A new case management concept to decrease the rehospitalisation rate in heurischemic
© Rümenapf et al; licensee BioMed Central Ltd. 2011
Published: 29 June 2011
Introduction / objectives
The treatment of patients suffering from the neuroischemic diabetic foot syndrome (DFS) comprises arterial revascularization (e.g. below-knee bypass surgery), minor amputations, debridements, as well as long-term specialized wound care. Following premature discharge to the homecare sector, the quality of postoperative care is often inadequate. Many patients are readmitted. We studied the influence of a trans-sectoral case management (CM), ensuring outpatient care according to our clinical standards, on the readmission rate, length of hospital stay (LOS) and the hospital's costs/benefit situation.
DFS patients after implementation of the CM (Case Management Group (CMG); n = 202; 2007-2008) were compared with a historic control group (HCG; n = 190; 2005-2006). All patients had high maintenance foot wounds as well as healing incisional wounds following bypass surgery. Both groups were matched for the principal diagnosis, a patients clinical complexity level (PCCL) of 4, and G-DRG-related flat rate. From the 202 CMG patients evaluated, 54 received long-term trans-sectoral care by the CM.
The rehospitalization rate in the CMG was significantly reduced versus the HCG (9,8 % vs.16,7%; p = 0,041). The reduction of the revolving door effect in the CMG significantly improved the costs/revenue situation for the hospital. The LOS was unchanged.
The implementation of a hospital-based trans-sectoral CM significantly reduces the rehospitalization rate in patients with neuroischemic DFS requiring bypass surgery. Hospital economics are improved.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.