DRG-Systeme in der Versorgung von Patienten mit psychischen Störungen: Zur Konzeption eines Klassifikationssystems für Fallgruppen

Andreas, Stefan; Dirmaier, Jörg; Koch, Uwe; Schulz, Hartwig

doi:10.1055/s-2003-39066

Cited by 10 publications

(9 citation statements)

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“…Little is known about the relationship between psychosocial needs [27], chronicity of the mental illness or response to previous treatment [27] and the LOS. The variable social support has been considered as an important predictor of LOS in previous studies [28]. …”

Section: Discussionmentioning

confidence: 99%

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

2011

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BackgroundThe debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables.MethodsWe considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS.ResultsAll but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%.ConclusionsPsychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be considered in the development of future costing systems in psychiatry.

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Section: Discussionmentioning

confidence: 99%

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

2011

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“…Leistungen der stationären psychiatrischen Versorgung wer− den in Deutschland, wie in der Schweiz, nach wie vor auf der Basis von Tagespflegesätzen abge− rechnet. Eine an Fallpauschalen orientierte Ver− gütung findet bisher nicht statt [1]. Dagegen wurde für somatische Erkrankungen ein Vergü− tungssystem auf der Basis von diagnosebezoge− nen Fallpauschalen eingeführt (diagnosis−related groups DRGs; German DRG [2]).…”

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“…Dies wäre auch für die Psychiatrie interessant. Letztlich werden von Fallpauschalen eine leis− tungsgerechtere Vergütung sowie erhöhte Leis− tungstransparenz und Effizienz erwartet [1]. An− dererseits könnte aber auch die Leistungsqualität stationärer Versorgung sinken [5].…”

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Psychopathologische Syndrome gemäß AMDP-System als Grundlage für Fallgruppierungen in der Psychiatrie

Herwig¹,

Warnke²,

Rössler³

2009

Psychiat Prax

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“…B. "psychiatric severity of illness index"; Horn et al 1989), die in der Lage sein sollen, eine Varianzaufklärung zu erreichen, die zumindest dem gleicht, was das DRG-System für einige internistische Fallgruppen erreicht (Andreas et al 2003;Burgmer et al 2003;, erscheint auch hier die Einführung der Fallpauschalen in Abhängigkeit vom politischen Willen in absehbarer Zeit möglich.…”

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DRG-Verg�tung und Kosten station�rer integrierter psychosomatischer Behandlung

et al. 2004

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DRG-Systeme in der Versorgung von Patienten mit psychischen Störungen: Zur Konzeption eines Klassifikationssystems für Fallgruppen

Cited by 10 publications

References 4 publications

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services

Psychopathologische Syndrome gemäß AMDP-System als Grundlage für Fallgruppierungen in der Psychiatrie

DRG-Verg�tung und Kosten station�rer integrierter psychosomatischer Behandlung

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