T Rath1, G Büscher, D Schwartze, A Drabik, E Bokern, M Lüngen. 1. Institut für Gesundheitsökonomie und Klinische Epidemiologie (IGKE), Klinikum der Universität zu Köln (AöR), 50935 Köln, Deutschland. thomas.rath@uk-koeln.de
Abstract
BACKGROUND: An increase in the convergence of medical services toward specialized hospitals with high case numbers as well as the effects on quality of care are often assumed to be the result of diagnosis-related groups (DRGs; case-based lump-sum reimbursement). Estimates of the extent to which these effects occur in emergency diagnoses are not available. METHODS: Claims data relating to approximately 23.6 million insured within the period 2004-2007 (inclusive) were analyzed. All cases with the main diagnosis of stroke (ICD-10: I63 and I64) and myocardial infarction (ICD-10: I21) were included in the study. RESULTS: Increasing case numbers could be observed for all entities within the period studied (myocardial infarction: +12.71%; stroke: +1.73%). The absolute increase in case numbers seems to affect those hospitals with case numbers >100 per year, whereas case numbers of hospital groups including hospitals with low case numbers per year remain unchanged or grow slower. No absolute trend in mortality could be seen. However, a disproportionate rate of mortality in hospitals with low case numbers per year for both diagnoses was observed. CONCLUSION: The convergence of emergency treatment in a few specialized centers has not yet been accelerated by the implementation of DRGs. Essentially, relative changes can be seen due to case number increases in large centers rather than because of service cutbacks and shifts from smaller hospitals. The reason for this could be the need to maintain emergency care in rural regions, while specialized centers are increasingly built in urban areas.
BACKGROUND: An increase in the convergence of medical services toward specialized hospitals with high case numbers as well as the effects on quality of care are often assumed to be the result of diagnosis-related groups (DRGs; case-based lump-sum reimbursement). Estimates of the extent to which these effects occur in emergency diagnoses are not available. METHODS: Claims data relating to approximately 23.6 million insured within the period 2004-2007 (inclusive) were analyzed. All cases with the main diagnosis of stroke (ICD-10: I63 and I64) and myocardial infarction (ICD-10: I21) were included in the study. RESULTS: Increasing case numbers could be observed for all entities within the period studied (myocardial infarction: +12.71%; stroke: +1.73%). The absolute increase in case numbers seems to affect those hospitals with case numbers >100 per year, whereas case numbers of hospital groups including hospitals with low case numbers per year remain unchanged or grow slower. No absolute trend in mortality could be seen. However, a disproportionate rate of mortality in hospitals with low case numbers per year for both diagnoses was observed. CONCLUSION: The convergence of emergency treatment in a few specialized centers has not yet been accelerated by the implementation of DRGs. Essentially, relative changes can be seen due to case number increases in large centers rather than because of service cutbacks and shifts from smaller hospitals. The reason for this could be the need to maintain emergency care in rural regions, while specialized centers are increasingly built in urban areas.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245