Acute and Transitional Care or Rehabilitation? Retrospective analysis of discharge planning from a municipal hospital in Switzerland

Abstract

Background Due to rising health care costs, in 2012 Switzerland introduced SwissDRG, a reimbursement system for hospitals based on lump sums per case. To circumvent possible negative consequences like reduction in length of stay, acute and transitional care (ATC) was anchored into the law (Federal act on health insurance) in 2011. ATC as a discharge option is applicable to patients with no capacity for rehabilitation, but are unable to return home and are in need of temporary professional nursing care. ATC is associated with higher out of pocket costs to the patient than rehabilitation. Since social service workers are responsible for organizing discharge of patients with ongoing care needs after hospitalization, the aim of this study was to investigate how social service workers manage patient discharge in light of the new discharge option ATC. Methods Data was collected from 660 medical records of inpatients from Zurich's municipal hospital, Triemli, in 2016. We compared patients discharged to ATC and rehabilitation using inferential statistics and qualitatively analyzed written statements from social service workers. Results Our results showed that patients discharged to rehabilitation had a higher total number of discussions, but a shorter duration of discussions. Patients discharged to rehabilitation faced more delays, above all because of unavailability of free places. Conflicts concerning discharge arose mainly because of costs, discharge placement and too early discharge. Conclusions Our findings demonstrate how important social service workers are in explaining to patients about different discharge options. The newness of SwissDRG and ATC is still likely to cause longer discussion times and, consequently, more workload for social service workers. Only a small fraction of patients disagreed with their place of discharge, mostly due to financial reasons.

Application and Management of Big Data in Medical Payment

“…On the one hand, the continuous adjustment and change of DRG grouping version has affected the progress of the negotiation on payment weights and constrained the realization of the negotiation goal, which is not conducive to the rational allocation of medical resources and the standardization of the order of medical consultation. On the other hand, the DRG payment weight negotiation has the characteristics of heavy task, short time, and prominent contradiction, which requires the hospital experts involved in the negotiation to have solid medical professionalism and the basic theoretical knowledge of DRG [9][10] .…”