RESUMEN
The aim of this study was to evaluate the costs involved in treating severely injured patients at the clinic differentiated by several characteristics (injury, age), sectors (emergency room, surgery, intensive and normal care), and kinds of costs (fixed costs, variable costs) and to determine influencing factors regarding costs based on the register of the DGU (Deutsche Gesellschaft für Unfallchirurgie). All patients were taken into account who had an injury severity score (ISS) of at least 16. On this basis costs of 3702 patients were analyzed. They were compared by using analysis of variance for different groups of patients classified according to kind of injury, severity of injury, and age. Moreover, multiple regression was performed to control the common influence of demographic factors and the type of injury on costs. The average ISS of the analyzed patients was 30.6 (+/-11.6) points. The average costs of the clinic were 32,166 (+/-25,404) EUR per patient. More than half of the costs was incurred by intensive care and about one-fourth by surgery. On average 30.6% were variable costs and 69.4% were fixed costs. The analysis of variance revealed that costs increased with advancing age and severity of injury (ISS). Multiple regression confirmed these interrelations indicating that extremities are very cost intensive. Due to the high portion of fixed costs, the overall costs strongly depend on the capacity utilization and less on hospital stay. That is why it may be necessary in the future to create centers for trauma care to maintain economic efficiency for treatment of these patients. Besides large differences of costs within closely defined groups of patients, hospitals carry a high economic risk so that a more complex reimbursement system should be discussed than implemented by the German DRGs.
Asunto(s)
Costos de Hospital/estadística & datos numéricos , Traumatismo Múltiple/economía , Adulto , Anciano , Costos y Análisis de Costo , Cuidados Críticos/economía , Femenino , Alemania , Costos de Hospital/clasificación , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/clasificación , Traumatismo Múltiple/cirugía , Sistema de RegistrosRESUMEN
UNLABELLED: The introduction of diagnosis related groups (DRG) will radically change the payment system for German hospitals. In 2002 the values for most DRG's were published for the german system (G-DRG). The polytrauma working group of the German Trauma Society developed a calculating algorithm to estimate the comprehensive hospital costs for every patient in the German trauma registry. The aim of this study was to compare these costs with the reimbursement according the the G-DRG's for a standardized population of polytrauma patients. MATERIAL AND METHODS: For polytrauma patients treated at Hannover Medical School in 2000 and 2001 the reimbursement according to the G-DRG's was calculated using a base value of 2900 euro. In the same patients the total cost of inpatient treatment was calculated according to the algorithm developed by the polytrauma working group of the German Trauma Society. The difference between these values represents the economic result. This was calculated as an overall result, but also for specific subgroups of patients (injury severity, mortality, G-DRG grouping). RESULTS: Datasets of 103 polytrauma patients were included. The following G-DRG's were most frequently occuring: A06Z (n=41), A07Z (n=16), W01Z (n=13). All other G-DRG's were documented less than 3 times. The mean reimbursement according to the G-DRG was 21.380+/-12.300 euro for a polytrauma patient. However, the mean hospital cost accounted to 34.274+/-22.501 euro, which resulted in a mean deficit of 12.893+/-15.534 euro. Analysis of subgroups revealed, that an ISS of more than 35 points, patients with a prolonged hospital stay and patients of the G-DRG group A06Z show a particularly negative result. CONCLUSION: The comprehensive hospital costs for treating polytrauma patients are on average 12.893 euro higher than the reimbursement according the G-DRG's. For hospitals to be fully reimbursed G-DRG values have to be reconfigured according to the German health care system. Thus, inclusion criteria to specific G-DRG have to be changed and a specific G-DRG group for very severely injured patients needs to be established.
Asunto(s)
Grupos Diagnósticos Relacionados/economía , Costos de Hospital , Traumatismo Múltiple/economía , Adulto , Algoritmos , Femenino , Alemania , Humanos , Reembolso de Seguro de Salud , Tiempo de Internación , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Traumatismo Múltiple/terapia , Sistema de RegistrosAsunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Modelos Económicos , Traumatismo Múltiple/economía , Programas Nacionales de Salud/economía , Costos y Análisis de Costo , Alemania , Costos de Hospital/estadística & datos numéricos , Humanos , Traumatismo Múltiple/rehabilitación , Grupo de Atención al Paciente/economía , Sistema de RegistrosRESUMEN
Polytrauma treatment (40-60,000,-[symbol: see text]) and trauma killed victims (750,000,-[symbol: see text]) are a severe economical problem. The data of the German Trauma Registry show a significant influence of arrival time of the emergency doctor and lethality. There is also a significant increase of the length of stay at the intensive unit in severe thoracic and abdominal trauma (AIS > 3). The analysis of the audit filter for quality management showed between 1999-2000 a decrease of the time till first CCT from 41 to 31 minutes and for the first thoracic X-ray from 20 to 16 minutes. The German Trauma Registry includes till now more than 10,000 polytraumatized patients. There is an increase of 110% between the years 1998 and 2000.