[Decision criteria for the appropriateness of inpatient treatment in patients with peripheral angiopathy]

Abstract

In various medical subspecialties like angiology, invasive diagnostic procedures and elective therapy, which under certain conditions may be carried out on outpatients, represent a large proportion of all inpatient medical treatment. As regulations for the statutory health insurance in Germany demand that medical procedures should be preferentially carried out in outpatient facilities, there is a high potential for conflicting views with respect to the question whether hospitalisation of an individual patient is mandatory for medical reasons. Explicit criteria may be useful to prevent conflicting views and to increase truth and fairness in the proceedings of hospitals on one hand and the medical service of the statutory health insurance on the other hand. With respect to this problem we present decision criteria which were compiled by a hospital (Hochrhein-Eggberg-Klinik Bad Säckingen) and the medical service of the statutory health insurance in the state of Baden-Württemberg (MDK-Baden-Württemberg). Our model has proven to be of value in our practical experience. It seems to be transferable to medical subspecialties with similar problems.