title: Quality of care delivered by fee-for-service and DRG hospitals in Switzerland in patients with community-acquired pneumonia.
abstract: BACKGROUND
  Reimbursement for inpatient treatment in Switzerland is in transition. While hospitals in some cantons already use Diagnosis Related Groups (DRG) based systems for hospital financing, others use fee-for-service (FFS) based systems, a situation that provides the opportunity to perform a head-to-head comparison between the two reimbursement systems. The aim of this analysis was to compare reimbursement systems with regard to length of hospital stay (LOS) and patient outcomes in a cohort of community-acquired pneumonia patients from a previous prospective multicentre study in Switzerland.
  
  
  METHODS
  This is a post-hoc analysis of 925 patients with community-acquired pneumonia from a previous randomised-controlled trial. We calculated multivariate regression models adjusted for age, gender, comorbidities and severity of illness (using the Pneumonia Severity Index) and accounting for clustering within hospitals to compare LOS and outcomes between FFS (n = 4) or DRG hospitals (n = 2).
  
  
  RESULTS
  LOS in DRG hospitals was significantly shorter compared to FFS hospitals (8.4 vs 10.3 days, absolute difference 1.9 days [95%CI 0.8-3.1]). This was confirmed in multivariate adjusted Cox models (hazard ratio 1.2 [95% 1.1-1.3]). There were no differences in 30-day and 18-month mortality rates (adjusted odds ratio 1.7 [95% 0.9-3.2] and 1.3 [95% 0.9-1.9]) or recurrence rates within 30 days (adjusted odds ratio 0.8 [95% 0.4-1.7]). Also, no differences were found in the rate of still ongoing clinical symptoms at 30 days, satisfaction with the discharge process and quality of life measures at 30 days of follow-up.
  
  
  CONCLUSIONS
  This study focusing on community-acquired pneumonia patients with different severities found a 20% shorter LOS in hospitals with DRG financing compared to FFS hospitals without apparent harmful effects on patient outcomes, satisfaction with care and different quality of life measures. Further studies are required to validate these findings for other medical and surgical patient populations.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard School of Public Health, Boston, MA, USA. Schuetzph@gmail.com
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Werner C
authors.initials: WC
authors.lastname: Albrich
authors.forename: Isabelle
authors.initials: I
authors.lastname: Suter
authors.forename: Balthasar L
authors.initials: BL
authors.lastname: Hug
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.forename: Thomas
authors.initials: T
authors.lastname: Holler
authors.forename: Christoph
authors.initials: C
authors.lastname: Henzen
authors.forename: Martin
authors.initials: M
authors.lastname: Krause
authors.forename: Ronald
authors.initials: R
authors.lastname: Schoenenberger
authors.forename: Werner
authors.initials: W
authors.lastname: Zimmerli
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000401:mortality*; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D013557:Switzerland