title: Head-to-head comparison of length of stay, patients' outcome and satisfaction in Switzerland before and after SwissDRG-Implementation in 2012 in 2012: an observational study in two tertiary university centers.
abstract: BACKGROUND
  On 1 January 2012 Swiss Diagnosis Related Groups (DRG), a new uniform payment system for in-patients was introduced in Switzerland with the intention to replace a "cost-based" with a "case-based" reimbursement system to increase efficiency. With the introduction of the new payment system we aim to answer questions raised regarding length of stay as well as patients' outcome and satisfaction.
  
  
  METHODS
  This is a prospective, two-centre observational cohort study with data from University Hospital Basel and the Cantonal Hospital Aarau, Switzerland, from January to June 2011 and 2012, respectively. Consecutive in-patients with the main diagnosis of either community-acquired pneumonia, exacerbation of COPD, acute heart failure or hip fracture were included. A questionnaire survey was sent out after discharge investigating changes before and after SwissDRG implementation. Our primary endpoint was LOS.
  
  
  RESULTS
  Of 1,983 eligible patients 841 returned the questionnaire and were included into the analysis (429 in 2011, 412 in 2012). The median age was 76.7 years (50.8% male). Patients in the two years were well balanced in regard to main diagnoses and co-morbidities. Mean LOS in the overall patient population was 10.0 days and comparable between the 2011 cohort and the 2012 cohort (9.7 vs 10.3; p = 0.43). Overall satisfaction with care changed only slightly after introduction of SwissDRG and remained high (89.0% vs 87.8%; p = 0.429).
  
  
  CONCLUSIONS
  Investigating the influence of the implementation of SwissDRG in 2012 regarding LOS patients' outcome and satisfaction, we found no significant changes. However, we observed some noteworthy trends, which should be monitored closely.
authors: Division of Internal Medicine, University Hospital Basel, Switzerland.
authors: Désirée
authors: D
authors: Thommen
authors: Division of Internal Medicine, University Hospital Basel, Switzerland.
authors: Noemi
authors: N
authors: Weissenberger
authors: Division of Internal Medicine, Cantonal Hospital Aarau, Switzerland.
authors: Philipp
authors: P
authors: Schuetz
authors: Division of Internal Medicine, Cantonal Hospital Aarau, Switzerland.
authors: Beat
authors: B
authors: Mueller
authors: Division of Medical Controlling, Cantonal Hospital Aarau, Switzerland.
authors: Christoph
authors: C
authors: Reemts
authors: Division of Medical Controlling, Cantonal Hospital Aarau, Switzerland.
authors: Thomas
authors: T
authors: Holler
authors: Division of Internal Medicine, University Hospital Basel, Switzerland.
authors: Juerg A
authors: JA
authors: Schifferli
authors: Financial Department, University Hospital Basel, Switzerland.
authors: Martin
authors: M
authors: Gerber
authors: Division of Internal Medicine, University Hospital Basel, Switzerland.
authors: Balthasar L
authors: BL
authors: Hug
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000628:therapy; D003953:Diagnosis-Related Groups / Q000458:organization & administration*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006620:Hip Fractures / Q000175:diagnosis / Q000628:therapy; D006785:Hospitals, University / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D010359:Patient Readmission / Q000639:trends; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy; D011795:Surveys and Questionnaires; D013557:Switzerland; D062606:Tertiary Care Centers / Q000639:trends*; D016896:Treatment Outcome