Hoehn Thomas, Drabik Attyla, Lehmann Christian, Christaras Andreas, Stannigel Hans, Mayatepek Ertan
Department of General Pediatrics, Heinrich-Heine-University, Duesseldorf, Germany.
Acta Paediatr. 2008 Oct;97(10):1438-42. doi: 10.1111/j.1651-2227.2008.00926.x. Epub 2008 Jul 10.
The aim of the present study was to investigate the correlation between neonatal, paediatric and adult disease severity scores and reimbursement by health insurances.
The setting was a university hospital's neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU). We performed a prospective study of all patients admitted over the 3-month study period. Data collected included five scoring systems to predict mortality or to quantify disease severity (Paediatric Index of Mortality [PIM], Paediatric Risk of Mortality [PRISM], Simplified Acute Physiological Score [SAPS], Score for Neonatal Acute Physiology [SNAP], Therapeutic Intervention Scoring System [TISS]) on a daily basis, the total reimbursement as calculated by the grouper according to the German diagnosis-related groups (DRG) system, age of the patient, length of stay (LOS), International Classification of Diseases (ICD)-10 and DRG diagnosis. Our intention was to determine the correlation between different neonatal, paediatric and adult scores (PIM, PRISM III, SAPS-II, SNAP, Core-10-TISS), and reimbursement by the health insurance on the basis of the German DRG system in its 2005 and 2007 version.
No positive correlation between any score applied and reimbursement by the health insurance could be identified. Reimbursement was positively correlated to the length of hospital stay. Positive correlations could also be shown for some of the scores among each other.
We conclude that other scoring systems or measures of disease severity urgently need to be established to terminate the chronic underfunding of paediatric intensive care medicine in the developed countries.
本研究旨在调查新生儿、儿科和成人疾病严重程度评分与医疗保险报销之间的相关性。
研究地点为一家大学医院的新生儿重症监护病房（NICU）和儿科重症监护病房（PICU）。我们对研究期间3个月内收治的所有患者进行了一项前瞻性研究。每天收集的数据包括用于预测死亡率或量化疾病严重程度的五个评分系统（儿科死亡率指数[PIM]、儿科死亡风险[PRISM]、简化急性生理评分[SAPS]、新生儿急性生理评分[SNAP]、治疗干预评分系统[TISS]）、根据德国诊断相关分组（DRG）系统由分组器计算出的总报销金额、患者年龄、住院时间（LOS）、国际疾病分类（ICD）-10和DRG诊断。我们的目的是确定不同的新生儿、儿科和成人评分（PIM、PRISM III、SAPS-II、SNAP、Core-10-TISS）与基于2005年和2007年版本德国DRG系统的医疗保险报销之间的相关性。
未发现所应用的任何评分与医疗保险报销之间存在正相关。报销与住院时间呈正相关。各评分之间也有一些呈正相关。
我们得出结论，迫切需要建立其他疾病严重程度评分系统或衡量标准，以终止发达国家儿科重症监护医学长期资金不足的状况。
