Franz D, Franz K, Roeder N, Hörmann K, Fischer R-J, Alberty Jürgen
Medizinisches Management, DRG-Research-Group, Universitätsklinikum Münster, Münster, Germany.
HNO. 2007 Jul;55(7):538-45. doi: 10.1007/s00106-007-1561-5.
When the German DRG system was implemented there was some doubt about whether patients with extensive head and neck surgery would be properly accounted for. Significant efforts have therefore been invested in analysis and case allocation of those in this group. The object of this study was to investigate whether the changes within the German DRG system have led to improved case allocation.
Cost data received from 25 ENT departments on 518 prospective documented cases of extensive head and neck surgery were compared with data from the German institute dealing with remuneration in hospitals (InEK). Statistical measures used by InEK were used to analyse the quality of the overall system and the homogeneity of the individual case groups.
The reduction of variance of inlier costs improved by about 107.3% from the 2004 version to the 2007 version of the German DRG system. The average coefficient of cost homogeneity rose by about 9.7% in the same period. Case mix index and DRG revenues were redistributed from less extensive to the more complex operations. Hospitals with large numbers of extensive operations and university hospitals will gain most benefit from this development.
Appropriate case allocation of extensive operations on the head and neck has been improved by the continued development of the German DRG system culminating in the 2007 version. Further adjustments will be needed in the future.
德国疾病诊断相关分组（DRG）系统实施时，对于接受广泛头颈手术的患者能否得到恰当核算存在一些疑问。因此，已投入大量精力对该组患者进行分析和病例分配。本研究的目的是调查德国DRG系统的变化是否带来了病例分配的改善。
将从25个耳鼻喉科收集到的518例前瞻性记录的广泛头颈手术病例的成本数据，与德国医院薪酬机构（InEK）的数据进行比较。使用InEK采用的统计方法分析整个系统的质量和各个病例组的同质性。
从德国DRG系统的2004版到2007版，组内成本方差的减少提高了约107.3%。同期，成本同质性平均系数上升了约9.7%。病例组合指数和DRG收入从范围较小的手术重新分配到更复杂的手术。进行大量广泛手术的医院和大学医院将从这一发展中获益最多。
德国DRG系统持续发展，最终形成2007版，对头颈广泛手术的病例分配得到了改善。未来还需要进一步调整。
