Das Gesundheitswesen , Thieme Verlag Heft S 3-2023, Jahrgang 85) ISSN 1439-4421 Seite(n) S205 bis S211 DOI: 10.1055/a-2130-2479 CareLit-Dokument-Nr: 318600 |
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Abstract Background The consequences of economization and staff shortage in the German health care system strongly affect paediatric care structures, especially in rural regions. It is not known how closures of paediatric departments influence patient flows of surrounding hospitals. Here, we investigate the quantitative effects of closure of the paediatric department of a district hospital and the subsequent opening of an alternative inpatient service on the utilisation of inpatient and outpatient care services of the two neighboring hospitals and the emergency services of the region. Methodology In the observation period from 2015 to 2019, patient-related data from the three hospitals in the study region as well as data from the rescue service were evaluated. Results In the year after the paediatric department of the district hospital was closed in 2016, the total number of inpatient cases in the region decreased by 33% (2015: n=1,787; 2016: n=1,193) and then decreased by an additional 11% (2019: n=1,005). The number of outpatient cases decreased by further 8% (2015: n=6,250; 2019: n=5,770). In the last observation year, emergency services were used much more frequently than in the year before the closure (2015: n=398; 2019: n=572). This means an increase of 44%. Conclusion After the closure of the paediatric department, the total number of inpatient cases in the region fell sharply. However, actual gaps in care apparently did not arise. Before closing, the consequences for the surrounding hospitals should be assessed more precisely. Real gaps in care must be counteracted, e. g. through alternative outpatient services. Key words paediatrics - inpatient care - regional care - rescue service - patient flows 26 September 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany Literatur 1 Statistisches Bundesamt https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankenhaeuser/Tabellen/krankenhaeuser-fa.html. (last accessed on 13 April 2023) PubMed 2 Reinhardt D, Petermann F. Neue Morbiditäten in der Pädiatrie. Monatsschr Kinderheilkd 2010; 158: 14 CrossrefPubMedGoogle Scholar 3 Fischbach T, Fehr F, Fegeler U. Flächendeckende ambulante pädiatrische Versorgung in Deutschland, Monatsschrift Kinderheilkunde 2018; 166: 108-115 CrossrefPubMed 4 Fegeler U, Jäger-Roman E, Martin R. et al. Ambulante allgemeinpädiatrische Grundversorgung Versorgungsstudie der Deutschen Akademie für Kinder- und Jugendmedizin, Monatsschrift Kinderheilkunde 2014; 162: 117-1130 PubMed 5 Weyersberg A, Roth B, Woopen C. Pädiatrie: Folgen der Ökonomisierung. Dtsch Arztebl 2018; 115 A 382-386 PubMedGoogle Scholar 6 BT-Drucksache 19/7270, S.2, 8 https://dserver.bundestag.de/btd/19/072/1907270.pdf. (last accessed on 13 April 2023) PubMed 7 Bundesrat Drucksache 513/20, S. 2., Antrag der Länder Mecklenburg-Vorpommern, Bremen, Sachsen-Anhalt an den Bundesrat https://www.bundesrat.de/SharedDocs/drucksachen/2020/0501-0600/513-20.pdf?__blob=publicationFile&v=(last accessed on 13 April 2023) PubMed 8 Rahmsdorf I. Die große Not der kleinen Patienten, in: Sueddeutsche Zeitung. 2020. https://www.sueddeutsche.de/muenchen/muenchen-kliniken-kinder-aufnahmestopp-1.4761147. (last accessed on 13 April 2023) Google Scholar 9 Deutsche Presse Agentur, dpa-infocom, dpa:210423-99-328722/2, in: Sueddeutsche Zeitung. 2021. https://www.sueddeutsche.de/gesundheit/gesundheit-bergen-auf-ruegen-verband-bestuerzt-ueber-abmeldung-der-geburtshilfe-in-bergen-dpa.urn-newsml-dpa-com-20090101-210423-99-328722. (last accessed on 13 April 2023) Google Scholar 10 Schäfers B. Kinderkliniken an der Kapazitätsgrenze, in: Deutschlandradio. 