Warnke Ingeborg, Rössler Wulf, Nordt Carlos, Herwig Uwe
Centre for Social Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland; Competence Tandem, Innovation Incubator, Leuphana University Lüneburg, Germany.
University of Zurich, Switzerland; Competence Tandem, Innovation Incubator, Leuphana University Lüneburg, Germany; University of Sao Paulo, Faculty of Medicine, LIM 27, Laboratory of Neuroscience, Brazil.
Swiss Med Wkly. 2014 Aug 7;144:w13991. doi: 10.4414/smw.2014.13991. eCollection 2014.
Restricted government budgets are forcing countries to implement more efficient health measures. Unlike in somatic medicine, the process of evaluating payment systems in psychiatry in Switzerland is ongoing. A pilot approach in one psychiatric hospital, here called "new remuneration system (NRS)", was introduced to better control length of stay (LOS) by combining a lump sum with degressive daily rates. This is a first evaluation of the NRS in terms of a reduction of the LOS, and the prevention of early readmissions by analysing meaningful outcome categories.
The total sample consisted of N = 66,626 psychiatric inpatient episodes and a subsample of N = 60,847. Data were collected from the hospital using the NRS and three comparison hospitals in the Canton of Zurich. The observation period covered 2005 to 2011, the years before and after the implementation of the NRS in 2009. To examine the outcome categories, general logistic models were used.
The median LOS at all four hospitals was 21 days (IQR: 46-8). In the NRS-hospital, there was a significantly higher proportion of 6 to10day stays after 2009, indicating an influence of the lumpsum measure. At the same time, data revealed a somewhat lower proportion of readmissions within 30 days in the NRS-hospital. In general, effect sizes were small.
Within the observation period of three years since 2009, the NRS had a small influence on LOS and early readmissions. The stability of effects needs to be monitored. More sophisticated modellings of the NRS might lead to further insights.
政府预算受限迫使各国实施更高效的卫生措施。与躯体医学不同，瑞士精神科支付系统的评估过程仍在进行中。一家精神病医院引入了一种试点方法，即本文所称的“新薪酬体系（NRS）”，通过将一笔总付与递减日费率相结合，更好地控制住院时间（LOS）。这是对NRS在缩短住院时间以及通过分析有意义的结果类别预防早期再入院方面的首次评估。
总样本包括N = 66,626例精神科住院病例，子样本为N = 60,847例。数据是从使用NRS的该医院以及苏黎世州的三家对照医院收集的。观察期涵盖2005年至2011年，即2009年NRS实施前后的年份。为了检验结果类别，使用了一般逻辑模型。
四家医院的住院时间中位数均为21天（四分位间距：46 - 8）。在NRS医院，2009年后住院6至10天的比例显著更高，表明了一笔总付措施的影响。同时，数据显示NRS医院30天内再入院的比例略低。总体而言，效应量较小。
在2009年以来的三年观察期内，NRS对住院时间和早期再入院的影响较小。需要监测效应的稳定性。对NRS进行更复杂的建模可能会带来进一步的见解。
