Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital: a cohort study.

Autor: Chok L; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.; Department of Internal Medicine, Hospital Uster, Brunnenstrasse 42, CH-8610, Uster, Zurich, Switzerland., Bachli EB; Department of Internal Medicine, Hospital Uster, Brunnenstrasse 42, CH-8610, Uster, Zurich, Switzerland., Steiger P; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland., Bettex D; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland., Cottini SR; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland., Keller E; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland., Maggiorini M; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland., Schuepbach RA; Institute of Intensive Care Medicine, University Hospital Zurich, University Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. reto.schuepbach@usz.ch.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2018 Feb 05; Vol. 18 (1), pp. 84. Date of Electronic Publication: 2018 Feb 05.
DOI: 10.1186/s12913-018-2869-4
Abstrakt: Background: In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity and referring institution, and screened whether implementation of Swiss-DRG affected admission policy, ICU length-of-stay (ICU-LOS) or ICU mortality.
Methods: Retrospective, single centre, cohort study conducted at the University Hospital Zurich, Switzerland between January 2009 and end of September 2013. Demographic and clinical data was retrieved from a quality assurance database.
Results: Admissions (n = 17,231) before the introduction of Swiss-DRG were used to model expected admissions after DRG, and then compared to the observed admissions. Forecasting matched observations in patients with a high clinical severity admitted from internal units and external hospitals (admitted / predicted: 709 / 703, [95% Confidence Interval (CI), 658-748] and 302 / 332, [95% CI, 269-365] respectively). In patients with low severity of disease, in-house admissions became more frequent than expected and external admission were less frequent (admitted / predicted: 1972 / 1910, [95% CI, 1898-1940] and 436 / 518, [95% CI, 482-554] respectively). Various mechanisms related to Swiss-DRG may have led to these changes. DRG could not be linked to significant changes in regard to ICU-LOS and ICU mortality.
Conclusions: DRG introduction had not affected ICU admissions policy, except for an increase of in-house patients with a low clinical severity of disease. DRG had neither affected ICU mortality nor ICU-LOS.
Databáze: MEDLINE
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