Year-end Sale % OFF 
Abstract
The aim of the presented study was to analyze the care expenditure for outpatients after allogeneic hematopoietic stem cell transplantation (alloHSCT) done in accordance with the national, European guidelines and the German Social Law. We performed an analysis of the National and European survivorship care guidelines and in parallel recorded the time expenditure and staff costs separated according to different occupational groups involved in outpatient care at two German transplantation centers [University Hospital Regensburg (UKR) and University Hospital Hamburg-Eppendorf (UKE)]. In addition, we performed a comparison of real costs vs. reimbursed costs according to the standard rating benchmark catalog (EBM), which was supplemented by a survey of German transplantation centers. The results showed that the staff costs are only covered by the EBM for patients without complications during long-term follow-up care—notably, this accounts for 15% of alloHSCT patients. Staff costs for patients requiring treatment of graft-vs.-host disease or relapse of the malignant underlying malignancy exceed to the factor 6.5 (UKR) to 12 (UKE) of the EBM revenue, caused both by the increased duration and frequency of the outpatient visits. As a result of the survey at German transplant centers, 15 out of 18 responding centers reported a lack of cost coverage for follow-up care. Two/15 centers reported that survivorship care is limited to a restricted time, independent of patient's needs, due to a lack of cost reimbursement. The results show that alloHSCT survivorship care of patients requires significant staff resources, which are not covered by the current version of the German EBM catalog. New approaches to finance labor intensive after care of transplant patients are required.
Highlights
The lifelong survivorship care of patients after allogeneic haematopoietic stem cell transplantation is becoming increasingly important due to the rising number of long-term survivors
The total time expenditure per 3 months at the UKR for physicians was a medium of 220 min (8.9 visits a 24.77 min) for Graft-vs.-Host disease (GvHD) patients, 349.74 min (17.4 visits a 20.1 min) for patients treated for relapse of the underlying malignancy, 147.88 min (6.5 visits a 22.75 min) for patients with infectious complications or multimorbidity independent of GvHD, 282 min (12 visits a 23.5 min) for early standard survivorship care, 200 min (10 visits a 20 min) for intermediate standard and 18.7 min (1 visit) for long-term standard survivorship care patients
For nurses (N), the required time required for care within a 3 months interval of GvHD patients was 35.54 min, 69.6 min for relapsed patients, 26 min for patients treated for complications, 48 min for standard early follow-up, 40 min for standard intermediate follow-up, and 4 min for standard long-term followup (Figure 1)
Summary
The lifelong survivorship care of patients after allogeneic haematopoietic stem cell transplantation (alloHSCT) is becoming increasingly important due to the rising number of long-term survivors. AlloHSCT survivorship care requires a special expertise due to transplantation-specific long-term complications such as Graft-vs.-Host disease (GvHD) (1) as outlined by the German social law, the JACIE guidelines (JACIE: Joined Accreditation Committee of the International Society for Stem Cell Transplantation (ISCT) for the accreditation of transplantation centers), and national and European guidelines (2, 3). In Germany, financial coverage of outpatient services is currently ensured by the standard rating benchmark catalog (EBM). In the present research project we analyzed the institutional care expenditure required to provide survivorship care according to the German and European guidelines and compared the results to the current version of the EBM catalog and developed subsequent suggestions to resolve the identified discrepancies
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
