Robra B P, Swart E, Klas P, Leber W D
Institut für Sozialmedizin, Medizinische Fakultät, Universität Magdenburg.
Gesundheitswesen. 1998 Apr;60(4):211-6.
In 1995 the statutory sickness fund (AOK) in Magdeburg arranged target agreements with 10 of 23 acute care hospitals in its district to exercise an influence on the development of the average length of hospital stay. With the aim of decreasing the length of stay as well as the administrative cost and effort, these agreements set upper limits on the average length of stay which were hospital-specific and period-specific. In return, with only a few exceptions, the AOK Magdeburg refrained from limiting the coverage of individual cases. Hospital cases discharged from 1994 and 1996 were analysed to determine whether the development of the length of stay in the ten hospitals with target agreements differed from that in the other 13 hospitals. Only some of the hospitals were successful in reaching their target agreements. The average length of stay dropped by 4.2% in the hospitals with target agreements and by 7.9% in those without target agreements. This must be considered in the context of the development of the case load and number of available hospital beds. For instance, in spite of a target agreement, one hospital showed a (compensatory) increase in the average length of stay in association with an increase in the number of authorized beds and a concurrent decrease in the number of cases. The number of days billed by AOK patients per authorized bed (as an indicator of hospital productivity) showed a more favourable development in the group of hospitals with target agreements than in the other group. This was not a controlled trial as far as the selection of the hospitals is concerned. The results suggest that there is no harm in incentives that induce hospitals to manage primarily on their own the average length of stay. The use of routine aggregate data in monitoring this development, rather than the current more expensive individual case approach, also seems reasonable. Well planned studies that further test the "tool" of target agreements can be recommended.
1995年，马格德堡的法定疾病基金（AOK）与其辖区内23家急症医院中的10家达成了目标协议，以影响平均住院天数的发展。为了缩短住院天数以及降低行政成本和工作量，这些协议设定了因医院和时期而异的平均住院天数上限。作为回报，除少数例外情况，马格德堡AOK避免限制个别病例的承保范围。对1994年和1996年出院的医院病例进行了分析，以确定达成目标协议的10家医院的住院天数发展情况是否与其他13家医院不同。只有部分医院成功达成了目标协议。达成目标协议的医院平均住院天数下降了4.2%，未达成协议的医院下降了7.9%。这必须结合病例数量和可用病床数量的发展情况来考虑。例如，尽管有目标协议，但一家医院的平均住院天数出现了（补偿性）增加，同时授权病床数量增加，病例数量减少。AOK患者每授权病床的计费天数（作为医院生产率的指标）在达成目标协议的医院组中比在另一组中呈现出更有利的发展态势。就医院的选择而言，这并非一项对照试验。结果表明，促使医院主要自主管理平均住院天数的激励措施并无危害。使用常规汇总数据来监测这一发展情况，而非当前更昂贵的个别病例方法，似乎也是合理的。可以推荐开展精心规划的研究，进一步检验目标协议这一“工具”。
