The Development of a Certification and Grading Procedure for German SCI Units.

Background/Objectives: Spinal cord injury (SCI) care in Germany was established after the Second World War, following Guttman's philosophy that post-SCI rehabilitation should not be separated from the acute treatment phase. Reimbursement is negotiated with only rudimentary eligibility requirements. Over time, however, more and more centers have emerged that offer "only" rehabilitation. Therefore, in 2014, the German-Speaking Paraplegic Society (DMGP) saw the need to establish a certification and grading process to protect existing centers and enable qualified reimbursement negotiations. Methods: In a modified delpi process, key data reflecting the human resources and equipment of the units were collected, and, after lengthy consensus negotiations, a grading was proposed which recognizes four levels of performance. Level Ia—24/7 coverage for all SCI-related emergencies (including intensive care unit care and surgery)—to Level IIb (rehab only, no intensive care unit). Results: In 2019, the grading was accepted by the extended board of the DMGP, and all but one of the 27 SCI centers applied to be graded and certified according to a self-reported questionnaire (2020). Conclusions: The development of the certification requirements and grading system was a complicated process, but it was possible to reach a solution which allowed its acceptance by all German SCI centers. Whether it will result in better care for the patients remains to be seen. [ABSTRACT FROM AUTHOR]