von Eiff W, Meyer N, Klemann A, Greitemann B, Karoff M
Institut für Krankenhausmanagement, Westfälische Wilhelms-Universität Münster.
Rehabilitation (Stuttg). 2007 Apr;46(2):74-81. doi: 10.1055/s-2007-971043.
As experiences from other countries show, introduction and use of Diagnosis Related Groups (DRG), as of January 2004 now also mandatory in Germany, may have a significant impact on associated rehabilitation. The Institute of Hospital Management (IKM) in a multi-centre study promoted by Deutsche Rentenversicherung Bund and Deutsche Rentenversicherung Westfalen is conducting a study regarding potential diversion of healthcare expenditures from acute care towards rehabilitation as a result of DRG introduction in Germany. For documentation of potential short-term changes in patient populations and patient streams, extensive data have been collected in the first two phases in 2003/04 and 2005/06 for a total of 1342 cardiologic and orthopaedic patients. Indication-specific comparison of the two phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in an intake of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversion of treatment efforts from the acute to the rehabilitative sector, regarding increased nursing effort and potential changes in the therapeutic and medical treatment to be provided, has not been proven as yet. The increase in wound problems expected by practitioners was confirmed in the orthopaedic area by an increasing number of wound healing disturbances and haematomas; in bypass-patients, an increasing number of pericardium and pleura bruises was found. The analyses performed on the data collected revealed no limitations in the patients' ability to participate in rehabilitative measures when the first and the second phase of the study are compared. To be able to depict the further course and interdependencies of changes, continuous systematic observation of developments would be desirable. To ascertain a lasting impact of DRG implementation at least a third study-phase will be necessary, which should be placed at the end of 2008, at the time when the DRG convergence phase will end.
正如其他国家的经验所示，自2004年1月起在德国也强制推行的诊断相关分组（DRG）的引入和使用，可能会对相关康复产生重大影响。德国联邦养老保险和德国威斯特法伦州养老保险推动的一项多中心研究中，医院管理研究所（IKM）正在开展一项关于德国引入DRG后医疗保健支出可能从急性护理转向康复的研究。为记录患者群体和患者流的潜在短期变化，在2003/04年和2005/06年的前两个阶段共收集了1342名心脏病和骨科患者的大量数据。两个阶段的适应症特异性比较显示，急性部门的住院时间显著缩短，各部门之间的过渡时间也缩短，从而使患者在康复过程的早期阶段就进入康复护理。关于护理工作量增加以及所提供的治疗和医疗治疗的潜在变化，尚未证实治疗工作从急性部门向康复部门有显著转移。从业者预期的伤口问题增加在骨科领域得到证实，伤口愈合障碍和血肿数量增加；在搭桥手术患者中，发现心包和胸膜瘀伤的数量增加。对收集到的数据进行的分析显示，比较研究的第一阶段和第二阶段时，患者参与康复措施的能力没有受到限制。为了能够描绘变化的进一步过程和相互依存关系，持续系统地观察发展情况将是可取的。为确定DRG实施的持久影响，至少需要第三个研究阶段，该阶段应安排在2008年底，即DRG趋同阶段结束之时。
