Geuss S, Jungmeister A, Baumgart A, Seelos R, Ockert S
Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstr. 16, 6000, Luzern, Schweiz.
Universität Luzern, Luzern, Schweiz.
Chirurg. 2018 Feb;89(2):138-145. doi: 10.1007/s00104-017-0555-4.
In prospective reimbursement schemes a diagnosis-related group (DRG) is assigned to each case according to all coded diagnoses and procedures. This process can be conducted retrospectively after (DC) or prospectively during the hospitalization (PC). The use of PC offers advantages in terms of cost-effectiveness and documentation quality without impairing patient safety.
A retrospective analysis including all DRG records and billing data from 2012 to 2015 of a surgical department was carried out. The use of PC was introduced into the vascular surgery unit (VS) in September 2013, while the remaining surgical units (RS) stayed with DC. Analysis focused on differences between VS and RS before and after introduction of PC. Characteristics of cost-effectiveness were earnings (EBIT-DA), length of stay (LOS), the case mix index (CMI) and the productivity in relation to the DRG benchmark (productivity index, PI). The number of recorded diagnoses/procedures (ND/NP) was an indicator for documentation quality.
A total of 1703 cases with VS and 27,679 cases with RS were analyzed. After introduction of PC the EBIT-DA per case increased in VS but not in RS (+3342 Swiss francs vs. +84, respectively, p < 0.001). The CMI increased slightly in both groups (+0.10 VS vs. +0.08 RS, p > 0.05) and the LOS was more reduced in VS than in RS (-0.36 days vs. -0.03 days, p > 0.005). The PI increased in VS but decreased in RS (+0.131 vs. -0.032, p < 0.001), ND increased more in VS (+1.29 VS vs. +0.26 RS, p < 0.001) and NP remained stable in both groups.
The use of PC helps to significantly improve cost-effectiveness and documentation quality of in-patient hospital care, essentially by optimizing LOS and cost weight in relation to the DRG benchmark, i. e. increasing the PI. The increasing ND indicates an improvement in documentation quality.
在预期报销方案中，根据所有编码的诊断和程序为每个病例分配一个诊断相关组（DRG）。此过程可在出院后进行回顾性操作（DC），或在住院期间进行前瞻性操作（PC）。采用PC在成本效益和文档质量方面具有优势，且不影响患者安全。
对某外科科室2012年至2015年的所有DRG记录和计费数据进行回顾性分析。2013年9月在血管外科单元（VS）引入PC的使用，而其余外科单元（RS）仍采用DC。分析重点为引入PC前后VS和RS之间的差异。成本效益特征包括收益（息税折旧摊销前利润，EBIT - DA）、住院时间（LOS）、病例组合指数（CMI）以及与DRG基准相关的生产率（生产率指数，PI）。记录的诊断/程序数量（ND/NP）是文档质量的一个指标。
共分析了VS的1703例病例和RS的27679例病例。引入PC后，VS每例的EBIT - DA增加，而RS未增加（分别为增加3342瑞士法郎和增加84瑞士法郎，p < 0.001）。两组的CMI均略有增加（VS增加0.10，RS增加0.08，p > 0.05），VS的LOS降低幅度大于RS（-0.36天对-0.03天，p > 0.005）。VS的PI增加而RS的PI降低（+0.131对-0.032，p < 0.001），VS的ND增加更多（VS增加1.29，RS增加0.26，p < 0.001），两组的NP均保持稳定。
采用PC有助于显著提高住院医疗护理的成本效益和文档质量，主要是通过优化与DRG基准相关的LOS和成本权重，即提高PI。ND的增加表明文档质量有所改善。
