Process evaluation of the pilot project “Use of the risk index disability pension for proactive access strategies”

Background: The rehabilitative care provided by the pension insurance institutions aims at promoting returning to work and preventing disability pensions. However, the need for rehabilitation is often recognized very late or not at all in Germany, and many people with chronic diseases are insufficiently informed about the possibility of medical rehabilitation. The pension insurance institutions therefore aim to independently identify people in need for rehabilitation and contact them in order to provide early and tailored information about the rehabilitation services (medical or vocational rehabilitation) provided by German Pension Insurance.
The pension insurance institutions intend to use the risk index for disability pensions (RI-DP) for this purpose. This allows the identification of insured persons with a potential need for rehabilitation using routine data. The RI-DP aggregates this data from the accounts of the insured persons to describe the probability of receiving a disability pension within the next five years. With the availability of this information, the pension insurance institutions can contact people with an increased risk (at least 60 points) of receiving a disability pension in order to develop strategies with the people to modify the identified risk. The use of the RI-DP as a screening tool enables a more targeted and cost-efficient approach to risk groups compared to general information for all insured persons.
A pilot project will now test the nationwide application of the RI-DP at the pension insurance institutions in order to proactively approach people with a possible need for rehabilitation and to inform them about rehabilitation services.
In our study, we will scientifically accompany the implementation of the administrative process to be established by means of a process evaluation.
Methods: Our project is a mixed-methods study that examines the implementation of the administrative process in twelve pension insurance institutions.
We assess the planned administrative processes of each pension insurance institution with the process managers in guided interviews. The findings are used to model the institutional processes by means of Business Process Model and Notation. This enables us to map the differences in planning between the pension insurance institutions. In order to describe the process actually implemented and to identify differences in the implementation compared to the planned process (implementation fidelity), the actual implementation of the administrative process and the counseling provided is documented electronically and standardized. This also includes the documentation of the application for rehabilitation services as well as the time and personnel required for the process.
In order to identify the causes of differences between the institutions and between the planned and implemented process, guided interviews are conducted with the process managers at the end of the implementation. We describe the population reached using website usage data and a cross-sectional survey. In this survey, insured persons are asked about their subjective need for rehabilitation, their intention to apply for rehabilitation and their intention to use both the website and the counseling services as well as socio-demographic, health-related and occupational characteristics. In a second survey, insured persons who have taken part in a counseling service are asked about their acceptance, satisfaction and potential areas for improvement of the counseling service. In-depth, guided interviews will be conducted with both the people participating in counseling and those providing it.