title: Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) - a potential model for monitoring and evaluating healthcare reform.
abstract: OBJECTIVE
  The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment.
  
  
  METHODS
  Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes.
  
  
  RESULTS
  Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined.
  
  
  CONCLUSIONS
  Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation.
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Verina
authors: V
authors: Wild
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Fourie
authors: F
authors: Carina
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Regula
authors: R
authors: Frouzakis
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Caroline
authors: C
authors: Clarinval
authors: University of Zurich.
authors: Margrit
authors: M
authors: Fässler
authors: Institute of Biomedical Ethics, University of Basel, Switzerland.
authors: Bernice
authors: B
authors: Elger
authors: Institute of Legal Sciences, University of Zurich, Switzerland.
authors: Thomas
authors: T
authors: Gächter
authors: Institute of Biomedical Ethics, University of Basel, Switzerland.
authors: Agnes
authors: A
authors: Leu
authors: Institute of Nursing Science, University of Basel, Switzerland; Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Switzerland.
authors: Rebecca
authors: R
authors: Spirig
authors: Centre for Clinical Nursing Sciences, University Hospital Zurich, Switzerland.
authors: Michael
authors: M
authors: Kleinknecht
authors: Institute of Epidemiology, Biostatistics & Prevention, University of Zurich, Switzerland.
authors: Dragana
authors: D
authors: Radovanovic
authors: Institute of Epidemiology, Biostatistics & Prevention, University of Zurich, Switzerland.
authors: Corine
authors: C
authors: Mouton Dorey
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland.
authors: Bernard
authors: B
authors: Burnand
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland.
authors: John-Paul
authors: JP
authors: Vader
authors: Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland.
authors: Jean-Marie
authors: JM
authors: Januel
authors: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland.
authors: Nikola
authors: N
authors: Biller-Andorno
authors: The IDoC Group
mesh_terms: D000465:Algorithms; D003363:Cost Control; D003953:Diagnosis-Related Groups / Q000191:economics; D004992:Ethics, Medical; D018166:Health Care Reform; D006801:Humans; D017146:Models, Organizational; D015397:Program Evaluation / Q000379:methods; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013557:Switzerland