Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard School of Public Health, Boston, MA, USA.
Swiss Med Wkly. 2011 Jul 18;141:w13228. doi: 10.4414/smw.2011.13228. eCollection 2011.
Reimbursement for inpatient treatment in Switzerland is in transition. While hospitals in some cantons already use Diagnosis Related Groups (DRG) based systems for hospital financing, others use fee-for-service (FFS) based systems, a situation that provides the opportunity to perform a head-to-head comparison between the two reimbursement systems. The aim of this analysis was to compare reimbursement systems with regard to length of hospital stay (LOS) and patient outcomes in a cohort of community-acquired pneumonia patients from a previous prospective multicentre study in Switzerland.
This is a post-hoc analysis of 925 patients with community-acquired pneumonia from a previous randomised-controlled trial. We calculated multivariate regression models adjusted for age, gender, comorbidities and severity of illness (using the Pneumonia Severity Index) and accounting for clustering within hospitals to compare LOS and outcomes between FFS (n = 4) or DRG hospitals (n = 2).
LOS in DRG hospitals was significantly shorter compared to FFS hospitals (8.4 vs 10.3 days, absolute difference 1.9 days [95%CI 0.8-3.1]). This was confirmed in multivariate adjusted Cox models (hazard ratio 1.2 [95% 1.1-1.3]). There were no differences in 30-day and 18-month mortality rates (adjusted odds ratio 1.7 [95% 0.9-3.2] and 1.3 [95% 0.9-1.9]) or recurrence rates within 30 days (adjusted odds ratio 0.8 [95% 0.4-1.7]). Also, no differences were found in the rate of still ongoing clinical symptoms at 30 days, satisfaction with the discharge process and quality of life measures at 30 days of follow-up.
This study focusing on community-acquired pneumonia patients with different severities found a 20% shorter LOS in hospitals with DRG financing compared to FFS hospitals without apparent harmful effects on patient outcomes, satisfaction with care and different quality of life measures. Further studies are required to validate these findings for other medical and surgical patient populations.
瑞士的住院治疗报销正在发生转变。虽然一些州的医院已经采用基于诊断相关组（DRG）的系统来为医院提供资金，而其他州则采用按服务收费（FFS）的系统，这种情况为两种报销系统提供了直接比较的机会。本分析旨在比较社区获得性肺炎患者队列中两种报销系统的住院时间（LOS）和患者结局。
这是对瑞士之前一项前瞻性多中心随机对照试验中 925 名社区获得性肺炎患者的事后分析。我们计算了多变量回归模型，这些模型根据年龄、性别、合并症和疾病严重程度（使用肺炎严重指数）进行调整，并考虑到医院内的聚类，以比较 FFS（n = 4）或 DRG 医院（n = 2）之间的 LOS 和结局。
DRG 医院的 LOS 明显短于 FFS 医院（8.4 天比 10.3 天，绝对差异 1.9 天[95%CI 0.8-3.1]）。在多变量调整后的 Cox 模型中也得到了证实（风险比 1.2[95%CI 1.1-1.3]）。30 天和 18 个月死亡率（调整后的优势比 1.7[95%CI 0.9-3.2]和 1.3[95%CI 0.9-1.9]）或 30 天内复发率（调整后的优势比 0.8[95%CI 0.4-1.7]）无差异。此外，在 30 天内仍有持续临床症状的发生率、对出院过程的满意度以及 30 天随访时的生活质量测量方面也没有差异。
这项针对不同严重程度的社区获得性肺炎患者的研究发现，DRG 融资医院的 LOS 比 FFS 医院缩短了 20%，但对患者结局、对护理的满意度以及不同的生活质量测量没有明显的不良影响。需要进一步的研究来验证这些发现是否适用于其他医疗和手术患者人群。
