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DOI:
https://doi.org/10.57187/3824

Original article

Vol. 156 No. 9 (2026)

Implementation of Activity-Based Funding and Patient Trajectory Managers’ contributions to financial indicators and care in a Swiss General Internal Medicine Department: a retrospective study

Cite this as:
Swiss Med Wkly. 2026;156:3824
Published
30.09.2026

Summary

BACKGROUND: In 2012, Switzerland introduced a new activity-based funding system (SwissDRG). In 2014, Geneva University Hospitals also introduced a new staff role, Patient Trajectory Manager (PTM), aimed at optimising patient care trajectories, hospital length of stay (LOS) and clinical documentation. The objective of the present study was to analyse the impact of the SwissDRG on quality and efficiency of care in our division. We also analysed the impact of the implementation of Patient Trajectory Managers on efficiency.

METHODS: We analysed 59,621 hospitalisations between 2007 and 2019 using statistical description with an ARIMA model, complemented by interrupted time-series analysis based on SARIMA intervention models. The primary outcome was LOS; secondary outcomes included average length of stay (ALOS), Cost Weight, discharge destination, difference vs theoretical ALOS, readmissions and mortality.

RESULTS: Following SwissDRG implementation, median LOS decreased from 10 days (2007–2011) to 8 days (2012–2019; p <0.001), with a higher proportion of patients discharged home (70.2% vs 75.4%, p <0.001). Interrupted time-series analyses confirmed a significant immediate reduction in LOS at the time of SwissDRG introduction, followed by a sustained downward trend. No significant effects were observed on 18-day readmissions or in-hospital mortality. After the introduction of PTMs, LOS continued to decrease and remained below predicted trajectories derived from pre-PTM trends, but interrupted time-series analyses did not identify an additional significant abrupt level reduction. However, significant post-intervention slope changes were observed for LOS-related efficiency indicators, indicating a sustained monthly reduction over time rather than an immediate effect. The period after PTM implementation was also associated with a reduced gap between observed and theoretical DRG LOS and fewer LOS upper-outliers, without adverse effects on readmissions or mortality.

CONCLUSION: There was a significant decrease in LOS across the three successive periods of observation. The introduction of activity-based funding through SwissDRG was associated with a major and immediate significant reduction in hospital LOS. However, subsequent organisational interventions through the implementation of Patient Trajectory Managers did not produce an additional causal level significant reduction in LOS but was associated with sustained improvements in efficiency-related trends, optimisation of DRG-related performance and stabilisation of care processes over time, without compromising patient outcomes.

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