[Cost analysis of emergency room patients in the German diagnosis-related groups system. A practice relevant depiction subject to clinical parameters].
BACKGROUND
Since the implementation of the diagnosis-related system there has been a continuous lack of finances in the treatment of multiple injured patients. The current investigation summarizes consecutive patients from a level I trauma centre and tests the hypothesis that an injury severity score (ISS) based reimbursement would be an improvement in the cost-effectiveness of this patient population.


METHODS
The study is based on multiple injured patients admitted to the emergency department in 2009. The ISS, intensive care unit (ICU) stay and cost data were recorded for every patient and two subgroups were formed: group I ISS < 16 and group II ISS ≥ 16.


RESULTS
A total of 442 patients with an average age of 40.5 ± 9.1 years (ISS 12) were included. The average amount of coverage during an average length of stay of 13.15 ± 6.3 was -2,752 <euro> per patient. Patients in group I (n = 296, ISS 6.3) showed a value of -1,163 <euro> with an average length of stay of 8 ± 4.6 days. In group II (n = 146, ISS 23.6) the average amount of coverage was -5,973 <euro> during an average hospital stay of 23 ± 8.7 days.


CONCLUSIONS
Improvements have been made with the recent adjustment of the reimbursement within the last year. Nevertheless, several factors identified in this study require additional adjustment: the ISS, the requirement of blood transfusion and the presence of additional chest trauma should be weighted in the calculation of reimbursement.
Abteilung für Orthopädie und Unfallchirurgie - Schwerpunkt Unfallchirurgie, Unfallchirurgische Klinik, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland, cgarving@ukaachen.de.
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D000328:Adult; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D009104:Multiple Trauma / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*