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首页> 美国卫生研究院文献>European Journal of Medical Research >Pharmaco-economic evaluation of antibiotic therapy strategies in DRG-based healthcare systems - a new approach
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Pharmaco-economic evaluation of antibiotic therapy strategies in DRG-based healthcare systems - a new approach

机译：基于DRG的医疗系统中抗生素治疗策略的药物经济学评估-一种新方法

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The cost of treatments especially in conditions where multiresistant bacteria are involved are a major issue in times where in most developed countries in the world payment systems based on diagnoses-related-groups (DRG) are in place. There is great evidence that especially the length of stay in hospital (LOS), the time in the intensive care unit (ICU-days) and the hours of mechanical ventilation (HMV) are major cost drivers.While established methods of pharmacoeconomical analyses focus on the efficiency of drugs from healthcare system perspective, these data are often not sufficient for improving treatment strategies in a given hospital context.We developed a system that allows the analysis of patients with severe infections on the basis of routine data that is also used for reimbursement. These data contain a lot of information concerning the clinical conditions. By using the ICD-coding we developed an algorithm which allows the detection of patients with infections and gives information on the potential financial outcome of these patients. By using the analysis it is possible to identify subsets of infections and the patient records that had a potentially negative DRG-result, i.e. the costs are higher than the reimbursement. When identified the patient records undergo a peer review, where the clinical situation and the antibiotic therapy are reviewed by medical experts. In case simulations it is possible to find out if a different therapeutic approach, e.g. by different choices in initial (empirical) antibiotic treatment would have caused other outcomes.Data driven analyses together with peer reviews of patient records are a useful tool to examine antibiotic treatment strategies and to establish changes that again can be reviewed on a regular basis. Doing this a continous improvement process can be established in hospitals which can lead to a better balance of clinical and economical outcomes in patients with severe infections. Moreover these analyses are helpful in assessing the literature on economical benefits of new therapies.
机译：在世界上大多数发达国家，存在基于诊断相关人群（DRG）的支付系统的时代，特别是在涉及多药耐药细菌的情况下，治疗费用是一个主要问题。有充分的证据表明，尤其是住院时间（LOS），重症监护病房的时间（ICU天数）和机械通气时间（HMV）是主要的成本驱动因素。从医疗保健系统的效率来看，这些数据通常不足以改善给定医院背景下的治疗策略。我们开发了一种系统，该系统可以根据常规数据对重症感染患者进行分析，该系统也可用于报销。这些数据包含许多有关临床状况的信息。通过使用ICD编码，我们开发了一种算法，可以检测感染的患者并提供有关这些患者潜在财务状况的信息。通过使用该分析，有可能识别出感染子集和DRG结果可能为负的患者病历，即费用高于报销费用。当确定患者记录后，将进行同行评审，并由医学专家对临床情况和抗生素治疗进行评审。在情况模拟中，有可能找出是否有不同的治疗方法，例如通过不同的初始（经验）抗生素治疗选择可能会导致其他结果。数据驱动的分析以及对患者病历的同行审查是检查抗生素治疗策略并确定可以定期进行重新检查的有用工具。这样做可以在医院中建立持续改进的过程，从而可以在严重感染患者中更好地平衡临床和经济结果。此外，这些分析有助于评估有关新疗法的经济效益的文献。

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