Year-end Sale % OFF 
Abstract
BackgroundIn 2012, Switzerland introduced the diagnosis-related group hospital payment system. Fearing that vulnerable patients may be discharged early, Acute and Transitional Care (ATC) was introduced to address the nursing care of patients who no longer needed an acute hospital stay. ATC is more costly for patients when compared to other discharge options like rehabilitation while providing less rehabilitative services. This study investigates factors associated with the place of discharge for patients in need of care.MethodsData was collected from 660 medical records of inpatients 50 years and older of the municipal hospital Triemli in Zurich, Switzerland. We used stepwise logistic regression to identify factors associated with their discharge into ATC or rehabilitation.ResultsOlder patients with higher Delirium Observation Scale (DOS), lack of supplementary health insurance, resuscitation order and a lower social network were more likely to be discharged into ATC than rehabilitation.ConclusionsThe association of supplementary health insurance and social network with discharge into ATC or rehabilitation is problematic because patients that are already vulnerable from a financial and social perspective are potentially discharged into a more costly and less rehabilitative post-acute care facility.
Highlights
In 2012, Switzerland introduced the diagnosis-related group hospital payment system
ATC patients were more often living alone prior to hospitalization (62.4% vs. 48.8%) and were less likely to have supplementary health insurance compared to rehabilitation patients (18.6% vs. 34.1%)
Inpatients discharged into rehabilitation, in turn, had a longer length of hospital stay (LOS) (16.9 vs. 13.0 days) and more rarely had a do not resuscitate” (DNR) order (28.6% vs. 62.5%)
Summary
In 2012, Switzerland introduced the diagnosis-related group hospital payment system. Fearing that vulnerable patients may be discharged early, Acute and Transitional Care (ATC) was introduced to address the nursing care of patients who no longer needed an acute hospital stay. The introduction of an inpatient reimbursement system based on diagnosis-related groups in Switzerland (SwissDRG) in 2012 changed the incentive structures of the healthcare system in various ways It meant to incentivize the reduction of hospital stays, higher productivity, general cost awareness, stronger structures and process quality, increased transparency and reduced medical training activities. Experts pointed out that misdirected incentives lead to disadvantages for vulnerable groups, e.g. inadequate reflection of chronically-ill and elderly patients within the new tariff structure SwissDRG [1, 2]. To overcome this risk, Switzerland introduced a new category of post-acute care services, the Acute and Transitional Care (ATC). Similar post-acute transitional care units have been implemented in different national healthcare systems [4,5,6]
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.
