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When John Thompson and I first began talking about finding a way to measure and cost the output of hospitals in the s. Diagnosis-Related Groups in. Busse, Geissler, Quentin and Wiley The views expressed by authors or editors do not necessarily represent the health policies and, in particular, will be of use to health policy-makers and advisers. Because most countries in Europe moved to DRG based payment from global budgets. Diagnosis-Related Group DRG systems can be optimized by This study explores the stakeholder's perspective on integrating functioning information in the G-DRG casemix system in Europe that covers almost all inpatient cases.

Nor is it clear who will invest in and receive the benefits from adding. Berlin: Springer- Verlag. Codman, E. The product of a hospital Philadelphia. Casas M.

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Wiley Eds. Youngsoo Shin. Freeman for their efforts over many years. The diagnosis-related groups DRGs constitute a way of identifying the normal output of.

Patients with multiple stays e. Patients with another SDRG e. The revenue is the remuneration obtained by the hospital for each hospital stay. Each SDRG has a number of points cost-weight , according to the gravity of the group's pathologies [Table 1 ]. The cost-weights are calculated measuring the cost for treatment of each SDRG in a sample of hospitals.

They are adjusted annually. The base rate corresponds to the price of a SDRG point and is negotiated every year between each hospital and its insurance companies. The remuneration is obtained by multiplying the number of points cost-weight by the current price of the point base rate [Figure 4 ].

For each SDRG, a "normal" length of hospital stay is defined. The cases in which the length of stay lays between the limits are qualified inliers. To minimize the economic incentive to refer a patient too soon, lengths of stays below the lower limit, called low-outliers, obtain a reduced remuneration.

Conversely, remuneration of high-outliers, with a duration above the upper limit, is increased. Adjustments are done by increasing or decreasing the number of points cost-weight per day above or below the limits. The cost is the expense of the hospital for a hospital stay.

In it, the annual costs directly generated by the patients material, medication, medical fees, etc. The sum of the costs is divided by all the hospital stays depending on the resources used. Thus, the cost of a hospital stay is calculated by documenting all the resources spent [Table 2 ]. Six patients were excluded because they had multiple stays. More than two thirds of the costs came from the medical care and one third from the surgical procedure. The length of the hospital stay generated therefore the major part of the costs. As the length of stay seemed to be the most relevant parameter to act on, a simple linear regression was carried out to investigate its relationship to the costs.

The R 2 value was 0. We observed that a main determinant of the costs was the length of stay.

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Several options could be considered to act on it. The innovative patient hotel concept, developed in Scandinavia in the 90s has proven to save money while maintaining high-quality care. This could be an interesting option between the explantation and the reimplantation in two-stage exchange to reduce the length of the hospital stay. It could also be possible to transfer temporally the patient to a rehabilitation hospital between the explantation and the reimplantation. Another cost-saving potential would be to refer the patient back home with home caring and oral antibiotic therapy between the first and second stage of the surgical procedure.

According the SwissDRG system, the rehospitalization would have to take place after a period of 18 days in order to be considered as a new stay [Figure 8 ]. We compared the same costs and double revenues in a projection of the rehospitalization concept. It is also crucial to have more specific SDRGs for prosthetic-joint infections. The three SDRGs applied for treating prosthetic-joint infections include uncomplicated cases e.

This causes a decrease in the length of the SDRG and thus in its ensuring revenues.

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Our study has several limitations. Currently, there is no consensus regarding the optimal interval duration between the prosthesis explantation and reimplantation procedure. The interval varies from two weeks to several months [Figure 1 ]. The economic consequences associated with treating periprosthetic infections are known.


  1. Review of Diagnosis-Related Group-Based Financing of Hospital Care.
  2. Diagnosis Related Groups in Europe - Uses and Perspectives | Merce Casas | Springer.
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Already in , Sculco et al. It was first implemented in in the USA to measure each individual patient's consumption of hospital resources. SwissDRG is supposed to provide homogenous, transparent and comparable hospital remuneration, improve efficiency and reduce costs. Therefore, hospitals are not paid for each therapeutic act. A software with a classification algorithm grouper allocates an inpatient admission in a SDRG. This allocation applies to several criteria, including the condition that has requested most of the resources principal diagnosis which does not always match the hospitalization pattern [Figure 2 ].

The literature contains few economic evaluations of the revenues from the treatment of prosthetic-joint infections. We compared the revenues and the costs of each cases at the University Hospital of Lausanne in Switzerland from , the year when the DRG system was introduced in Switzerland, to Patients with multiple stays e. Patients with another SDRG e.

The revenue is the remuneration obtained by the hospital for each hospital stay. Each SDRG has a number of points cost-weight , according to the gravity of the group's pathologies [Table 1 ].

Diagnosis Related Groups in Europe: Uses and Perspectives

The cost-weights are calculated measuring the cost for treatment of each SDRG in a sample of hospitals. They are adjusted annually. The base rate corresponds to the price of a SDRG point and is negotiated every year between each hospital and its insurance companies. The remuneration is obtained by multiplying the number of points cost-weight by the current price of the point base rate [Figure 4 ]. For each SDRG, a "normal" length of hospital stay is defined.

The cases in which the length of stay lays between the limits are qualified inliers. To minimize the economic incentive to refer a patient too soon, lengths of stays below the lower limit, called low-outliers, obtain a reduced remuneration. Conversely, remuneration of high-outliers, with a duration above the upper limit, is increased. Adjustments are done by increasing or decreasing the number of points cost-weight per day above or below the limits.

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The cost is the expense of the hospital for a hospital stay. In it, the annual costs directly generated by the patients material, medication, medical fees, etc. The sum of the costs is divided by all the hospital stays depending on the resources used. Thus, the cost of a hospital stay is calculated by documenting all the resources spent [Table 2 ]. Six patients were excluded because they had multiple stays. More than two thirds of the costs came from the medical care and one third from the surgical procedure. The length of the hospital stay generated therefore the major part of the costs.

As the length of stay seemed to be the most relevant parameter to act on, a simple linear regression was carried out to investigate its relationship to the costs. The R 2 value was 0.


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  • We observed that a main determinant of the costs was the length of stay.