship module the aspect switching was raised as external criteria. To each achiever it had to be indicated whether she or she was taken over after the internship. If this was not the case, the justification had to be indicated. On all four scales of the PraMos significant differences between the taken-over achievers and those achievers who were not taken-over could be observed. The taken-over ones were significantly better judged than the other achievers. The third developed instrument is the placement module („Vermittlungsmodul”). With this module the application activities and skilld are evaluated on the basis standardized categories. Since this module was used for the first time only descriptive statements can be made. It showed up that all Items exhibited good up to sufficient discriminatory power. However it showed up that the six-level scaling was not completely used with all Items. The evaluation value 6 (very bad) was nearly never assigned, therefore the module should be evaluated more exactly in further studies. The advantage of a particularly designed system for the vocational rehablitation is, that the special characteristics of the domain can be covered. The comparability makes it possible to use the modules for the internal quality management system but also for an external benchmarking.