Department of Neurology, UniversitäsMedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
J Neurol. 2011 Nov;258(11):1929-32. doi: 10.1007/s00415-011-6032-y. Epub 2011 Apr 6.
The introduction of the diagnosis related groups (DRG) system in Germany has radically influenced the organization of in-hospital patient treatment. Case-mix-index and duration of treatment in a stroke unit (SU) play a central role. Our SU started in 1998 and was gradually extended to the current "Stroke Competence Center" (SCC), with a total capacity of 29 patients. The SCC combines acute treatment, work-up and post-stroke management by the same specialized team. We aimed primarily at demonstrating the financial effects of this concept. Data from stroke patients treated in our SU/SCC between 2004 and 2009 were analyzed. We analyzed the number of treated stroke patients, number of thrombolytic treatments, the number of cases coded with procedure codes OPS 8-981.x and the ratio of OPS 8-981.0 (24-72 h on SU) to the higher remunerated OPS 8-981.1 (>72 h on SU). The number of treated patients increased by 118.3% (from 469 in 2004 to 1024 in 2009). The number of thrombolyses per year has more than quadrupled (2004: 46, 2009: 253, i.e. 25% of SU patients). The introduction of the stroke center concept lead to a great increase in the ratio of the higher rewarded OPS 8-981.1 to OPS 8-981.0 (from 1.5 in 2005 to 5.21 in 2009). Our data demonstrates that the SCC concept leads to a greater financial potential, while offering considerable medical advantages concerning more effective stroke treatment and work-up as well as improved flow of information and enhanced individual patient-physician relationship.
德国引入诊断相关分组（DRG）系统后，医院内患者治疗的组织方式发生了重大变化。病例组合指数和卒中单元（SU）的治疗时间起着核心作用。我们的 SU 成立于 1998 年，逐渐扩展为目前的“卒中能力中心”（SCC），共有 29 个床位。SCC 由同一支专业团队进行急性治疗、检查和卒中后管理。我们主要旨在展示该理念的财务效果。分析了 2004 年至 2009 年在我们的 SU/SCC 中治疗的卒中患者的数据。我们分析了治疗的卒中患者数量、溶栓治疗数量、编码为 OPS 8-981.x 的病例数量以及 OPS 8-981.0（SU 上 24-72 小时）与 OPS 8-981.1（SU 上>72 小时）的比例。接受治疗的患者数量增加了 118.3%（从 2004 年的 469 例增加到 2009 年的 1024 例）。每年溶栓治疗的数量增加了四倍以上（2004 年：46 例，2009 年：253 例，即 SU 患者的 25%）。卒中中心概念的引入导致 OPS 8-981.1 与 OPS 8-981.0 的比例显著增加（从 2005 年的 1.5 增加到 2009 年的 5.21）。我们的数据表明，SCC 概念具有更大的财务潜力，同时在更有效的卒中治疗和检查、改善信息流动以及增强医患关系方面具有显著的医疗优势。
