【正文】 ? German Pension insurance (with rehab units) 德國養(yǎng)老保險（含康復(fù)單元部分） ? German Workers Accident insurance 德國工人意外保險 ? Chinabridge Germany ? China: 中方 ? Nanjing University 南京大學(xué) ? Tonji University Wuhan 華中科技大學(xué)同濟醫(yī)學(xué)院 武漢 ? Chinabridge China ? International: 國際 ? ISPRM (and other NGO’s with relation to WHO) ISPRM（及其他 WHO相關(guān)合作組織） Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Outlook 展望 ? Rehabilitation should be implemented into all phases of health care 康復(fù)應(yīng)當(dāng)在健康管護的全階段進行 ? The implementation of highquality rehabilitation programs can improve functioning and quality of life of patients after cardiosurgery 高質(zhì)量康復(fù)項目的實施可以改進心臟外科手術(shù)后的生活質(zhì)量及功能 ? Rehabilitation programs also have the potential to reduce costs in health system 康復(fù)項目同樣具有在健康系統(tǒng)中節(jié)約資源的潛力 ? It makes sense to bine the rehabilitation strategy with preventive programs 康復(fù)策略同預(yù)防項目相結(jié)合具有積極意義 ? Concepts, standards and expertise exist to design good rehabilitation programs and service 概念、標準及?？茮Q定了是否可以設(shè)計出好的康復(fù)項目 ? More scientific research on outes of rehabilitation is needed, in particular after cardiosurgery 更多關(guān)于康復(fù)的科研結(jié)果需求增加，特別在心血管術(shù)后 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Christoph Gutenbrunner, MD, PhD, Professor Department for Rehabilitation Medicine Coordination Centre for Rehabilitation Research Hanover Medical School D30625 Hannover Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Level 1a Level 1b Level 2a Level 2b Rehabilitation policy 康復(fù)政策 Highly specialized centre Specialized centre Rehab centre Rehab centre Doctor PT OT Samp。LT others Peers, families, selfhelping groups and others Level 3 Case management Levels of care provision 護理級別 高度?？浦行? 專科中心 康復(fù)中心 康復(fù)中心 病歷管理 同伴，家人，自主互助小組及其他 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Acute Rehab Unit 急診 /急性期康復(fù)單元 Other wards of hospital 院內(nèi)其他科室病房 Postacute Rehabilitation (outpatient。 dayclinic) 后急診康復(fù) 門診及日間 Outpatient Rehabilitation 門診康復(fù) Postacute Rehabilitation (inpatient) 后急診康復(fù) 病房 Intensive Care Unit 集中管護單元 Acute Rehabilitation Teams take care of patients, the medical focus is on other specialised care medical focus is on functional rehabilitation Examples of interfaces 對接舉例 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Evidence of rehabilitation in ICU ICU病房康復(fù)實例 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Clinical field Reviewer /1st author Studies (numbers of participants) MDT more effective? low back pain – multidisciplinary biopsychosocial intervention Guzman J, 2022 10 RCTs(1964) Better function amp。 pain control Coronary heart disease multidisciplinary disease management McAlister FA, 2022 12 (9803) Fewer admitted, better control of risk factors. MI recurrence amp。 survival unchanged Chronic disabling lung disease. Outpatient multidisciplinary rehabilitation Griffiths TL, 2022 1 RCT (200) lower hospital amp。 home visit rates better walking amp。 health status Heart failure. munity MDT treatment versus usual care Stewart S 1999 1 RCT (200) Fewer admitted, better diet amp。 drug pliance, survival same Multiple sclerosis – Inpatient MDT Khan F, 2022 8 RCTs (747) better activity participation, impairment unchanged brain injury – munity MDT versus information only Powell J, 2022 1 RCT (110) better than information alone Severe TBI – MDT versus standard hospital care Semylen JK 1998 1 quasirandom CT (56) Better clinical oute amp。 carers less distressed V. Neumann A., C. Gutenbrunner amp。 A. Delarque: Position Paper on Team Work in Physical amp。 Rehabilitation Medicine Evidence of teamintegrated rehabilitation 綜合團隊康復(fù)實例 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Gerdes N et al.: Die PROTOSStudie. Steinkopff 2022 Evidence of rehab in chronic conditions 慢性病康復(fù)實例 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Gutenbrunner et al.: Phys Med Rehab Kuror 2022。 12: 272283 Evidence of rehab in chronic conditions Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 28% 23% Evidence of job orientated prevention 面向工作者的預(yù)防實例 Days Days on sicklist: other diagnoses Days on sicklist: JobRehab diagnoses Total number of days on sicklist before JobRehab after JobRehab