Department of Health Care Management, Berlin University of Technology, Germany.
Int J Nurs Stud. 2013 Feb;50(2):219-29. doi: 10.1016/j.ijnurstu.2012.07.008. Epub 2012 Jul 28.
As other countries which have introduced diagnosis-related groups (DRGs) to pay their hospitals Germany initially expected that quality of care could deteriorate. Less discussed were potential implications for nurses, who might feel the efficiency-increasing effects of DRGs on their daily work, which in turn may lead to an actual worsening of care quality.
To analyze whether the DRG implementation in German acute hospitals (as well as other changes over the 10-year period) had measurable effects on (1) the nurse work environment (including e.g. an adequate number of nursing staff to provide quality patient care), (2) quality of patient care and safety (incl. confidence into patients' ability to manage care when discharged), and (3) whether the effects from (1) and (2)--if any--impacted on the nurses themselves (satisfaction with their current job and their choice of profession as well as emotional exhaustion).
Two rounds of nurse surveys with the Practice Environment Scale of the Nursing Work Index (PES-NWI), five years before DRG implementation (i.e. in 1998/1999; n=2681 from 29 hospitals) and five years after (i.e. in 2009/2010; n=1511 from 49 hospitals). The analysis utilized 15 indicators as outcomes for (1) practice environment, (2) quality of patient care and safety, as well as (3) nurses' satisfaction and emotional exhaustion. Multivariate analyses were performed for all three sets of outcomes using SPSS version 20.
Aspects of the practice environment (especially adequate staffing and supportive management) worsened within the examined time span of 10 years, which as a consequence had significant negative impact on the nurse-perceived quality of care (except for patient safety, which improved). Both the aspects of the practice environment and the quality aspects impacted substantially on satisfaction and emotional exhaustion among nurses.
The DRG implementation in Germany has apparently had measurable negative effects on nurses and nurse-perceived patient outcomes, however, not as distinct as often assumed.
德国在引入按疾病诊断相关分组（DRGs）支付医院费用后，最初预计医疗质量可能会下降。但较少被讨论的是潜在的对护士的影响，他们可能会感受到 DRGs 对日常工作效率的提高，而这反过来可能导致护理质量的实际恶化。
分析德国急性医院引入 DRG（以及 10 年间的其他变化）对（1）护士工作环境（包括例如提供高质量患者护理的适当护理人员数量）、（2）患者护理质量和安全性（包括患者出院时管理护理的能力的信心）以及（3）如果有任何影响的话，这些影响是否会影响到护士自身（对当前工作的满意度以及对职业的选择，以及情绪疲惫）的测量效果。
两轮护士调查，使用护理工作指数的实践环境量表（PES-NWI），在 DRG 实施前五年（即 1998/1999 年；来自 29 家医院的 2681 名护士）和五年后（即 2009/2010 年；来自 49 家医院的 1511 名护士）。分析利用了 15 个指标作为（1）实践环境、（2）患者护理质量和安全性以及（3）护士满意度和情绪疲惫的结果。使用 SPSS 版本 20 对所有三个结果集进行了多元分析。
在 10 年的研究期间，实践环境的各个方面（尤其是充足的人员配备和支持性管理）恶化，这对护士感知的护理质量产生了显著的负面影响（除了患者安全性有所提高）。实践环境的各个方面以及质量方面都对护士的满意度和情绪疲惫产生了实质性的影响。
德国引入 DRG 显然对护士和护士感知的患者结果产生了可衡量的负面影响，但并不像人们通常假设的那样明显。
