Nimptsch U, Mansky T
Technische Universität Berlin, Fachgebiet Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Deutschland.
Dtsch Med Wochenschr. 2012 Jul;137(28-29):1449-57. doi: 10.1055/s-0032-1305086. Epub 2012 Jul 3.
Using the categories of the German Inpatient Quality indicators (G-IQI) important characteristics of inpatient care were analyzed on the national level in Germany. The evaluation gives an overview of total national case numbers and number of hospitals involved in the treatment of important diseases.
The analysis was based on the national so called 'DRG database' for the year 2010, which covers all German inpatient DRG cases (all patient / all payer database). With the major exception of psychiatric and psychosomatic cases this database covers 17.43 of the 18.49 million German inpatient cases. The coded diagnoses and procedures as well as demographic information were used to group cases into G-IQI disease categories. The respective total case numbers, number of hospitals providing the services, interquartile range of case distribution, in-hospital mortality and interquartile range of standardized mortality ratios were investigated.
Especially for less frequent diseases and procedures it is shown, that many hospitals treat very low case numbers. For example for gastric resection the lower quartile is 4, for esophageal resection 1 and for cystectomy 5. Even for a more frequent disease like myocardial infarction the lower quartile is 36. Mortalities also show considerable variation. However, due to the low case numbers in many hospitals, the deviation of hospital mortality from the German average can only become significant for rather few hospitals.
On the one hand this paper provides national reference values for the German Inpatient Quality Indicators, which cover 38.7 % of all inpatient cases and 50.8 % of in-hospital deaths. On the other hand it gives a first overview of the disease specific patterns of inpatient hospital care in Germany. Despite the high overall quality of the German health care system it suggests, that further improvement might be possible, if structural problems were addressed.
运用德国住院患者质量指标（G-IQI）类别，对德国全国范围内住院治疗的重要特征进行分析。该评估概述了全国病例总数以及参与重要疾病治疗的医院数量。
分析基于2010年全国所谓的“疾病诊断相关分组（DRG）数据库”，该数据库涵盖了德国所有住院患者的DRG病例（所有患者/所有支付方数据库）。除精神科和身心疾病病例外，该数据库涵盖了德国1849万住院病例中的1743万例。利用编码诊断、手术操作以及人口统计学信息，将病例分组到G-IQI疾病类别中。对各自的病例总数、提供服务的医院数量、病例分布的四分位距、住院死亡率以及标准化死亡率的四分位距进行了调查。
尤其对于发病率较低的疾病和手术操作而言，结果显示许多医院治疗的病例数非常少。例如，胃切除术的下四分位数为4，食管切除术为1，膀胱切除术为5。即使对于像心肌梗死这样更常见的疾病，下四分位数也为36。死亡率也存在显著差异。然而，由于许多医院的病例数较少，只有相当少的医院其住院死亡率与德国平均水平的偏差才会变得显著。
一方面，本文提供了德国住院患者质量指标的全国参考值，这些指标涵盖了所有住院病例的38.7%以及住院死亡病例的50.8%。另一方面，它首次概述了德国住院医院护理的疾病特定模式。尽管德国医疗保健系统总体质量较高，但这表明，如果解决结构问题，可能会有进一步的改善。
