2021, Müller, Magdalena, Huembelin, Monika, Baechli, Ciril, Wagner, Ulrich, Schuetz, Philipp, Mueller, Beat, Kutz, Alexander

Multimorbidity poses a worldwide health- and socio-economic challenge, exacerbated by changing demographics. The association of multimorbidity with healthcare outcomes in hospitalised medical inpatients remains incompletely understood. Objective: To examine the prevalence and burden of in-hospital multimorbidity over a 6-year time period and its association with in-hospital mortality, intensive care unit admission, length of hospital stay and readmission rates. Design: This cross-sectional study analysed Swiss hospital discharge records from 1 January 2012 to 31 December 2017. Setting: The study used population-based, administrative data from the Swiss Federal Statistical Office to investigate all adult medical cases in Switzerland. Participants: 2,220,000 population-based medical discharge records from 1,463,781 anonymised patients were included in the analysis. Multimorbidity was defined according to the World Health Organization as the presence of at least two chronic conditions. We applied the “Chronic Condition Indicator for the International Classification of Diseases (ICD-10-CM)”, which divides all ICD-10 codes into chronic and acute conditions, to define the number of chronic conditions. Main measures: Time- and age-stratified prevalence of multimorbidity and its association with in-hospital mortality, ICU admission rate, length of stay, 30-day and 1-year all-cause readmission rates

2020, Kutz, Alexander, Ebrahimi, Fahim, Aghlmandi, Soheila, Wagner, Ulrich, Bromley, Miluska, Illigens, Ben, Siepmann, Timo, Schuetz, Philipp, Mueller, Beat, Christ-Crain, Mirjam

Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. Objective The objective of this work is to examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. Design and Setting A population-based cohort study was conducted using a Swiss claims database of medical inpatients from January 2012 to December 2017 Patients Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. Main Outcome Measure The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. Results After matching, 94 352 patients were included in the cohort. Among 47 176 patients with hyponatremia, 8383 (17.8%) reached the primary outcome compared with 7994 (17.0%) in the matched control group (odds ratio [OR] 1.06 [95% CI, 1.02-1.10], P = .001). Hyponatremic patients were more likely to be admitted to the ICU (OR 1.43 [95% CI, 1.37-1.50], P < .001), faced a 56% increase in prolonged LOS (95% CI, 1.52-1.60, P < .001), and were admitted more often to a postacute care facility (OR 1.38 [95% CI 1.34-1.42, P < .001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95% CI, 0.56-0.80], P < .001) as compared with matched normonatremic controls. Conclusion In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.

2019, Kutz, Alexander, Gut, Lara, Ebrahimi, Fahim, Wagner, Ulrich, Schuetz, Philipp, Mueller, Beat

To examine the association of the SwissDRG implementation with length of hospital stay (LOS), in-hospital mortality, and 30-day readmission rates in the overall adult inpatient population and stratified by 5 individual diagnoses. CONCLUSIONS AND RELEVANCE Among medical hospitalizations in Switzerland, SwissDRG implementation appeared to be associated with an increase in readmission rates and a decrease in in-hospital mortality but not with the gradual decrease in LOS observed in the historical control period.

2020, Kutz, Alexander, Ebrahimi, Fahim, Sailer, Clara O., Wagner, Ulrich, Schuetz, Philipp, Mueller, Beat, Christ-Crain, Mirjam

https://doi.org/10.1210/clinem/dgz320

2020, Bernet, Selina, Gut, Lara, Baechli, Ciril, Koch, Daniel, Wagner, Ulrich, Mueller, Beat, Schuetz, Philipp, Kutz, Alexander

2019, Ebrahimi, Fahim, Widmer, Andrea, Wagner, Ulrich, Mueller, Beat, Schuetz, Philipp, Christ-Crain, Mirjam, Kutz, Alexander

2020, Baechli, Ciril, Koch, Daniel, Bernet, Selina, Gut, Lara, Wagner, Ulrich, Mueller, Beat, Schuetz, Philipp, Kutz, Alexander

2020, Ebrahimi, Fahim, Kutz, Alexander, Wagner, Ulrich, Illigens, Ben, Siepmann, Timo, Schuetz, Philipp, Christ-Crain, Mirjam, Mueller, Beat, Christ, Emanuel R.

2018, Wagner, Ulrich

Background: legal setting and public discussion In Switzerland political responsibility for the health care system is divided vertically between the Confederation and the Cantons. In the general public each year there is an increasingly heated debate about rising premiums for sickness funds (4.7% growth per year on average since major health law revision in 1994). The actions taken by federal authorities have – to formulate positively - slowed down the total expenditure growth to only 3.2%. Of course – like everything in Switzerland - this growth is different from canton to canton. This is valid for total expenditure as well as for sickness fund premiums. Problem description The Swiss discussion about rising health care costs (78 bn in 2015) has from a governance perspective the following limitations: - Federal government is held responsible for rising health care costs, but is limited to regulate sickness funds (with minor exceptions). - A narrowed focus in the public debate on mandatory health