Die rolle von lokaler und übergreifender evidenz im kontext der rehabilitation: Nach einem plenarvortrag vor dem 5. Symposium des Deutschen Netzwerks Evidenz-basierte Medizin im Februar 2004 in Lübeck

When patient and physician (alone and together) make decisions on evidence-based therapeutic measures, the general efficacy and benefit of the measures have to be evaluated first. The second level of evaluation focuses on risks and benefits for the individual patient. The third level of evaluation focuses on whether the potential benefits can be achieved by the physician or clinic that have been chosen for treatment. Most often, indeed, the choice of a method (for example in-patient rehabilitation) influences also - directly or indirectly - the choice of a clinic and its equipment and personnel. The paper deals with the problems, data sources, and methods of comparison of clinic-specific efficacy. The limits of the quality-assurance program used thus far become also evident.