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["Hinweise zur Veröffentlichung der vergleichenden Zusammenstellung der Pflegepersonalquotienten gemäß § 137j Absatz 1 Satz 9 SGB V im Jahr 2024"]
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["Gemäß § 137j Absatz 1 Satz 9 Fünftes Buch Sozialgesetzbuch (SGB V) hat das InEK unter Angabe des Namens und der Kennzeichen nach § 293 Absätze 1 und 6 SGB V eine vergleichende Zusammenstellung der für jeden Standort eines Krankenhauses ermittelten Pflegepersonalquotienten bis zum 31. Oktober eines Jahres barrierefrei auf seiner Internetseite zu veröffentlichen. In der Zusammenstellung sind standortbezogen auch die prozentuale Zusammensetzung des Pflegepersonals nach Berufsbezeichnungen auf Grundlage der nach § 21 Absatz 2 Nummer 1 Buchstabe e Krankenhausentgeltgesetz (KHEntgG) übermittelten Daten auszuweisen.\nAn der in den letzten beiden Jahren etablierten Vorgehensweise bei der Ermittlung der Pflegepersonalquotienten wurde – in Absprache mit dem Bundesministerium für Gesundheit – in diesem Jahr festgehalten: Der Pflegelast-Katalog wurde mit den aktuellsten Kostendaten des Datenjahres 2023 und dem neuesten aG-DRG-System 2025 berechnet. Die Pflegepersonalquotienten wurden auf Basis des Datenjahres 2023 ermittelt.\nIm Auftrag der Selbstverwaltungspartner auf Bundesebene wurden die zwölf im Vorjahr neu geschaffenen „Hybrid-DRGs“ für ein spezielle sektorengleiche Vergütung gemäß § 115f SGB V im Rahmen der Weiterentwicklung des aG-DRG-Systems 2025 um zehn weitere Hybrid-DRGs ergänzt. Im Pflegelast-Katalog 2025 werden diese 22 Hybrid-DRGs in Anlage 1 ausgewiesen. Fälle in Hybrid-DRGs gehen damit in die Berechnung der Pflegepersonalquotienten ein.\nDer Pflegepersonalquotient gemäß § 137j Absatz 1 Satz 1 SGB V beschreibt das Verhältnis der Anzahl der Vollzeitkräfte des Pflegepersonals in der unmittelbaren Patientenversorgung auf bettenführenden Stationen zum Pflegeaufwand eines Krankenhauses. Zum besseren Verständnis wird in der nachfolgenden vergleichenden Zusammenstellung der Pflegepersonalquotienten das Verhältnis aus Pflegeaufwand geteilt durch die Pflegekräfte, also der Kehrwert, angegeben. Damit erfolgt die Darstellung analog zu den Vorjahren.\n"]
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["Datengrundlage"]
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["Grundlage für die Ermittlung der Pflegepersonalquotienten im Jahr 2024 auf Standortebene sind die von den Krankenhäusern an das InEK übermittelten Daten nach § 21 Absatz 1 KHEntgG des Datenjahres 2023. Es sind die aktuellsten dem InEK vorliegenden Daten, die sich für eine Gegenüberstellung von Leistungsdaten und dazu korrespondierenden Daten zum Pflegepersonal eignen, da miteinander korrespondierende Leistungsdaten und Daten zum eingesetzten Pflegepersonal vorliegen.\nIm Vergleich zum Vorjahr wurde im Datenjahr 2023 das Pflegepersonal in der Datei Pflegepersonal.csv der Datenlieferung nach § 21 Absatz 1 KHEntgG erneut geringfügig differenzierter abgefragt: so waren die Zahnmedizinischen Fachangestellten und die Sozialassistentinnen und -assistenten nun gesondert auszuweisen.\n"]
