Dez. Dezember geltenden Fassung der Veränderungswert nach § 9 . werden die Wörter,,der Bundespflegesatzverordnung” gestrichen und. ordinance on hospitalisation cost rate (Bundespflegesatzverordnung) and the annual The EN Official Journal of the European Union C / report went to press on 24 April , the bond price Hospital Fees Act) and the BPflV (“Bundespflegesatzverordnung”: German National Hospital Rate.
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Such an effect in an inpatient setting could not be observed in the present study. Sondergutachten Wettbewerb an den Schnittstellen der Gesundheitsversorgung. This is either because most of them need time to engage in a stable outpatient therapeutic relationship or because they are not actively given the opportunity to subscribe in the acute inpatient setting.
The fraction of cases who responded to treatment and were discharged as improved increased significantly under the RPB. Administrative, anonymised data for analysis were contributed a by the hospital controlling department, which provided the number of cases admitted to inpatient or day care treatment per year, starting in ; and b by the psychiatric department, which provided the number of forced admissions, the number of restraining procedures during inpatient stays which must be documented in Germanyand the clinical parameters that were documented in a standardised basic psychiatric documentation system BADO for the admission and discharge of each case [ 1314 ].
Indeed, the hospital began to cooperate with the public medical service that is responsible for initiating compulsory admissions in cases of severe acute mental illness. Psychiatric patients bundesflegesatzverordnung particular difficulties in navigating through various treatment offers and Social Insurance Codes when receiving continuous treatment.
The ethical committee of the Medical Association of Schleswig-Holstein was informed about the study. First, the integrated treatment model was applied to bundespflegesatzverodrnung patients seeking inpatient treatment in the district.
§ 6 KHEntgG – Einzelnorm
In this setting, ANOVA showed an effect of diagnosis on the length of stay in a similar way as in the inpatient setting. Under RPB conditions the number of voluntary admissions increased significantly and the number of cases with suicidal ideas or behaviour before admission declined significantly. Methods Study Design The study used a pre-post comparison design.
This is the factor of main interest, while the other factors serve for adjustment to changes in the composition of the patient groups over years. But besides those elements, the absence of a relevant reduction in the average length of stay raises concerns about the ability of model projects and other similar initiatives to change long-established care traditions.
R Foundation for Statistical Computing. Final results of backward analysis of variance for day care patients. It can be implemented in the community as well as in hospitals without the participation of all insurance companies, since it is based on cooperation agreements between a care provider and a single insurance company. In consideration of these limitations, no indicators of health status and social functioning of psychiatric patients in the region indicate any worsening associated with the implementation of the RPB in the long run, nor did indicators of quality of psychiatric care under conditions of the RPB indicate any worsening.
Final results of backward analysis of variance for inpatients. Therefore, the RPB-model is well-suited to facilitating fundamental structural and procedural changes in psychiatric patient care. This should help to reduce the duration of their hospital stays and to transfer them effectively in the outpatient care. Despite forced savings due to the capitation fee several indicators hint at an improvement of health status and response to treatment under the RPB conditions.
One of the most important limitations of the present study is the lack of outpatient data. The day care department is located in the same buildings as the outpatient department, and both are located outside of the main hospital building where the inpatient sector is located.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. However, as this effect has been controversial and is poor at least for severely ill patients, we estimate this confounder to be weak. Therefore, it cannot be estimated whether individual diagnostic subgroups differ in their benefits from the RPB.
The RPB provides incentives to deliver equal or higher quality of care with stable cost and to reduce inpatient treatment time. Their bundespflegesatzverrdnung length of stay has been taken into account for Inthe average length of stay of patients in the model project was However, when compared to standard care, both new models of care led to a reduction in the average length of stay that could not be shown in the inpatient setting. In return the provider is free to offer all forms of treatment and to construct individual models of integrated care within the RPB that bundespflegesatzverrordnung suit the region and the needs of community members.
The length of stay of patients who did not take part in this program was Table 2 Sociodemographic and clinical indicators of bundespflebesatzverordnung of psychiatric care of cases at discharge from hospital or day care before and after implementation of the Regional Psychiatry Budget RPB in the administrative District of Dithmarschen.
Busse, R and Blumel, M The significance level for all analyses was set to 0. Under a major health system reform in Germany inthe legislative authorities allowed several innovative models of care [ 5 ]. The regional budget for mental health care: Introduction The treatment of chronic psychiatric disorders is seriously hampered by the division of the German health care system into the sectors of outpatient and inpatient acute care, rehabilitation and social support care [ 12 ].
These results are summarized in Table 2. Psychiatr Prax 40 Psychiatr Prax 37 7: In this model, a global annual budget is allocated to hospitals by the insurance companies to finance psychiatric care.