Zugl.: Bochum, Univ., Diss., 2007

Zugl.: Bochum, Univ., Diss., 2006 u.d.T.: Miele, Bernd: Entwicklung eines prozessorientierten Kostenrechnungssystems für eine operative Intensivstation / Hergestellt on demand

Zugl.: Bielefeld, Univ., Diss., 2007 / Hergestellt on demand

Zugl.: Aachen, Techn. Hochsch., Diss., 2004.

Zugl.: Hannover, Universiẗat, Diss., 2006.

A mail questionnaire surveyed Arizona hospital dietary departments to reveal the most frequently initiated changes in dietary practice since the implementation of Diagnostic Related Groups (DRGs). The most frequently initiated change was remodeling the service/cafeteria areas to increase consumer appeal and subsequent sales. Fee-for-service nutrition was the tenth most frequently initiated change. Non-subsidized employee feeding was the second least frequently initiated change since DRGs. Hospital size was found to correlate significantly (alpha ≥ 05) with innovative management, development of DRG avenues of recovery, purchase of computers, development of clearly defined treatment plans, utilization of time studies and staffing, and the implementation of corporate wellness programs. Only a few hospitals have determined costs for DRG dietary treatments, or know standard length of stay for each DRG. The number of dietitians documenting services and patient outcome must increase or their cost effectiveness may never be known.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-08-13T19:37:53Z No. of bitstreams: 1 Marcus Reusch.pdf: 2604830 bytes, checksum: a7d8af2b022aae968a9783f70ec12fb3 (MD5) / Made available in DSpace on 2015-08-13T19:37:53Z (GMT). No. of bitstreams: 1 Marcus Reusch.pdf: 2604830 bytes, checksum: a7d8af2b022aae968a9783f70ec12fb3 (MD5) Previous issue date: 2015-04-30 / Nenhuma / A dificuldade e os métodos para avaliar o desempenho das organizações de saúde representam um enorme desafio para os gestores hospitalares. O Diagnosis Related Groups (DRG) constitui-se em um completo sistema de classificação, que visa instrumentalizar a gestão hospitalar possibilitando a mensuração e avaliação de desempenho das instituições hospitalares. Foi proposta a utilização da metodologia DRG para avaliar o desempenho da casuística cirúrgica de uma unidade hospitalar. A fundamentação teórica enfatizou três temas: Histórico e evolução da classificação DRG, a classificação AP-DRG e a avaliação do desempenho e gestão hospitalar por DRG. O método utilizado consistiu em uma pesquisa tipo estudo de caso único com abordagem exploratória e descritiva de dados, de natureza quali-quantitativa. O campo do estudo foi um Hospital Geral de Grande Porte (HGGP). Os dados foram coletados a partir das informações contidas nos documentos de alta hospitalar de cada paciente submetido a procedimento cirúrgico, no período de um ano (Agosto de 2013 a Julho de 2014), foram após processados no Software Grouper, instrumento inicial da análise, dando origem a 213 DRGs cirúrgicos distintos. Foi desenvolvido o processo de implantação da metodologia DRG, identificados impactos na gestão dos serviços hospitalares com o uso do DRG, comparado o desempenho da casuística cirúrgica do HGGP com outras instituições hospitalares utilizando o DRG e foram identificadas oportunidades de melhoria em processos da assistência hospitalar no HGGP. Constatou-se que 16 DRGs corresponderam a 50% de toda casuística cirúrgica, e 44 DRGs (20% dos 213 DRGs cirúrgicos da amostra) representaram 80% de toda casuística cirúrgica da instituição. Para comparação de desempenho, foram utilizados dados publicados anualmente do Sistema de Saúde de Portugal. Dos 20 DRGs mais frequentes do HGGP, três apresentaram um desempenho inferior ao do grupo de Portugal. Nos outros 17 DRGs da amostra estudada, o desempenho foi superior, aferido em termos de tempo de permanência hospitalar. O objetivo geral proposto para o trabalho, da utilização do DRG para avaliar o desempenho da casuística cirúrgica da instituição foi alcançado. / The difficulty and the methods to evaluate the performance of health organizations represent a huge challenge for hospital managers. The Diagnosis Related Groups (DRG) is a complete classification system, which aims to equip the hospital management enabling the measurement and evaluation of hospitals performance. We propose the use of DRG methodology to evaluate the performance of the surgical cases within a hospital unit. The theoretical foundation emphasized three themes: History and evolution of the DRG classification, the AP-DRG classification and performance evaluation and hospital management by DRG. The method used consisted of case study research with qualitative and quantitative exploratory and descriptive approach of data. The field of study was a General Hospital with 386 beds. The data were collected from the information contained in the hospital discharge document of each patient that underwent surgery in the period of one year (August 2013 to July 2014), and processed in the Grouper Software, initial instrument of the analysis, originating 213 different surgical DRGs. It was found that 16 DRGs accounted for 50% of all surgical cases, and 44 DRGs (20% of 213 sample surgical DRGs) accounted for 80% of all surgical cases of the institution. For comparison, we used data published annually by the Health Care System of Portugal. Of the 20 most frequent DRGs of the General Hospital, three presented a performance lower than the group of Portugal. However the performance of the other 17 DRGs of the sample was higher considering the hospital length of stay. The general objective proposed for the study, using the DRG to evaluate the performance of the surgical cases of the institution was achieved, as well as the objectives of developing the process of implementation of the DRG methodology, identification of impacts in the management of hospital services with the use of DRG, the comparison of the surgical series of the General Hospital performance with other hospitals using DRG and identification of improvement opportunities in processes of hospital care.

The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered. The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.

Increase in the cost of medical care services has become an important issue in many countries that have implemented national health insurance, including Taiwan. On July of 2002, the National Health Insurance of Taiwan implemented a global budgeting system for all hospital payments. It was hoped that such a system would control the increase of medical expenses within a certain expected range. However, in the absence of reasonable payment bases and effective utilization management and control mechanism, the outcome of implementing this new payment system has been difficult to measure. Therefore, the National Health Insurance (NHI) studied the possibility of implementing DRGs (diagnosis related groups) for all in-patient payments. To evaluate the impact of the new payment system, the medicinal datas collected 1 year before and after implementation of TW-DRGs were analyzed. The tested target is an orthopaedic department in a Public Medical Center. The tested items including average of days in hospital, medical costs, application of National insurance, and sub-item total knee replacement (TKR) and total hip replacement (THR). For overall investigation of the tested orthopaedic department, our findings revealed that implementation of TW-DRGs significantly diminished the average of days in hospital and the average of medical costs. However, implementation of TW-DRGs showed slight influence on the National Health Insurance Application. As to investigate common surgeries, TKR and THR, only the average of days in hospital of TKR was significantly decreased by implementation of TW-DRGs. In addition, other specific TW-DRGs numbered items were also examined to determine the alteration of the factors described above. Our results showed that implementation of TW-DRGs significantly diminished the days in hospital, the medical cost, and the National Health Insurance Application for the selected TW-DRGs numbered items. However, the quality in health care didn¡¦t have significant change after implementation of TW-DRGs. More complete data pools are needed for the more precise analysis to evaluate the influence of TW-DRGs system on the management of hospital and other medical factors in Taiwan.

Blekinge Hospital suffers from a budget shortage of 100 million SEK, while the government now requires that hospitals will no longer be running a deficit. Blekinge Hospital will then use their limited resources to survive in the future and the activity must be enhanced in order to keep costs low without having to lay off personnel. The idea is that the organisation should be more efficient with a more efficient resource usage. Performance measurement systems are important tools for achieving the policies set out within an organization, measuring and evaluating performance is a way to see where improvements in efficiency may be necessary in the business. Balanced Scorecard (BSC) is one of several measuring systems, where the focus is on measuring non-financial performances. Diagnosis Related Groups (DRG) is another performance measurement systems used in healthcare so that comparisons between hospitals can easily be performed. The purpose of this study was to investigate what performance measurement systems that Blekinge Hospital uses and how they are used. To examine this, qualitative interviews with politicians and officials of the Blekinge county council and employees working at one of Blekinge Hospital clinics has been conducted. The result shows that the Blekinge Hospital has problems in maintaining and evaluating the results of performance measurements. This is mainly due to time and resource constraints, but also as a result of lack of communication down to the clinics from the hospital's management and officials. On the other hand, this study shows that Blekinge Hospital used DRG to a greater extent than the BSC which was not used at all. We see this as a result of good communication and understanding of what the measurement system is good at. / Blekingesjukhuset dras med ett budgetunderskott på 100 miljoner kronor, samtidigt som regeringen nu kräver att sjukhusen inte längre får gå med underskott. Blekingesjukhuset får då använda sina knappa resurser för att klara sig framöver och verksamheten måste effektiviseras för att hålla nere kostnaderna utan att behöva avskeda personal. Tanken är att verksamheten ska effektiviseras och att resurser ska användas på ett mer effektivt sätt. Prestationsmätningssystem är viktiga verktyg för att uppnå de strategier som satts upp inom ett företag, att mäta och utvärdera prestationer är ett sätt att se var effektivitetsförbättringar kan behöva göras i verksamheten. Balanced Scorecard (BSC) är ett av flera mätsystem, där fokus ligger på att mäta icke finansiella prestationer. Diagnosrelaterade grupper (DRG) är ett annat prestationsmätningssystem som används inom vården för att jämförelser mellan olika sjukhus enkelt ska kunna utföras. Syftet med denna studie var att undersöka vilka prestationsmätningssystem som Blekingesjukhuset använder och hur dessa används. För att undersöka detta har kvalitativa intervjuer med politiker och tjänstemän på landstinget Blekinge samt anställda som arbetar på en av Blekingesjukhusets kliniker genomförts. Resultatet visar att Blekingesjukhuset har problem när det gäller att upprätthålla och utvärdera resultatet av prestationsmätningar. Detta beror främst på tid- och resursbrist, men även som följd av brist på kommunikation till Klinikerna, från sjukhusets ledning och tjänstemän. Däremot användes DRG i större utsträckning än BSC, som inte användes alls, vilket vi ser som ett resultat av god kommunikation och förståelse för vad mätsystemet är bra till.