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Ansätze für ein integriertes Versorgungsmodell aus der Weiterentwicklung einer Kurzzeitchirurgie?

Aim: The surgical spectrum of a regional hospital was limited to the procedures of short-stay surgery to study new per case prospective payment options. It was evaluated whether a reduced spectrum could provide more cost-effective health care, adapted to local demand and with quality equal to normal departments. Methods: A spectrum of 15 procedures was defined; parameters of process and outcome quality were studied. The final evaluation was based on all the procedures between 10/2000 und 12/2002 (1248 data sets). The published results of the quality assessment in hospitals in Baden-Württemberg served for comparison. The significance of differences was assessed using the standard t-test and chi-square test. Results: The main fields of activity were hernia repair, vein surgery and cholecystectomy. The laparoscopic approach prevailed, so that all procedures were compatible with a short stay. 90 % of the spectrum was covered by 7 procedures. General and operation- specific complication rates were low and below average (e.g. hernia repair: general complications 1.2 % compared with 3.4 % in the results for Baden-Württemberg, significance p = 0.05). Structural process standards were met. The length of stay corresponded with contract agreements. Conclusions: The results outline for further development the integration of procedural care on an outpatient basis as well as risk-adjusted short-stay offers as an option to preserve local structures for basic surgical care — regional payment adjustments included.