Reimbursement of care for severe trauma under SwissDRG.

Autor:	Moos RM; Medical Directorate, University Hospital of Zurich, Switzerland., Sprengel K; Division of Trauma Surgery, University Hospital of Zurich, Switzerland., Jensen KO; Division of Trauma Surgery, University Hospital of Zurich, Switzerland., Jentzsch T; Division of Trauma Surgery, University Hospital of Zurich, Switzerland., Simmen HP; Division of Trauma Surgery, University Hospital of Zurich, Switzerland., Seifert B; Biostatistics Department, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland., Ciritsis B; Division of Trauma Surgery, University Hospital of Zurich, Switzerland., Neuhaus V; Division of Trauma Surgery, University Hospital of Zurich, Switzerland., Volbracht J; Medical Directorate, University Hospital of Zurich, Switzerland., Mehra T; Medical Directorate, University Hospital of Zurich, Switzerland.
Jazyk:	angličtina
Zdroj:	Swiss medical weekly [Swiss Med Wkly] 2016 Aug 21; Vol. 146, pp. w14334. Date of Electronic Publication: 2016 Aug 21 (Print Publication: 2016).
DOI:	10.4414/smw.2016.14334
Abstrakt:	Questions: Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014). Material/methods: The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002. Results: The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001). Conclusion: The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu