Removing barriers to access medical rehabilitation for children and adolescents

Research question
The study accompanies the development and implementation of a multimodal intervention to improve the number of applications for medical rehabilitation for children and adolescents. The objective is to reduce the complexity of the application process through a simplified application form and to increase the number of requests in the model regions through further measures to provide rehabilitation-related information.

Background
The number of requests for medical rehabilitation for children and adolescents has declined significantly since 2007. This development cannot be explained solely by socio-demographic shifts or a decrease in the prevalence of rehabilitation-related conditions in the relevant age groups. Recent data also shows that while acute respiratory diseases or other infectious diseases are on the decline, rehabilitation-relevant diseases such as metabolic or circulatory diseases, as well as depression, have increased during the COVID-19 pandemic. The reasons for the decline in the number of requests are probably multifactorial. It is known that system-related and personal factors can impact the use of rehabilitation. These include, for example, knowledge about rehabilitation, the satisfaction of peers with rehabilitation experience, support from physicians and the complexity of the application process.
The ZuKiJu project aims to address these different factors with a multimodal intervention. In order to reduce the complexity of the application process, a new application form is being developed with the involvement of several interest groups such as pediatricians, affected families or patient representatives and pension insurance employees (measure 1). At the same time, the German Pension Insurance North is developing a web-based information service (measure 2) and promoting the medical rehabilitation services for children and young people and the shortened application process at regional information events (measure 3). The Ethno-Medical Center e. V. is developing and implementing a coaching concept for families with extended support needs, which is intended to ensure active support in the application process as a low-threshold offer of assistance (measure 4).

Methods
The evaluation is based on a mixed-methods study with formative and summative evaluation elements. The development of the new application form is accompanied by cognitive interviews and written user surveys. Participants in the information events and the coachings will be surveyed in writing on the quality of implementation and satisfaction. For the development of the web-based information service, user needs are initially assessed in workshops and users are subsequently questioned about their satisfaction with the service.
The effectiveness of the overall intervention (measures 1 to 4) is assessed using a difference-in-differences approach, in which repeated cross-sectional data is used to estimate the difference between two before-after changes in an exposed and a non-exposed region. The exposure represents the introduction of the intervention. The insurance area of the German Pension Insurance North (Hamburg, Mecklenburg-Vorpommern, Schleswig-Holstein) represents the exposed intervention region. The insurance territory of another regional German Pension Insurance provider represents the non-exposed control region. The outcome is the mean change in requests for child and adolescent rehabilitation in the exposed intervention region in relation to the non-exposed control region.