PMID- 21769757
OWN - NLM
STAT- MEDLINE
DCOM- 20111228
LR  - 20220310
IS  - 1424-3997 (Electronic)
IS  - 0036-7672 (Linking)
VI  - 141
DP  - 2011
TI  - Quality of care delivered by fee-for-service and DRG hospitals in Switzerland in 
      patients with community-acquired pneumonia.
PG  - w13228
LID - 10.4414/smw.2011.13228 [doi]
AB  - PRINCIPLES: Reimbursement for inpatient treatment in Switzerland is in 
      transition. While hospitals in some cantons already use Diagnosis Related Groups 
      (DRG) based systems for hospital financing, others use fee-for-service (FFS) 
      based systems, a situation that provides the opportunity to perform a 
      head-to-head comparison between the two reimbursement systems. The aim of this 
      analysis was to compare reimbursement systems with regard to length of hospital 
      stay (LOS) and patient outcomes in a cohort of community-acquired pneumonia 
      patients from a previous prospective multicentre study in Switzerland. METHODS: 
      This is a post-hoc analysis of 925 patients with community-acquired pneumonia 
      from a previous randomised-controlled trial. We calculated multivariate 
      regression models adjusted for age, gender, comorbidities and severity of illness 
      (using the Pneumonia Severity Index) and accounting for clustering within 
      hospitals to compare LOS and outcomes between FFS (n = 4) or DRG hospitals (n = 
      2). RESULTS: LOS in DRG hospitals was significantly shorter compared to FFS 
      hospitals (8.4 vs 10.3 days, absolute difference 1.9 days [95%CI 0.8-3.1]). This 
      was confirmed in multivariate adjusted Cox models (hazard ratio 1.2 [95% 
      1.1-1.3]). There were no differences in 30-day and 18-month mortality rates 
      (adjusted odds ratio 1.7 [95% 0.9-3.2] and 1.3 [95% 0.9-1.9]) or recurrence rates 
      within 30 days (adjusted odds ratio 0.8 [95% 0.4-1.7]). Also, no differences were 
      found in the rate of still ongoing clinical symptoms at 30 days, satisfaction 
      with the discharge process and quality of life measures at 30 days of follow-up. 
      CONCLUSIONS: This study focusing on community-acquired pneumonia patients with 
      different severities found a 20% shorter LOS in hospitals with DRG financing 
      compared to FFS hospitals without apparent harmful effects on patient outcomes, 
      satisfaction with care and different quality of life measures. Further studies 
      are required to validate these findings for other medical and surgical patient 
      populations.
FAU - Schuetz, Philipp
AU  - Schuetz P
AD  - Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and 
      Harvard School of Public Health, Boston, MA, USA. Schuetzph@gmail.com
FAU - Albrich, Werner C
AU  - Albrich WC
FAU - Suter, Isabelle
AU  - Suter I
FAU - Hug, Balthasar L
AU  - Hug BL
FAU - Christ-Crain, Mirjam
AU  - Christ-Crain M
FAU - Holler, Thomas
AU  - Holler T
FAU - Henzen, Christoph
AU  - Henzen C
FAU - Krause, Martin
AU  - Krause M
FAU - Schoenenberger, Ronald
AU  - Schoenenberger R
FAU - Zimmerli, Werner
AU  - Zimmerli W
FAU - Mueller, Beat
AU  - Mueller B
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110718
PL  - Switzerland
TA  - Swiss Med Wkly
JT  - Swiss medical weekly
JID - 100970884
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Community-Acquired Infections/mortality
MH  - Diagnosis-Related Groups/*statistics & numerical data
MH  - Fee-for-Service Plans/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Length of Stay/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Patient Satisfaction/*statistics & numerical data
MH  - Pneumonia/*mortality
MH  - Proportional Hazards Models
MH  - *Quality of Health Care
MH  - *Quality of Life
MH  - Recurrence
MH  - Severity of Illness Index
MH  - Switzerland
EDAT- 2011/07/20 06:00
MHDA- 2011/12/29 06:00
CRDT- 2011/07/20 06:00
PHST- 2011/07/20 06:00 [entrez]
PHST- 2011/07/20 06:00 [pubmed]
PHST- 2011/12/29 06:00 [medline]
AID - smw-13228 [pii]
AID - 10.4414/smw.2011.13228 [doi]
PST - epublish
SO  - Swiss Med Wkly. 2011 Jul 18;141:w13228. doi: 10.4414/smw.2011.13228. eCollection 
      2011.