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["Berechnung der standortbezogenen Pflegelast "]
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["Der Kehrwert des Pflegepersonalquotienten berechnet sich als Pflegelast des Standortes geteilt durch das am Standort berücksichtigte Pflegepersonal. Die veröffentlichte vergleichende Zusammenstellung ist aufsteigend nach den Kehrwerten des Pflegepersonalquotienten sortiert, so dass zu Beginn die Standorte abgebildet sind, die mit einem niedrigen Kehrwert des Pflegepersonalquotienten ein relativ niedriges Verhältnis von Pflegelast zu Pflegekraft aufweisen, während sich am Ende der Zusammenstellung die Standorte mit hohen Kehrwerten des Pflegepersonalquotienten befinden, an denen einer Pflegekraft also relativ gesehen eine höhere Pflegelast gegenüberstand.\nDer Pflegeaufwand wird mit Hilfe des Katalogs zur Risikoadjustierung für Pflegeaufwand (\"Pflegelast-Katalog\") in der Version 2025 ermittelt. Der Pflegelast-Katalog steht unter https://www.g-drg.de/pflegepersonaluntergrenzen-2024/katalog-zur-risikoadjustierung-fuer-pflegeaufwand-pflegelast-katalog-version-2025 auf der Internetseite des InEK zum Download zur Verfügung. Der Katalog basiert auf den Leistungs- und Kostendaten des Datenjahres 2023 und bezieht sich auf das aG-DRG-System 2025.\nBei der Ermittlung des Pflegepersonalquotienten wurden die von den Krankenhäusern übermittelten vollstationären Fälle des Datenjahres 2023 im Entgeltbereich \"DRG\" (ohne Begleitpersonen, ohne rein vorstationäre Fälle, ohne teilstationäre Fälle) und die Fälle der Hybrid-DRGs berücksichtigt. Um die Pflegelast mit Hilfe des Katalogs zur Risikoadjustierung für Pflegeaufwand in der Version 2025 für jeden einem bestimmten Standort zugeordneten Fall ermitteln zu können, wurden die Fälle nach dem aG-DRG-System 2025 gruppiert.\nDer Pflegepersonalquotient ist auf Standortebene zu ermitteln. Dazu war sowohl fallseitig die Pflegelast als auch das Pflegepersonal den jeweiligen Standorten eines Krankenhauses zuzuordnen. Bei Fällen, die nur an einem Standort versorgt wurden, ist die Zuordnung zum Standort klar. Bei zwischen Standorten verlegten Fällen wird die Pflegelast des Falls mit Hilfe der Informationen zu seinen Fachabteilungsaufenthalten in der Datei FAB.csv auf die tatsächlichen Behandlungsstandorte (Spalte „Standortnummer Behandlungsort“ in der Datei FAB.csv) aufgeteilt, siehe nachfolgendes Beispiel.\nDie für die Ermittlung der Pflegelast notwendige Unterscheidung von Versorgung auf Normal- und Intensivstation erfolgt über die \"Kennung Intensivbett\" durch die Krankenhäuser selbst in der Datei FAB.csv der Datenlieferung nach § 21 Absatz 1 KHEntgG. Die Fachabteilungsaufenthalte werden minutengenau ausgewertet. Für die Anwendung des Pflegelast-Katalogs muss die Dauer der Fachabteilungsaufenthalte in Tage umgerechnet werden; bspw. entspricht ein sechsstündiger Fachabteilungsaufenthalt 0,25 Tagen (= 6 Stunden / 24 Stunden pro Tag)."]
