Head-to-head comparison of length of stay, patients' outcome and satisfaction in Switzerland before and after SwissDRG-Implementation in 2012 in 2012: an observational study in two tertiary university centers.

BACKGROUND: On 1 January 2012 Swiss Diagnosis Related Groups (DRG), a new uniform payment system for in-patients was introduced in Switzerland with the intention to replace a "cost-based" with a "case-based" reimbursement system to increase efficiency. With the introduction of the new payment system we aim to answer questions raised regarding length of stay as well as patients' outcome and satisfaction. METHODS: This is a prospective, two-centre observational cohort study with data from University Hospital Basel and the Cantonal Hospital Aarau, Switzerland, from January to June 2011 and 2012, respectively. Consecutive in-patients with the main diagnosis of either community-acquired pneumonia, exacerbation of COPD, acute heart failure or hip fracture were included. A questionnaire survey was sent out after discharge investigating changes before and after SwissDRG implementation. Our primary endpoint was LOS. RESULTS: Of 1,983 eligible patients 841 returned the questionnaire and were included into the analysis (429 in 2011, 412 in 2012). The median age was 76.7 years (50.8% male). Patients in the two years were well balanced in regard to main diagnoses and co-morbidities. Mean LOS in the overall patient population was 10.0 days and comparable between the 2011 cohort and the 2012 cohort (9.7 vs 10.3; p = 0.43). Overall satisfaction with care changed only slightly after introduction of SwissDRG and remained high (89.0% vs 87.8%; p = 0.429). DISCUSSION: Investigating the influence of the implementation of SwissDRG in 2012 regarding LOS patients' outcome and satisfaction, we found no significant changes. However, we observed some noteworthy trends, which should be monitored closely.

Diagnosis and treatment of iron deficiency in medical inpatients at a Swiss tertiary university referral hospital: a retrospective observational cohort study of clinical practice.

BACKGROUND: Iron deficiency anaemia is a common disease with a prevalence of up to 19.2% in populations at risk. However, the prevalence of iron deficiency (ID) in hospitalised patients is not well known. The aims of this retrospective, observational cohort study were to evaluate the current diagnostic procedures for, and treatment of, ID as well as to estimate the prevalence of undiagnosed ID in hospitalised patients at the division of internal medicine in a Swiss tertiary university referral centre. METHODS: Within a study period of 6 months, data from all patients hospitalised at the division of internal medicine were analysed for the presence of anaemia (defined as haemoglobin levels for males <130 g/l and for females <120 g/l) and ID (ferritin <15 µg/l or ferritin <50 µg/l and transferrin saturation <20%). RESULTS: A total of 2,781 hospitalisation cases were analysed (2,251 unique patients, male 55.5%, mean age 66.4 years). In 2,267 cases (81.5%) results of a red blood cell count were available. In 329 cases (14.5%) iron parameters (IP) were determined and 45 (13.7%) cases / unique patients with ID were detected. Among the remaining 1,938 cases without IP determination, statistical estimation predicted 103 (56-329) undiagnosed ID cases. In ID patients, the most prevalent diagnosis was heart failure (24.4%). Of these patients, 72.7% had haemorrhage-facilitating drugs on hospital admission or discharge. CONCLUSION: Iron deficiency is common in internal medicine and up to two-thirds of cases may not be diagnosed. Every seventh patient who had iron parameters analysed was iron deficient and two-thirds of patients with ID were treated with intravenous iron.

Head-to-head comparison of fee-for-service and diagnosis related groups in two tertiary referral hospitals in Switzerland: an observational study.

BACKGROUND: Reimbursement for inpatients in Switzerland differed among states until 2012. Some hospitals used diagnosis related groups (DRG) and others used fee-for-service (FFS). We compared length of hospital stay (LOS), patient satisfaction and quality of life between the two systems before a nation-wide implementation of DRG. METHODS: In a prospective, two-centre observational cohort study, we identified all patients with a main diagnosis of either community-acquired pneumonia, exacerbation of chronic pulmonary obstructive disease, acute heart failure or hip fracture from January to June 2011 and performed a systematic questionnaire survey 2-4 months after hospital discharge. RESULTS: Of 1,093 inpatients, 450 were included. Mean age was 71.1 (±SD 19.5) years (48% male). Patients in the FFS hospital were older (mean age 74.8 vs. 65.2 years; p <0.001) and suffered from more co-morbidities. Mean LOS was 9 days and shorter in the all-patient DRG (AP-DRG) hospital (unadjusted mean 8.2 vs. 9.5 days, p = 0.04). After multivariate adjustment, no significant difference in LOS was found (p = 0.24). More patients from the FFS hospital were re-hospitalised for any reason (35% vs. 17.5%; p = 0.01), re-admitted to acute-care institutions (11.7% vs. 5.2%; p = 0.014), not satisfied with the discharge process (15.3% vs. 9.7%; p = 0.02), showed problems with self-care (93.8% vs. 88%; p = 0.03) and usual activities (79.3% vs. 76%; p = 0.02). DISCUSSION: This study suggested that the AP-DRG hospital showed higher patient satisfaction regarding discharge, lower re-hospitalisation rates and shorter LOS partly explained by a lower burden of co-morbidities and disease severity. This study needs validation in a larger cohort of patients and at multiple time points.