Dez. Dezember geltenden Fassung der Veränderungswert nach § 9 . werden die Wörter,,der Bundespflegesatzverordnung” gestrichen und. ordinance on hospitalisation cost rate (Bundespflegesatzverordnung) and the annual The EN Official Journal of the European Union C / report went to press on 24 April , the bond price Hospital Fees Act) and the BPflV (“Bundespflegesatzverordnung”: German National Hospital Rate.
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German Federal Ubndespflegesatzverordnung Agency. The day care department is located in the same buildings as the outpatient department, and both are located outside of the main hospital building where the inpatient sector is located.
In conclusion, model projects constitute a possible way of bridging in- and outpatient care for all patient categories, particularly the most severely ill. Data management was bundespflegesatzverodnung line with the data protection requirements in the federal state of Schleswig-Holstein.
German Federal Employment Agency Psychiatric and psychotherapeutic inpatient care for the approximatelyresidents of this predominantly rural district are provided by the only hospital that bundespflegesatzverorsnung in the region.
A third form of these innovative integrated models is the Regional Psychiatry Budget RPBaccording to paragraph 26 of the former Federal Hospital Refund Regulation Bundespflegesatzverordnungwhich is based on the capitation principle. Publications Office of the European Union, p.
Data Sources Administrative, anonymised data for analysis were contributed a by the hospital controlling department, which provided the number of cases admitted to inpatient or day care treatment per year, starting in ; and b by the psychiatric department, which provided the number of forced admissions, the number of restraining procedures during inpatient stays which must be documented in Germanyand the clinical parameters that were documented in a standardised basic psychiatric documentation system BADO for the admission and discharge of each case [ 1314 ].
MH contributed to the conception of the article, discussion of the results, and manuscript redaction and supervised the whole process. Final results of backward analysis of variance for day care patients. The distribution of first line diagnoses among these main categories remained stable between and Under RPB conditions the number of voluntary admissions increased significantly and the number of cases with suicidal ideas or behaviour before admission declined significantly.
Pre-post comparison study design for evaluation of selected indicators of health status and quality of psychiatric care. The introduction of a subscription-based integrated care model was supposed to lead to shorter average lengths of stay. Total costs of treatment were kept stable during the RPB because reimbursement of the care provider was capitalised based on the caseload and reimbursement before implementation of the RPB.
However, as this effect has been controversial and is poor bundespfldgesatzverordnung least for severely ill patients, we estimate this confounder to be weak. Table 2 Sociodemographic and clinical indicators of quality of psychiatric care of cases at discharge from hospital or day care before and after implementation of the Regional Psychiatry Budget RPB in the administrative District of Dithmarschen.
The overrepresentation of patients of the F3 group led to an increase in the average length of stay that could then be countered with the new model project.
§ 6 KHEntgG – Einzelnorm
However, when compared to standard care, both new models of care led to a reduction in the average length of stay that could not be shown in the inpatient setting. This result was obviously linked to the negative effect of the subscription model and the repartition of diagnoses it led to, as shown in a previous work in which possible explanations are discussed The new psychiatric basic documentation. Model projects require the full commitment of all staff members in managing the limited financial resources allowed by the insurance company and allocating bundespflegesatzzverordnung preferentially to the outpatient sector.
Table 1 Sociodemographic and clinical indicators of health status and social adjustment of psychiatric cases at time of admission before and after implementation of the Regional Psychiatry Budget RPB in the administrative District of Dithmarschen. This article is part of the Research Topic New models of care for patients with severe mental illness — bridging in- and outpatients. Introduction The treatment of chronic psychiatric disorders is seriously hampered bundespflegsatzverordnung the division of the German health care system into the sectors of outpatient and inpatient acute care, rehabilitation and social support care [ 12 ].
Using administrative data generated by the hospital and the basic patient documentation of the psychiatric department, the analysis of selected quality indicators should clarify whether the introduction of a RPB changes the treatment results of patients. Selected indicators suggest equal or higher quality of bundespfleggesatzverordnung with stable cost in the population in need of psychiatric care in the district. Staff members are often reluctant to engage in new models of care that imply such a profound change in the definition and practice of inpatient psychiatric care.
Busse, R and Blumel, M Psychiatr Prax 37 bundespflgesatzverordnung Third, it is possible that the results might be biased by a change in data management between the pre and post observation periods. An analysis of the repartition of the diagnostic groups in both the integrated care program and the model project showed that patients with a F3 diagnosis were overrepresented and patients with a F1 diagnosis underrepresented in the integrated care program.
As a control group is missing, there are several limitations associated with the study design and data sources. ANOVA results for the inpatient setting showed age did not affect the average length of stay. Regional budgets are financing models that are based on the cooperation between regional health care providers and all health insurance companies involved.
The model has been described in detail elsewhere [ 791012 ]. These deficits have already been described in depth in previous studies and reports 12.
Despite forced savings due to the capitation fee several indicators hint at an improvement of health status and response to treatment under the RPB conditions. The shift of psychiatric care resources from the in- to the outpatient sector, and the reduction of bundespflegesxtzverordnung length of stay are crucial and have been addressed in many countries over the last years.
Bundespfleesatzverordnung this model, the care provider receives annually a fix amount of money per patient subscribing to the program.
Bundespflegesatzverprdnung, these are not available through the hospital information system, thus rendering their analysis bundespflegesatzverordhung.
Patients admitted to bundespflegeaatzverordnung hospital over the course of and were divided in three groups: Results A total of 19, cases could be included in the analysis. In Hamburg, a new model that focused on severely ill patients F2x und F3x ICD diagnostic codes contributed to an increase in the outpatient contacts, a decrease of the average inpatient length of stay, and higher patient satisfaction by maintaining cost-effectiveness 10 — Among these are the so called Integrated Care Models and the nationwide disease management programs.
Moreover, they do not allow for general conclusions to be made about their efficacy in reducing the gap between the in- and outpatient sectors, since the available data are based solely on observational studies of very heterogeneous projects and models 4. As in the case of regional budgets, this should be a powerful financial incentive to reduce the costs of the inpatient sector and to develop bundespfegesatzverordnung comprehensive outpatient care including assertive community treatment ACT and home treatment As we performed a pre-post comparison, there are several threats to the internal validity of the analysis.
The documentation of cases in the hospital controlling department did not change over time. The longer duration of stay, the traditional greater focus on long-term rehabilitation in a day care setting, and the persistent overrepresentation of affective disorders also explain that needing to subscribe to the integrated care program did not represent an obstacle in this setting.