Hensen P, Beissert S, Bruckner-Tuderman L, Luger T A, Roeder N, Müller M L
Department of Dermatology, Medical Management, University of Münster, D-48149 Münster, Germany.
Eur J Public Health. 2008 Feb;18(1):85-91. doi: 10.1093/eurpub/ckm059. Epub 2007 Jun 14.
German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology.
A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003-06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail.
It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed.
The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.
德国诊断相关分组（G-DRG）已在德国作为住院治疗的报销系统引入。本研究的目的是报告引入过程中基于数据的经验，并评估其对住院皮肤科的影响。
对两个大型大学皮肤科中心4年（2003 - 2006年）期间的临床数据进行了定量分析。详细研究了病例组合指数、病例数、平均年龄、住院时间（LOS）、手术和药物治疗以及住院病例组的特征和趋势。
发现病例组合指数值在引入期后有所增加，但随后又降至初始值。与此同时，可以注意到皮肤科住院人数增加，同时住院时间显著缩短（P < 0.001），平均年龄适度增加（P < 0.001）。对DRG分组的分析显示，住院手术程序最初显著减少，药物治疗增加，但没有明显的长期变化。此外，在住院环境中，皮肤科肿瘤学和炎症性皮肤病的重要性日益凸显。
德国引入G-DRG系统导致住院治疗发生变化，影响了住院率、住院时间和住院治疗的病例。引入DRG后住院活动并未减少；然而，需要长期的跨学科研究方法来深入探讨其对医疗保健提供和医疗质量的未来影响。
