title: Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery - attacking the problem by an integrated case management model.
abstract: BACKGROUND
  Patients with neuroischemic diabetic foot syndrome (DFS) may need arterial revascularization, minor amputations, débridements as well as meticulous wound care. Unfortunately, postoperative outpatient care is frequently inadequate. This is especially true for Germany, where the in- and outpatient sectors are funded and managed separately, with poor communication between the two. Thus, many patients may be readmitted to the hospital following successful treatment and discharge. In an attempt to overcome these problems, we looked at whether an integrated case management (CM) system for outpatient care according to in-hospital standards might improve patients care and avoid readmissions. In addition we analyzed the length of hospital stay (LOS) as well as hospital costs.
  
  
  METHODS
  In this retrospective cohort study patients with DFS, bypass surgery and foot surgery after implementation of the CM (study group; n = 376) were compared with a matched historic control group (HCG; n = 190) including the flat rate revenues (G-DRG K01B). Following a standardized assessment, integrated trans-sectoral CM care was offered to 116 patients (CMP).
  
  
  RESULTS
  The proportion of patients who were readmitted to hospital was reduced in CMP compared to HCG (8.8 vs. 16.4 %; p < 0.01), with consequent reduction of case consolidations (9.7 % versus 17.8 %, p < 0.001). Although initially, the mean LOS was higher in the CMP patients, the reduction in readmissions meant that this integrated CM program improved the hospital's economic situation.
  
  
  CONCLUSIONS
  A hospital-based integrated CM system significantly reduces the hospital readmissions in patients with neuroischemic DFS following bypass surgery, with lower hospital costs.
authors: Department of Vascular Surgery, Gefäßzentrum Oberrhein Speyer-Mannheim, Diakonissen-Stiftungs-Krankenhaus Speyer, Germany. gerhard.ruemenapf@diakonissen.de
authors: Gerhard
authors: G
authors: Rümenapf
authors: Sandra
authors: S
authors: Geiger
authors: Brigitte
authors: B
authors: Schneider
authors: Klaus
authors: K
authors: Amendt
authors: Norbert
authors: N
authors: Wilhelm
authors: Stephan
authors: S
authors: Morbach
authors: Norbert
authors: N
authors: Nagel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D019090:Case Management / Q000191:economics / Q000458:organization & administration*; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D017719:Diabetic Foot / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D005260:Female; D005858:Germany; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D017146:Models, Organizational; D010359:Patient Readmission / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics