[Otorhinolaryngology in the field of demography, growing outpatient care and regionalization]

[Centralization, Specialization, and Outpatient Care for Head and Neck Tumor Patients]

Demographically, the German population is aging and becoming more morbid. At the same time, urbanization trends, medical overcapacities, and increasing care costs are being observed in association with a tight healthcare budget. Centralization, specialization, and outpatient care are intended to provide a remedy and can be controlled by modifications to remuneration. This upheaval poses new challenges for patients and physicians, which were analyzed exemplarily at the Head and Neck Tumor (HNC) Center of the University Hospital Ulm. This is a retrospective, monocentric cohort study on the development of patient volume, catchment area, treatment modality, and demographics including 2070 HNC patients at the ENT clinic between the years 2011 and 2020. It was observed that the number (new diagnoses 2011: 134 vs. 2020: 204) and the average age (2011: 61.5 years vs. 2020: 65.8 years; p < 0.0001) of HNC patients increased over time. In addition, patients tended to travel longer distances (2011: 54.4 km vs. 2020: 64.4 km; p = 0.05). At the same time, the mean number of consultations and treatments per patient per 5-year follow-up interval grew (at initial diagnosis in 2011: 7.8 vs. 2016: 10.4; p = 0.0003), with the proportion of outpatient contacts increasing from 58.9 % to 62.4 % (p = 0.09) from 2011 to 2020. Accordingly, clinical centers are expected to become more important in the care of HNC patients as the healthcare system becomes more specialized, and centralized with a growing outpatient setting. The following consequences for patient care should be considered in restructuring strategies.

[Assessment of primary and secondary misallocations in the German Diagnosis Related Groups (G-DRG) system in otorhinolaryngology]

OBJECTIVE

Within the scope of a prospective study, the assessment reports completed in Otorhinolaryngology between March 1, 2011 and December 31, 2018 by the Health Advisory Boards in the German federal states of Lower Saxony and Bremen were analyzed regarding the primary and secondary misallocation in the G-DRG system.

METHODS

The assessment reports were documented using a standardized database system, which was developed on the basis of the electronic data interchange (EDI) by the Health Advisory Board in Lower Saxony. In addition, the documentation of medical assessment reports according to the G-DRG system was used for data analysis.

RESULTS

During the period from March 1, 2011 and December 31, 2018, a total of 42,126 cases of inpatient assessments of DRGs according to the G-DRG system were collected in the field of Otorhinolaryngology. In 1,946 cases, a primary and in 14,044 cases a secondary misallocation was detected. In 26,136 cases, neither a primary nor a secondary misallocation could be identified; thus, the rate of primary and secondary misallocations observed over the entire period was 5 % and 33 %, respectively.

CONCLUSIONS

Primary and secondary misallocations were most frequently found with treatments that included outpatient interventions in the catalog according to para. 115b of the German Social Code Fifth Book (SGB V). With secondary misallocations, exceeding the lower limit to length of stay (uGVD) therefore prevailed. In order to improve the demarcation between outpatient and (short-term) inpatient treatment in Otorhinolaryngology, in addition to the special consideration of the here presented "hit list" of Otorhinolaryngology departments, a more intensive cooperation between hospitals and the Health Advisory Boards of the federal states should be encouraged.