Abstract
Background: The World Health Organization (WHO) recognizes rehabilitation as essential in healthcare. Despite WHO’s guidelines, rehabilitation services across Europe remain inconsistent, a situation that also existed in Austria until 2022. The project aimed to integrate post-acute and follow-up adult rehabilitation, funded by Pension Insurance as part of Austria’s Social Insurance, into a comprehensive care concept that ensures patients receive the right service at the right time and place. It emphasizes occupational and social participation, irrespective of the primary diagnosis, following a person-centered and individualized approach.
Approach: Historically, rehabilitation in Austria was mainly function-oriented with strict specifications, determined by disease, setting, and rehabilitation phase, with limited emphasis on holistic, personalized care. The development of a new concept based on the International Classification of Functioning, Disability and Health (ICF) introduced a paradigm shift from function- to participation-oriented care in post-acute and follow-up rehabilitation, for both in- and outpatient services. This milestone established a foundation for highly individualized, person-centered, goal-oriented rehabilitation, aligned with the ICF’s bio-psycho-social model. A core focus was to create a disease-independent rehabilitation model aimed at restoring or maintaining work capacity and preventing or reducing the need for long-term care.
The initiative emphasized continuous care planning to help patients regain work abilities or live independently. It also involved assessing the need for further rehabilitation or other social insurance services, both, before assignment and after discharge from rehabilitation (vertical integration in the care pathway). Additionally, horizontal integration among the different professional groups involved in rehabilitation was prioritized to support person-centered care.
A mixed-methods approach was used, integrating quantitative desktop analysis, expert evaluations, and qualitative stakeholder focus groups, complemented by Strengths, Weaknesses, Opportunities, Threats (SWOT) and scenario-planning techniques, to identify barriers and facilitators for an integrated rehabilitation process. An ICF-based rehabilitation concept draft, considering the entire care pathway, was developed with input from focus groups. This concept was then implemented in the Pension Insurance’s proprietary rehabilitation centers across Austria, with evaluations based on key performance indicators (KPIs) to ensure full execution.
Results: A participation-oriented rehabilitation concept was introduced in 2022 across the 17 rehabilitation centers operated by the Austrian Pension Insurance. This approach has been fully integrated into both inpatient and outpatient care structures, including a telerehabilitation project based on this new model throughout Austria. This concept ensured that rehabilitation interventions are person-centered, goal-oriented, multidisciplinary, and participation-focused, regardless of disease or referral diagnosis. Evaluations based on the monitoring of KPIs across strategic fields and multi-method employee feedback showed that, despite initial challenges in the first quarter following its big-bang launch, full adoption in practice is feasible. Despite these early difficulties, patient satisfaction and PROMs - including activities of daily living, health-related quality of life, psychological well-being, and work-related factors - have demonstrated robust and sustained positive trends.
Implications: Austria’s Pension Insurance successfully implemented an evidence-informed approach to system development and change management to establish an integrated rehabilitation concept. This can serve as a framework for scaling up, adaptable to the different structures in various countries.