Hochlehnert Achim, Niehoff Dorothea, Herzog Wolfgang, Löwe Bernd
Abteilung für Psychosomatische und Allgemeine Klinische Medizin, Universitätsklinikum Heidelberg.
Psychother Psychosom Med Psychol. 2007 Feb;57(2):70-5. doi: 10.1055/s-2006-951924. Epub 2007 Jan 8.
So far, it remains unclear whether treatment of psychiatric comorbidity in medical inpatients is appropriately reflected in the German Diagnosis-Related Groups (DRG) system. Therefore, we investigated the relationship of psychiatric disorders and costs, returns, net gain, and duration of hospitalization in internal medicine inpatients.
For a period of 1 year, we analyzed costs, net gain and other outcome variables according to the DRG system for all inpatients of a university department of internal and psychosomatic medicine (n = 697). Psychiatric disorders were diagnosed by the treating physicians based on clinical criteria and results from the Patient Health Questionnaire (PHQ). With respect to the outcome variables, we compared three groups of patients with none, one, and more than one psychiatric disorder controlling for sociodemographic characteristics.
The average total costs of the hospitalization (M +/- SD) for internal medicine patients without psychiatric comorbidity (4357 +/- 5312 euro), for patients with one psychiatric disorder, (4733 +/- 5389 euro), and for patients with more than one psychiatric disorder (7163 +/- 8277 euro) differed significantly (p = 0.0003). However, the increased costs for patients with psychiatric comorbidity were not related to elevated returns: the net gain for patients without psychiatric comorbidity was 457 +/- 2884 euro; in contrast, the treatment of internal medicine patients with one and more than one psychiatric disorder resulted in a net loss of - 260 +/- 2389 euro and - 348 +/- 3370 euro, respectively (overall group difference, p = 0.03).
Additional work and expenses caused by patients with psychiatric comorbidity should be documented and reflected in the revenue systems. Practical self-report screening questionnaires may help to detect and treat psychiatric disorders in internal medicine inpatients as early as possible.
到目前为止，尚不清楚德国诊断相关分组（DRG）系统是否恰当地反映了内科住院患者精神疾病合并症的治疗情况。因此，我们调查了内科住院患者精神疾病与费用、收益、净收益及住院时长之间的关系。
在1年的时间里，我们根据DRG系统分析了一所大学内科与身心医学科所有住院患者（n = 697）的费用、净收益及其他结局变量。治疗医师根据临床标准和患者健康问卷（PHQ）的结果诊断精神疾病。关于结局变量，我们比较了三组患者，即无精神疾病、有1种精神疾病和有不止1种精神疾病的患者，并对社会人口学特征进行了控制。
无精神疾病合并症的内科患者住院平均总费用（M±SD）为（4357±5312欧元），有1种精神疾病的患者为（4733±5389欧元），有不止1种精神疾病的患者为（7163±8277欧元），差异有统计学意义（p = 0.0003）。然而，精神疾病合并症患者费用的增加与收益升高无关：无精神疾病合并症患者的净收益为457±2884欧元；相比之下，有1种和不止1种精神疾病的内科患者治疗分别导致净损失-260±2389欧元和-348±3370欧元（总体组间差异，p = 0.03）。
精神疾病合并症患者导致的额外工作和费用应予以记录并反映在收入系统中。实用的自我报告筛查问卷可能有助于尽早发现并治疗内科住院患者的精神疾病。
