[Quality of recorded data used for external quality assessment of proximal femoral neck fractures]. / Qualität von zum Zweck der externen Qualitätssicherung erfassten Daten zur hüftgelenknahen Femurfraktur.

BACKGROUND AND OBJECTIVES: Fracture of the proximal femur is a frequent injury, especially in elderly people, with considerable subsequent risks. For this reason its treatment is an obligatory part of external quality assessment. The results are affected by the quality of documentation and validity of the data. The aim of this study was to systematically analyse recorded data on the treatment of this fractures for the purpose of external quality assessment at a trauma surgery ward at the University Hospitals Giessen and Marburg, located at Marburg in 2005. METHODS: Independently controlled data were used to analyse and compare the quality of the recorded data, both descriptively and statistically. RESULTS: 13.5% of recorded cases did not match inclusion criteria. There were high error rates in the documentation of delay of operation (39%), the scoring system of the American Society of Anesthesiology (60%) and general medical complications (30%). CONCLUSIONS: Seen from the viewpoint of data quality several improvements will be necessary in support of the surgeons who are obliged to record data for external quality assessment. Otherwise such assessment will be quite inaccurate.

[Further development of the diagnosis-related groups system--fact or fiction? Differentiation of case severities in patients with proximal femoral fractures 2003-2005]. / Weiterentwicklung im G-DRG-System -- Fact or Fiction? Differenzierung der Fallschwere bei Patienten mit proximaler Femurfraktur 2003 -- 2005.

BACKGROUND: The previous system of hospital financing based on the returns (consisting of payments received minus cost of patient treatment) is undergoing considerable changes on the basis of learning to apply the new Diagnosis-Related Groups (G-DRG) system which differentiates the financial returns according to the individual severity of each case. AIM OF THE STUDY: 1. What are the differences in cost and returns when applying the G-DRG systems 2003, 2004 and 2005 to well-defined groups of patients (for example, surgery of proximal femoral fractures)? 2. The influence exercised by secondary (supplementary) diagnosis on the grouping of the patients. 3. Has the G-DRG system been appropriately developed further in respect of improved differentiation according to severity of the cases and homogenisation of the patient groups? PATIENTS AND METHODS: The study was based on comprehensive clinical data of 169 proximal femur fracture patients. We assessed the Case-Mix index, relative weights and returns, basic DRG, DRG, the number and weight of secondary diagnoses relevant for complexity and comorbidity levels (CCL), the summands of the CCL's and the resulting PCCL values (Patient Clinical Complexity Levels). The data were subjected to analysis of variance and graphically descriptive analysis. RESULTS: The effective Case Mix index decreases in the 2004 and 2005 systems compared to 2003. This is due to a significant drop in returns based on an unchanged rate of receipts of 3000 . The progressive development of the systems was partly associated with major changes in grouping without significant intra-group homogenisation or improved inter-group discrimination of indications. The differentiation process does not fully utilise the differentiation potential of the basic data. CONCLUSIONS: No definite improvement of the differentiation potential of the G-DRG systems seems to have been achieved by the 2004 and 2005 systems compared to 2003 using the data of the relevant group of patients with proximal femoral fractures. From 2005 onward the financial lumpsum receipts and returns will definitely affect hospital budgets. Hence, a substantial improvement of the the basis of calculation is imperative for 2005 as well as complete publication of the relevant data. It is indeed doubtful whether the extension of the convergence phase to 5 years presently under discussion would provide sufficient time for an adequate solution of the financial and system problems.

[Quality management and strategic consequences of assessing documentation and coding under the German Diagnostic Related Groups system]. / Die Vidierkonferenz. Qualitätsmanagementmassnahme zur Sicherstellung der Dokumentations- und Kodierqualität.

INTRODUCTION: The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. PURPOSE: The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. METHODS: In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. RESULTS: Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. CONCLUSIONS: Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

[Roentgen studies of the skull in head injuries--a multicenter study]. / Röntgenuntersuchungen des Schädels bei Kopfverletzungen--eine Multicenterstudie.

The multi-center study presented reveals that 76% of the conventionally performed X-ray investigations of the skull can be avoided without any relevance concerning the non-diagnosis of severe injuries. Only in 3.2% of all patients investigated a skull X-ray had instantaneous therapeutically consequences. Thus routinely performed skull X-rays are no longer acceptable in the light of cost reduction and radiation load. The clinical-neurological investigations however are inevitable to perform the state of the art treatment of patients with head injuries today, leading to computerized tomography if necessary. A check-list of clinical findings is presented to get the indications for conventional X-rays of the skull and to manage an effective use of such investigations in appropriate clinical situations.