ABSTRACT Essay, Research Paper

INTRODUCTION: The development of patient classification systems (PCS) in fields other than acute medicine raises thequestion if the principle of using existing data (i.e. diagnoses; procedures where available) is sufficent to describe theproducts of hospital care.

METHODS/MATERIAL: The essence of a PCS (type “iso-cost”) is to estimate costs of treatment needed in a definedsetting by means of a description of the patient status (conditions) and the treatment goals. Two hypotheses guided ourresearch into PCS development: (1) The description of patient status and treatment goals has to include multiple aspectswhich ideally are coded by using scales to show changes during the course of time. (2) In a multiprofessional team,costs of treatment of each professional sector can depend on different aspects of the patient status. Therefore, in a firststep treatment costs could be described multidimensionally: for each profession sector separately. – In a test study, 1795treatment weeks of 274 patients of 4 medical rehabilitation institutions were described by a variety of patient statusindicators.

RESULT: The test study showed that the sum of nursing times per week and patient were best grouped by atwo-dimensional grid constructed by using the motor scale and the cognitive scale of the Functional IndependenceMeasure (FIM). These scales are used as indicators of the patient status. The six final groups lead to a variancereduction of approx. 65%. But the time spent by several therapeutic professionals could not be explained by the sameindicators.

CONCLUSIONS: The test study encourages further research about the introduction of multidimensional and scaledmeasures in order to explain the multidimensional cost vectors of a multiprofessional health treatment. In the acutesetting a first model could be to use DRGs to estimate costs related to or dependent on physicians’ activities and ameasure of functional status to estimate (independent) nursing costs. A proposed research field is the treatment ofpatients with chronic diseases.

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