Gahr Susanne, Berendt Julia, Lödel Sarah, Ostgathe Christoph, Simon Steffen T, Tewes Mitra, Zader Kirsten, Schwartz Jacqueline, Neukirchen Martin
Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Landesamt für Gesundheit und Lebensmittelsicherheit, Nürnberg.
Dtsch Med Wochenschr. 2019 Nov;144(23):e153-e159. doi: 10.1055/a-0961-7236. Epub 2019 Aug 27.
A palliative care team is recognized as a quality indicator in the consultation and care of patients with a tumor disease and is used nationally (92 %) in the National Cancer Institutes, model of the German Comprehensive Cancer Center (CCC). This begs the question of how palliative care teams are presently integrated into the CCCs.
From July to August 2017, a paper-based quantitative survey of 16 locations of the CCCs, supported to that date, gathered information on the existence, personnel situation, use and prospects of a specialized inpatient palliative care service. The survey was addressed to the heads of the palliative medical units of the CCCs. The data were evaluated in SPSS (frequency, median, mean, range).
Fifteen CCCs took part in the survey (response 94 %). Thirteen of the fifteen CCCs have a service that also treats palliative patients. Twelve of thirteen CCCs of these are attainable during regular working hours (8a. m.-4 p. m. on weekdays). All services are staffed by physicians, additional eleven are staffed by nurses. Seven services are besides physicians and nurses joined by other professions. In 2016, 4482 median co-treatments were provided by the services, 80 % of these as additional charges without revenue and without codable OPS. In 2017, five centers plan to charge ZE 2017-133, two centers ZE 60 and three centers both intend to charge ZE 2017-133.
Services for palliative patients exist generally in the German CCCs, but only half of them satisfy the condition of multi-professionality required for the fulfillment of the german guidelines. The new surcharge introduced in 2017, which can be charged on an hourly basis, could create improvements in this regard and contribute to cost recovery. Thus, contrary to the previous arrangement, essential and reasonable performances with a time of treatment of less than seven days can be charged.
姑息治疗团队被视为肿瘤疾病患者会诊与护理的一项质量指标，在德国综合癌症中心（CCC）的国家癌症研究所模式中全国范围内使用（使用率为92%）。这就引出了一个问题，即目前姑息治疗团队是如何融入CCC的。
2017年7月至8月，对当时已获支持的16个CCC地点进行了纸质定量调查，收集了关于专门住院姑息治疗服务的存在情况、人员状况、使用情况和前景的信息。调查对象是CCC姑息治疗科室的负责人。数据在SPSS中进行评估（频率、中位数、均值、范围）。
15个CCC参与了调查（回复率94%）。15个CCC中有13个设有也收治姑息治疗患者的服务部门。其中13个CCC中的12个在正常工作时间（工作日上午8点至下午4点）可提供服务。所有服务部门都配备有医生，另外11个配备有护士。除医生和护士外，7个服务部门还有其他专业人员加入。2016年，这些服务部门共提供了4482次中位数的联合治疗，其中80%作为额外收费，没有收入且无可编码的德国医疗服务项目编号（OPS）。2017年，5个中心计划收取2017 - 133号德国疾病诊断相关分组（ZE）费用，2个中心收取60号ZE费用，3个中心既打算收取2017 - 133号ZE费用。
德国CCC中普遍存在姑息治疗患者的服务部门，但其中只有一半满足德国指南所要求的多专业性条件。2017年引入的新的按小时计费的附加费可能会在这方面带来改善并有助于成本回收。因此，与之前的安排不同，治疗时间少于7天的基本且合理的服务可以收费。