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["Beispiel zur Berechnung der Pflegelast eines Falls, der an zwei verschiedenen Standorten versorgt wurde:"]
["Ein vollstationär versorgter Patient A (Alter 42 Jahre) mit insgesamt 15,5 Tagen Verweildauer werde in die DRG B20E Kraniotomie oder große Wirbelsäulen-Operation ohne komplexe Prozedur, […] gruppiert. Die Verweildauer setze sich aus 10 Tagen Aufenthalt auf der Normalstation an Standort 770001000 sowie an Standort 770002000 aus 3 Tagen Aufenthalt auf der Intensivstation und 2,5 Tagen Aufenthalt auf der Normalstation zusammen.\nAls Pflegeaufwand ergibt sich für diesen Fall insgesamt eine Pflegelast in Höhe von 12,5 x 0,1349 + 3 x 0,4816 = 3,1311, wobei 0,1349 und 0,4816 die für den Patienten relevanten Bewertungsrelationen der DRG B20E im Pflegelast-Katalog in der Version 2025 sind. Dieser Pflegeaufwand wird entsprechend der Fachabteilungsangaben wie folgt auf die beiden Standorte aufgeteilt: Für den Standort 770001000 ergibt sich für diesen Fall ein Pflegeaufwand in Höhe von 10 x 0,1349 = 1,3490 Bewertungsrelationen. Für den Standort 770002000 geht dieser Fall mit einer Pflegelast in Höhe von 2,5 x 0,1349 + 3 x 0,4816 = 1,7821 Bewertungsrelationen in die Berechnung des Pflegepersonalquotienten ein.\n\nDie Ermittlung der Pflegepersonalquotienten erfolgt unabhängig davon, ob es sich bei dem Krankenhaus bzw. Krankenhausstandort um eine Besondere Einrichtung handelt und ob für die Abrechnung der Besonderen Einrichtung tatsächlich DRG-Fallpauschalen verwendet wurden. Die im Rahmen der Datenlieferung nach § 21 Absatz 1 KHEntgG übermittelten Leistungsdaten wurden in diesem Fall zur Ermittlung der Pflegelast mit dem aG-DRG-Grouper 2025 gruppiert. Die auf diese Weise erhaltenen Gruppierungsergebnisse werden verwendet, um zu einer Einordnung der Leistung und des Pflegeaufwands zu gelangen. Wie im obigen Beispiel gezeigt, werden unterschiedlich lange Verweildauern bei der Ermittlung der Pflegelast berücksichtigt.\nKrankenhausstandorte mit sehr geringer Fallzahl im Datenjahr 2023 (≤ 25 Fälle) werden in der vergleichenden Zusammenstellung der Pflegepersonalquotienten nicht aufgeführt, da es sich in einigen Fällen um Fehlkodierungen handelt oder beispielsweise um psychiatrische Krankenhäuser mit einzelnen Fällen im Entgeltbereich „DRG“. Für diese Krankenhausstandorte ergeben sich als statistische Artefakte häufig mit gewisser Zufälligkeit sehr hohe oder sehr niedrige Verhältniszahlen für den Pflegepersonalquotienten. Ebenso werden in der vergleichenden Zusammenstellung Krankenhausstandorte nicht aufgeführt, wenn diese zwischenzeitlich geschlossen wurden, sofern das InEK bereits Kenntnis über die Schließung erlangt hat. Ebenfalls wurden dem InEK bekannte und von den Krankenhäusern bestätigte Kooperationen berücksichtigt.\n"]
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["Ermittlung des berücksichtigten Pflegepersonals"]
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["Im Rahmen der Datenlieferung nach § 21 Absatz 1 KHEntgG war sowohl das insgesamt eingesetzte Pflegepersonal (alle) als auch das in der unmittelbaren Patientenversorgung auf bettenführenden Stationen eingesetzte Pflegepersonal (Pflege am Bett) als Davon-Angabe von den Krankenhäusern zu übermitteln. Bei der Berechnung des Pflegepersonalquotienten wurden die Angaben zu den in der Pflege am Bett auf bettenführenden Fachabteilungen eingesetzten Pflegekräften verwendet, unabhängig von der Art des Beschäftigungsverhältnisses (direkt oder nicht direkt). Da beim Pflegepersonalquotienten nur die vollstationär versorgten Fälle des Entgeltbereichs „DRG“ eingehen, werden nur Pflegekräfte berücksichtigt, welche im Entgeltbereich „DRG“ in der pflegerischen Versorgung von vollstationären Fällen tätig waren. Dementsprechend wird das Pflegepersonal, welches z.B. unter dem Entgeltbereich „PSY“ oder für die teilstationäre Versorgung von Fällen übermittelt wurde, auf Seite des Pflegepersonals nicht berücksichtigt.