DRG

Dieser Beitrag setzt sich mit der Frage auseinander, inwiefern Ökonomisierung als Gefahr für die ethische Handlungsorientierung betrachtet werden kann. Nach einer differenzierenden Klärung der Begriffe Ethik, Ökonomie und Ökonomisierung werden die so gewonnenen Kriterien auf ein konkretes Beispiel aus dem Bereich des Gesundheitswesens angewandt.

Background In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Methods Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Results Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Conclusions Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.

The present paper introduces an approach for the automatic development of reduced reaction mechanisms for hydrocarbon combustion. An iterative reduction procedure is adopted with the aim of gradually reducing the number of species involved in the mechanism, while still maintaining its predictiveness in terms of not only ignition delay times, but also the time evolution of important species. In particular, a global error function is defined taking into account a set of 18 ignition delay calculations at different, engine- ...

Research Festival University of Lucerne 2014:
The DRG implementation allowing for new perspectives in performance management both at a microeconomic and at a public health level. Using a case study within a large hospital and applying it to radiology data and investigating the relevance of the day of week of the medical intervention and its respective outcome.

The present paper introduces an approach for the automatic development of reduced reaction mechanisms for hydrocarbon combustion. An iterative reduction procedure is adopted with the aim of gradually reducing the number of species involved in the mechanism, while still maintaining its predictiveness in terms of not only ignition delay times, but also the time evolution of important species. In particular, a global error function is defined taking into account a set of 18 ignition delay calculations at different, engine-relevant, initial mixture compositions, temperatures and pressures. The choice of the species to be deleted is performed exploiting the element flux analysis method, first introduced by Revel et al.; when a global error function of the reduced mechanism exceeds the required accuracy, the collision frequencies and activation energies of selected reactions are corrected by means of a GA-based code. The procedure is repeated until the lowest number of species at the required global error tolerance is achieved. The methodology is applied to a detailed mechanism of ethanol combustion consisting of 58 species and 383 reactions to produce an optimal reduced mechanism of 33 species and 155 reactions.

In current discussions hospital stakeholders seem to have a purely cost saving approach when talking of result improvements in hospitals and generating saving at public health level. There is very little current evidence available on how diagnostics(Rechtzeitige Diagnose dank der Radiologie 2014) can influence hospital processes in order to be more efficient and thus also more profitable. One of the precariously researched areas is for example answers to how temporal aspects can influence the economic or clinical result dimension (Groot et al., 2012). One can encounter discussions on on how for example admission weekdays can influence endpoint dimensions (e.g. mortality) for example in (Dismuke and Sena, 1999) or (Aylin et al., 2013) but there is very little further evidence available. However prior investigative research (Napierala and Koller, Stefan, 2014) provide indicative results on how diagnostics might influence costs and benefits in hospitals. This working paper attempts to shed some light on these factors by driving findings ahead. The underlying general assumption remains that admission or intervention (i.e. in our case scan days) weekday influence a hospital’s economic results and largely drive average length of stay. It thus is able to confirm the influence of radiology on both results through the analysis of the importance of weekdays and also how relevant it is (Woodcock, 2010).
Conclusion
Management of patients going through a radiological analysis controls the latter induced cost and influence average length of stay as well as the economic result. The gain from appropriate case management can rely heavily on radiology expressed through an optimized radiology use. As it seems particular attention to weekdays both for admission and scan date pays off. This result is underpinned by the relevance of these two key days being close to each other.
• Evidence that the interaction of weekdays influence economic and operative outcomes exists - but what happens to clinical outcome
• Investigate into omitted confounder in the actual dataset or make an attempt to enrich data further
• Policy implications both at a hospital level and at a regional more public health oriented level benefit from such analysis and especially from its consequences to control these processes better
• Further research including clinical factors could be redeeming