Labus David, Weinhold Leonie, Heller Joerg
Krankenhaus Maria Hilf, Department of Internal Medicine, Bad Neuenahr, Germany.
University Hospital Bonn, Department of Medical Biometry, Informatics and Epidemiology, Bonn, Germany.
GMS Hyg Infect Control. 2019 Nov 29;14:Doc18. doi: 10.3205/dgkh000333. eCollection 2019.
Isolation precautions used in methicillin-resistant (MRSA) infection control are effective in inhibiting pathogen transmission, but may cause unintended consequences in medical care. In addition, while costs attributed to MRSA are known to be substantial, little is known about their reimbursement in the German Diagnosis Related Groups (G-DRG) payment system. The aim of our study was to examine the effect of isolation precautions used in MRSA infection control on care processes, patient outcomes and deliver reliable data on MRSA-attributed reimbursement. A retrospective, matched cohort study of inpatients admitted to a general care teaching hospital in Bad Neuenahr, Germany, between January 1, 2016, and December 31, 2017 was performed. Patients isolated for MRSA colonization were matched to non-isolated controls based on age, gender, MRSA-adjusted Patient Clinical Complexity Level (Ma-PCCL) and Major Diagnostic Category (MDC). Main outcome measures on care processes and patient outcomes included adverse events, patient complaints, 30-day readmission rates, length of stay, type of discharge, and performance of instrument-based diagnostics. MRSA-attributed reimbursement was measured by conducting two separate G-DRG groupings, one with inclusion of MRSA-related codes and one without. A total of 26,059 patients were admitted to Maria Hilf Hospital in Bad Neuenahr, Germany, during the study period. We identified 304 patients isolated for MRSA colonization. Compared to non-isolated matched controls, those on isolation precautions for MRSA colonization acquired about 45% more pressure ulcers and experienced significant delays in the performance of radiological diagnostics and echocardiographs. Patients isolated for MRSA colonization received about 49% fewer echocardiographs and had about 38% fewer abdominal ultrasound exams performed compared to non-isolated matched controls. A non-significant tendency towards fewer discharges to rehabilitation clinics and higher mortality rates were observed in patients isolated for MRSA colonization. Reimbursements were negligibly affected when MRSA-related codes were integrated by the grouper. Isolation precautions are associated with adverse consequences for care processes. These consequences need to be mitigated in order to justify placing patients at risk.
耐甲氧西林金黄色葡萄球菌（MRSA）感染控制中使用的隔离预防措施在抑制病原体传播方面是有效的，但可能在医疗护理中产生意想不到的后果。此外，虽然已知与MRSA相关的成本很高，但对于其在德国诊断相关分组（G-DRG）支付系统中的报销情况却知之甚少。我们研究的目的是检验MRSA感染控制中使用的隔离预防措施对护理过程、患者结局的影响，并提供关于MRSA相关报销的可靠数据。对2016年1月1日至2017年12月31日期间入住德国巴特新纳赫一家综合护理教学医院的住院患者进行了一项回顾性匹配队列研究。因MRSA定植而被隔离的患者根据年龄、性别、经MRSA调整的患者临床复杂程度水平（Ma-PCCL）和主要诊断类别（MDC）与未隔离的对照组进行匹配。护理过程和患者结局的主要衡量指标包括不良事件、患者投诉、30天再入院率、住院时间、出院类型以及基于仪器的诊断操作。通过进行两个单独的G-DRG分组来衡量MRSA相关报销，一个包含与MRSA相关的代码，另一个不包含。在研究期间，共有26059名患者入住德国巴特新纳赫的玛丽亚希尔夫医院。我们确定了304名因MRSA定植而被隔离的患者。与未隔离的匹配对照组相比，因MRSA定植而采取隔离预防措施的患者发生压疮的几率高出约45%，并且在进行放射诊断和超声心动图检查时出现了显著延迟。与未隔离的匹配对照组相比，因MRSA定植而被隔离的患者接受超声心动图检查的次数少约49%，进行腹部超声检查的次数少约38%。在因MRSA定植而被隔离的患者中，观察到转至康复诊所的出院人数减少以及死亡率升高的趋势，但不显著。当分组器整合与MRSA相关的代码时，报销受到的影响可忽略不计。隔离预防措施与护理过程的不良后果相关。为了使将患者置于风险之中合理化，需要减轻这些后果。
