Swiss Diagnosis Related Groups: A prospective study in rehabilitation comparing outcome before and after its introduction into acute health care
OBJECTIVE: To compare general health and the health-related quality of life of patients admitted to inpatient rehabilitation after a stay in an acute hospital before and after the introduction of Swiss Diagnosis Related Groups (SwissDRG).
METHODS: Consecutively referred patients with disorders of the lower extremities (LEX) or lumbar spine (LS) were evaluated by standardised outcome assessment instruments and for various co-factors. State (at entry to rehabilitation) and change of health (between entry and discharge from rehabilitation) were then compared between the cohorts before and after introduction of SwissDRG.
RESULTS: In LEX (n = 234), state of health, measured by the instruments’ scores at entry, was not significantly different before and after SwissDRG, except for emotional role (worse state after SwissDRG, p = 0.021). These results were consistent for the LS group (n = 161). Change of health from entry to dismissal was comparable before and after DRG in the LEX group, whereas in the LS group, improvements after SwissDRG were significantly smaller in physical role (p = 0.042), bodily pain (p = 0.012) and physical component summary (p = 0.009) than before SwissDRG. Duration of stay in an acute hospital and duration of stay in the rehabilitation clinic were comparable before and after SwissDRG in both groups.
CONCLUSIONS: While state of health was comparable in both diagnostic groups, some dimensions in the LS group revealed lesser improvements after introduction of SwissDRG compared to before. In analogy to long-term observations after the introduction of DRG in Germany, it is possible that greater differences will also be identified in Switzerland by future studies.
- Fetter RB, Freeman JL, Mullin RL. DRGs: how they evolved and are changing the way hospitals are managed. Pathologist. 1985;39(6):17–21.
- Information on SwissDRG 2013. (http://www.swissdrg.org/de/07_casemix_office/InformationenZuSwissDRG.asp?navid=8) [6.11.2013].
- Weissenberger N, Thommen D, Schuetz P, Mueller B, Reemts C, Holler T, et al. Head-to-head comparison of fee-for-service and diagnosis related groups in two tertiary referral hospitals in Switzerland: an observational study. Swiss Med Wkly. 2013;143: w13790.
- Wild V, Pfister E, Biller-Andorno N. Ethical research on the implementation of DRGs in Switzerland-a challenging project. Swiss Med Wkly. 2012;142: w13610.
- von Eiff W, Schüring S, Niehues C. REDIA Effect of the DRG introduction on the medical rehabilitation. Results of a prospective medicine-economic long time study from 2003 to 2011. LIT Publishing company Dr. Hopf W, Berlin, Germany, 2011.
- Tschanz HU. ST Reha aus ärztlicher Sicht (ST Reha from the physician’s viewpoint). (http://www.swissdrg.org/assets/pdf/Forum2013/8_SwissDRGDas_Projekt_ST_Reha_aus_aerztlicher_Sicht_2_.pdf) [2.8.2013].
- Ware JE, Snow KK, Konsinski M, Gandek B. SF-36 Health survery: manual and interpretation guide. In QualityMetric Incorporated 3rd edition. Lincoln, RI, USA, 2013.
- Bullinger M, Kirchberger I. SF-36 Fragebogen zum Gesundheitszustand. Handanweisung. (The SF – 36 questionnaires to assess health status. A manual). Hogrefe, Göttingen, Germany, 1998.
- Bellamy N. WOMAC Osteoarthritis Index. A user’s guide. London, Canada: University of Western Ontario, 1995.
- Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, et al. Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities). Arthrosis Index Rheumatologie. 1996;55(1):40–9.
- Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH. The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests. Spine. 1996;21(6):741–9.
- Pose B, Sangha O, Peters A, Wildner M. Validation oft the North American Spine Society Instrument for detecting the health status in patients with chronic back pain. Z Orthop. 1999;137(5):437–41.
- Sangha O, Wildner M, Peters A. Evaluation oft the North American Spine Society Instrument for assessment of the health status in patients with chronic backache. Z Orthop. 2000;138(5):447–51.
- Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45(4):384–91.
- Angst F, Goldhahn J, Drerup S, Aeschlimann A, Schwyzer HK, Simmen BR. Responsiveness of six outcome assessment instruments in total shoulder arthroplasty. Arthritis Rheum. 2008;59(3):391–8.
- Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatrics Soc. 1968;16(5):622–6.
- von Eiff W, Meyer N, Klemann A, Greitemann B, Karoff M. Rehabilitation and Diagnosis Related Groups (REDIA Study): Impact of DRG introduction in the Acute Sector on Medical Rehabilitation in Germany. Rehabilitation. 2007;46(2):74–81.
- von Eiff W, Schüring S, Greitemann B, Karoff M. REDIA-impacts of DRG introduction in the acute sector on medical rehabilitation. Rehabilitation. 2011;50(4):214–21.
- Büsching G, Hollander F, Schmidt C, Frey M, Steurer J. Finanzierung nach DRG: Schweiz Ärztezeitung. 2014;95(3):79–84.