Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011–2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately − €4000). While controls on average also have a negative reimbursement-cost difference (approximately − €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (− 1500, p < 0.01). HAIs caused by vancomycin-resistant Enterococci have the most unfavorable reimbursement-cost difference (− €10,800), significantly higher (− €9100, p < 0.05) than controls. Among infection types, pneumonia is associated with highest losses (− €8400 and − €5700 compared with controls, p < 0.05), while cost-reimbursement relationship for Clostridium difficile-associated diarrhea is comparatively balanced (− €3200 and − €500 compared to controls, p = 0.198). From the hospital administration’s perspective, it is not the additional costs of HAIs, but rather the cost-reimbursement relationship which guides decisions. Costs exceeding reimbursements for HAI may increase infection prevention and control efforts and can be used to show their cost-effectiveness from the hospital perspective.

中文翻译：

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在基于DRG的医院支付系统中，医院获得性感染对患者级报销成本关系的影响。

医院获得性感染（HAIs）是住院治疗中的常见并发症。我们研究了在基于德国DRG的报销系统下预防HAI的诱因。我们将弗莱堡大学医学中心（2011-2014）的188,731例患者记录中的资源使用与HAI报销之间的关系进行了分析，并将病例与适当的非HAI对照进行了比较。使用国家标准化成本核算系统数据估算资源使用量。报销是G-DRG系统下向医院的实际付款。考虑HAI暴露的时间，主要诊断中的成本聚类和风险调整。HAI患者的报销费用差额为负（约-€4000）。平均而言，控制项还具有负的报销费用差额（约-€2000），p  <0.01）。由耐万古霉素肠球菌引起的HAIs的报销成本差异最大（-€10,800）， 比对照组高得多（-€9100，p <0.05）。在感染类型中，肺炎的损失最高（与对照组相比为− 8400和− 5700，p  <0.05），而艰难梭菌相关性腹泻的费用报销关系相对平衡（与对照组相比为− 3200和− 500）到控制，p = 0.198）。从医院行政部门的角度来看，不是HAI的额外费用，而是指导决定的费用与报销关系。超过HAI报销额的费用可能会增加感染预防和控制的力度，并可用于从医院的角度显示其成本效益。