2021. https://www.deutschlandfunkkultur.de/notfaelle-abgewiesen-kinderkliniken-an-der-kapazitaetsgrenze.1001.de.html?dram:article_id=485631. (last accessed on 13 April 2023) Google Scholar 11 BT-Drucksache 19/21741 S. 7 https://dserver.bundestag.de/btd/19/217/1921741.pdf. (last accessed on 13 April 2023) PubMed 12 van den Berg N, Radicke F, Stentzel U. et al. Economic efficiency versus accessibility: Planning of the hospital landscape in rural regions using a linear model on the example of paediatric and obstetric wards in the northeast of Germany. BMC Health Serv Res 2019; 19: 245 CrossrefPubMedGoogle Scholar 13 Statistisches Amt M-V. Bevölkerungsentwicklung der Kreise und Gemeinden in Mecklenburg-Vorpommern (Faktoren der Bevölkerungsentwicklung) 2015: https://www.laiv-mv.de/static/LAIV/Abt4.Statistisches%20Amt/Dateien/Publikationen/A%20I%20Bev%C3%B6lkerungsstand/A%20113/A113%202015%2000.pdf. (last accessed on 13 April 2023) PubMed 14 Deutsche Gesellschaft für Epidemiologie. Leitlinien und Empfehlungen zur Sicherung von Guter Epidemiologischer Praxis (GEP): Deutsche Gesellschaft für Epidemiologie (DGEpi); 2018: https://www.dgepi.de/assets/Leitlinien-und-Empfehlungen/Leitlinien_fuer_Gute_Epidemiologische_Praxis_GEP_vom_September_2018.pdf. Return to ref 16 in article. (last accessed on 13 April 2023) PubMed 15 Swart E, Gothe H, Geyer S. et al. Good practice of secondary data analysis (GPS): guidelines and recommendations. Gesundheitswesen. 2015; 77: 120-126 PubMedGoogle Scholar 16 Statistisches Landesamt M-V. A – Bevölkerung, Gesundheitswesen, Gebiet, Erwerbstätigkeit https://www.laiv-mv.de/Statistik/Ver%C3%B6ffentlichungen/Statistische-Berichte/A/(last accessed on 13 April 2023) PubMed 17 Köster C, Wrede S, Herrmann T. et al. Ambulante Notfallversorgung. Analyse und Handlungsempfehlungen. Göttingen: AQUA – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH. 2016 https://www.vdek.com/presse/publikationen/_jcr_content/par/publicationelement/file.res/Aqua-Gutachten-Notfallversorgung.pdf. S. 21-26. (last accessed on 13 April 2023) PubMedGoogle Scholar 18 Weaver MD, Moore CG, Patterson PD. et al. Medical Necessity in Emergency Medical Services Transports. Am J Med Qual 2012; 27: 250-255 CrossrefPubMedGoogle Scholar 19 Camasso-Richardson K, Wilde JA, Petrack EM. Medically unnecessary pediatric ambulance transports: A medical taxi service?. Acad Emerg Med 1997; 4: 1137-1141 CrossrefPubMedGoogle Scholar 20 Oh HC, Chow WL, Gao Y. et al. Factors associated with inappropriate attendances at the emergency department of a tertiary hospital in Singapore. Singapore Med J 2020; 61: 75-80 CrossrefPubMedGoogle Scholar 21 Patterson PD, Baxley EG, Probst JC. et al. Medically unnecessary emergency medical services (EMS) transports among children ages 0 to 17 years. Matern Child Health J 2006; 10: 527-536 CrossrefPubMedGoogle Scholar 22 Poryo M, Burger M, Wagenpfeil S. et al. Assessment of Inadequate Use of Pediatric Emergency Medical Transport Services: The Pediatric Emergency and Ambulance Critical Evaluation (PEACE) Study. Front Pediatr 2019; 7: 442 CrossrefPubMedGoogle Scholar 23 Benahmed N, Laokri S, Zhang WH. et al. Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium. Eur J Pediatr 2012; 171: 1829-1837 CrossrefPubMedGoogle Scholar 24 Frick J, Möckel M, Schmiedhofer M. et al. Fragebogen zur Inanspruchnahme der Notaufnahmen: Implikationen für die Patientenbefragung. Medizinische Klin – Intensivmed und Notfallmedizin 2017; 1-7 PubMedGoogle Scholar 25 Löber N, Kranz G, Berger R. et al. Inanspruchnahme einer pädiatrischen Notaufnahme. Notfall Rettungsmed 2019; 22: 386-393 CrossrefPubMedGoogle Scholar 26 Ertmann RK, Siersma V, Reventlow S. et al. Infants’ symptoms of illness assessed by parents : Impact and implications. Scand J Prim Health Care 2011; 29: 67-74 CrossrefPubMedGoogle Scholar 27 Rodeck B, Lutterbüse N, Krägeloh-Mann I. 2021 zitieren: „Diagnosis related groups in der Pädiatrie – Segen oder Unsinn?“. Monatsschrift Kinderheilkunde 2021; 169: 520-526 PubMedGoogle Scholar 28 Beyer A, Moon K, Leiz M, et al. Tandem-Praxen – Pädiatrische Sprechstunden in Hausarzt-Praxen in ländlichen Regionen: ein Kooperations-Experiment [Tandem Practices: Pediatric Consultation Hours in General Practitionersʼ Practices in Rural Areas in Germany – a Collaborative Project]. Gesundheitswesen. 2022. German. 10.1055/a-1967-9912. Epub ahead of print. PMID: PubMed
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