Eismann Anika Marit, Klinder Annett, Mittelmeier Wolfram, Rohde-Lindner Martina, Osmanski-Zenk Katrin
Orthopedic Clinic and Policlinic, Rostock University Medical Center, D-18057 Rostock, Germany.
Healthcare (Basel). 2024 Sep 18;12(18):1869. doi: 10.3390/healthcare12181869.
BACKGROUND/OBJECTIVES: According to the guidelines of the EndoCert initiative, certified maximum-care arthroplasty centers (ACmax) are obliged to admit patients from certified arthroplasty centers (AC) if these patients need to be transferred to the more specialized ACmax due to difficult replacement and revision procedures as well as after complications in primary care that are beyond the expertise of the smaller centers. This study investigated whether the cohort of transferred patients differed from the patients directly recruited at the ACmax for factors such as severity of diagnosis, comorbidities or outcome. The aim was to determine whether transferred patients increased the resource requirements for the ACmax.
A total of 136 patients were included in the retrospective study and analyzed in terms of case severity, length of hospital stays (LOS), Diagnosis-Related Group charges, readmission rate and concomitant diseases. All patients were followed for up to 12 months after the initial hospital stay.
There were significant differences between the groups of transferred and self-recruited patients. For example, transferred patients had a higher Patient Clinical Complexity Level (PCCL). Similarly, the increased Case Mix Index (CMI) of transferred patients indicated more intensive care during the inpatient stay. The higher values for the comorbidity indices also supported these results. This had an impact on the LOS and overall costs, too. The differences between the groups were also reflected by adverse events during the one-year follow-up. The higher percentage of patients with septic revisions, whose treatment is especially demanding, among transferred patients aggravated the differences even further. Thus, transferred patients were associated with increased resource requirements for the ACmax.
While it serves patients' safety to transfer them to an ACmax with specialized expertise and greater structural quality, the care of transferred patients ties up considerable resources at the ACmax that might only be insufficiently reimbursed by the generalized tariffs.
背景/目的：根据EndoCert倡议的指导方针，认证的重症关节置换中心（ACmax）有义务接收来自认证关节置换中心（AC）的患者，前提是这些患者因置换和翻修手术困难，以及初级护理中出现超出小型中心专业范围的并发症，而需要转至更专业的ACmax。本研究调查了转院患者群体在诊断严重程度、合并症或治疗结果等因素方面是否与直接在ACmax招募的患者存在差异。目的是确定转院患者是否增加了ACmax的资源需求。
共有136例患者纳入这项回顾性研究，并对病例严重程度、住院时间（LOS）、诊断相关分组费用、再入院率和伴随疾病进行分析。所有患者在首次住院后随访长达12个月。
转院患者组和自招募患者组之间存在显著差异。例如，转院患者的患者临床复杂程度水平（PCCL）更高。同样，转院患者病例组合指数（CMI）的增加表明住院期间需要更密集的护理。合并症指数的较高值也支持了这些结果。这也对住院时间和总体费用产生了影响。两组之间的差异在一年随访期间的不良事件中也有所体现。转院患者中需要特别复杂治疗的感染性翻修患者比例较高，这进一步加剧了差异。因此，转院患者与ACmax增加的资源需求相关。
虽然将患者转至具有专业知识和更高结构质量的ACmax有助于患者安全，但转院患者的护理在ACmax占用了大量资源，而通用收费可能无法充分补偿这些资源。
