Computergestützte Entscheidungshilfen zur Bewertung von Reha-Anträgen (CEBRA)

Abstract

The CEBRA project aimed at developing a computer aided procedure by which applications for rehabilitation can be assessed according to uniform and transparent criteria so that the applications together with a recommendation for decision-making can be transferred to the sociomedical services for final decision. For this, we first analyzed the existing manuals and guidelines for assessing applications for rehabilitation with the aim of identifying the main criteria, and then to translate them into measurable parameters. We then developed questionnaires for physicians treating the applicants as well as for the applicants themselves. Finally, algorithms were defined which compress the various combinations of these parameters into a recommendation for decision-making. Between October 2004 and March 2005, a pilot study was performed which ran parallel to the normal processes of decision-making by the insurance administration. In the pilot study, 436 applications were included for which questionnaires were available both from a physician and an applicant. The recommendations given by the CEBRA programme were finally compared with the decisions that had in fact been made by the administration in these cases. The results of the pilot study showed that the algorithms employed are capable of distinguishing very clearly and in a meaningful way between applicants with only minor medical problems and disabilities, on the one hand, and with medium or severe problems on the other. The comparison with the administrative decisions in these cases showed a similar rate of approval (80%) in both procedures. This means that the CEBRA programme does not change the general rate of approval. With respect to the individual cases, however, the comparisons revealed no statistically significant concordance between the two procedures. Reasons for this finding may result from the fact that--even though the same persons were compared--the information underlying the CEBRA recommendations or the administrative decisions, respectively, were not the same and may in fact have been quite different. In sum, we conclude that the CEBRA programme can very well improve the basis of information as well as the objectivity of making decisions on applications for rehabilitation.