[在急性普通疾病诊断相关分组（aG-DRG）系统中，多发伤治疗是否存在不足？]

[Is polytrauma treatment in deficit in the aG-DRG system?].

作者信息

Schopow Nikolas, Botzon Anja, Schneider Kristian, Fuchs Carolin, Josten Christoph, von Dercks Nikolaus, Fakler Johannes, Osterhoff Georg

机构信息

Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.

Bereich 3 - Finanzen, Planung und Controlling, Universitätsklinikum Leipzig, Liebigstraße 18, 04103, Leipzig, Deutschland.

出版信息

Unfallchirurg. 2022 Apr;125(4):305-312. doi: 10.1007/s00113-021-01015-5. Epub 2021 Jun 8.

DOI:10.1007/s00113-021-01015-5

PMID:34100961

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8940839/

Abstract

BACKGROUND

The interdisciplinary care of severely injured patients is staff and resource intensive. Since the introduction of the G‑DRG system in Germany in 2003, most studies have identified a financial deficit in the care of severely injured patients. The aim of this study was to analyze the effects of the new aG-DRG system introduced in 2020 on cost recovery in the treatment of severely injured patients. For the first time, the costs for organization, certification and documentation as well as the costs for non-seriously injured shock room patients were included.

METHODS

All patients who were treated in the surgical shock room of the emergency department of the Leipzig University Hospital in 2017 were included. For the analysis, the cost model according to Pape et al. was extended by the module organization, documentation and certification and for the first time the costs for overtriaged patients were considered. A cost calculation was performed for the years 2017-2020 as well a comparison with the respective earnings.

RESULTS

A total of 834 patients were treated in the shock room and 258 severely injured patients were divided into 3 groups: ISS 9-15 + ICU (n 72; ∅ ISS 11.9; costs per patient 14,715 €),ISS ≥ 16 (n 186; ∅ ISS 27.7; costs per patient 30,718 €) and DRG polytrauma (n 59; ∅ ISS 32.4; costs per patient 26,102 €).

CONCLUSION

Polytrauma care under the aG-DRG 2020 is in deficit. Overall, in 2020 a deficit of 5858 € per severely injured patient resulted.

摘要

背景

重伤患者的跨学科护理需要大量人员和资源。自2003年德国引入G-DRG系统以来，大多数研究都发现重伤患者护理存在财务赤字。本研究的目的是分析2020年引入的新aG-DRG系统对重伤患者治疗成本回收的影响。首次纳入了组织、认证和文件编制成本以及非重伤休克室患者的成本。

方法

纳入2017年在莱比锡大学医院急诊科外科休克室接受治疗的所有患者。为了进行分析，根据帕佩等人的成本模型扩展了组织、文件编制和认证模块，首次考虑了过度分诊患者的成本。对2017 - 2020年进行了成本计算，并与各自的收入进行了比较。

结果

休克室共治疗834例患者，258例重伤患者分为3组：损伤严重度评分（ISS）9 - 15 +重症监护病房（ICU）（n = 72；平均ISS 11.9；每位患者成本14,715欧元），ISS≥16（n = 186；平均ISS 27.7；每位患者成本30,718欧元）和DRG多发伤（n = 59；平均ISS 32.4；每位患者成本26,102欧元）。