\nDas in der Pflege am Bett eingesetzte Pflegepersonal war von den Krankenhäusern in Pflegepersonal Gesamt, Gesundheits- und Krankenpfleger/-innen, Gesundheits- und Kinderkrankenpfleger/-innen, Altenpfleger/-innen, Akademischer Pflegeabschluss, Krankenpflegehelfer-/innen, Altenpflegehelfer/-innen, Medizinische Fachangestellte, Zahnmedizinische Fachangestellte, Anästhesietechnische Assistenten/-innen, Notfallsanitäter/-innen und Rettungsassistent/-innen, Pflegeassistenten/-innen, Sozialassistenten/-innen, Sonstige Berufe und Ohne Berufsabschluss zu gliedern. Die Summe aus den 14 genannten spezifischen Berufsgruppen ergibt das Pflegepersonal Gesamt.\n"]
["Bei der Berechnung des Pflegepersonalquotienten werden neben den Pflegefachkräften (Gesundheits- und Krankenpfleger/-innen, Gesundheits- und Kinderkrankenpfleger/-innen, Altenpfleger/-innen, Akademischer Pflegeabschluss) auch Pflegehilfskräfte (Krankenpflegehelfer-/innen, Altenpflegehelfer/-innen), weitere Fachkräfte (Medizinische Fachangestellte, Zahnmedizinische Fachangestellte, Anästhesietechnische Assistenten/-innen, Notfallsanitäter/-innen und Rettungsassistent/-innen, Pflegeassistenten/-innen und Sozialassistenten/-innen) sowie Pflegekräfte aus den Qualifikationsgruppen Sonstige Berufe und Ohne Berufsabschluss berücksichtigt. Wie im Vorjahr werden in diesem Jahr die weiteren Fachkräfte wie Pflegehilfskräfte gezählt.\nPflegehilfskräfte sowie die weiteren Fachkräfte werden jeweils bis zu 12,5% (im Vorjahr: 11,5%), Pflegekräfte der Qualifikationsgruppe Sonstige Berufe bis zu 6% (im Vorjahr: 6,5%) und Pflegekräfte der Qualifikationsgruppe Ohne Berufsabschluss bis zu 5,5% (im Vorjahr: 6%) des Pflegefachpersonals berücksichtigt (siehe nachfolgendes Beispiel). Über die Anrechnungsgrenze des Pflegehilfspersonals sowie der weiteren Fachkräfte hinausgehendes Pflegehilfspersonal bzw. darüber hinausgehende weitere Fachkräfte werden bei der Anrechnungsgrenze für Sonstige Berufe sowie bei der Anrechnungsgrenze für Pflegekräfte ohne Berufsabschluss berücksichtigt. Über die Anrechnungsgrenze der Qualifikationsgruppe Sonstige Berufe hinausgehende Pflegekräfte dieser Qualifikationsgruppe werden bei der Anrechnungsgrenze der Qualifikationsgruppe Ohne Berufsabschluss berücksichtigt. Die Anrechnungsanteile für Pflegehilfskräfte sowie weitere Fachkräfte, Sonstige Berufe und Ohne Berufsabschluss ergeben sich aus dem in § 137j Absatz 1 Satz 5 SGB V vorgegebenen Quartilsansatz. Beim Quartilsansatz orientieren sich die Anrechnungsgrenzen am oberen Quartil (= 75%-Quantil) der Anteile für Pflegehilfskräfte sowie weitere Fachkräfte, für Sonstige Berufe bzw. für Ohne Berufsabschluss über alle Krankenhausstandorte in Deutschland. Sie resultieren damit aus der Gesamtheit der von den Krankenhäusern übermittelten Daten zum Pflegepersonal.\n"]
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["Beispiele zur Ermittlung des berücksichtigten Pflegepersonals:"]
["• Krankenhaus A habe 100 Pflegefachkräfte (davon 90 Gesundheits- und Krankenpfleger/-innen, 5 Gesundheits- und Kinderkrankenpfleger/-innen, 5 Altenpfleger/-innen und 0 Akademischer Pflegeabschluss), 30 Pflegehilfskräfte (davon 20 Krankenpflegehelfer-/innen und 10 Altenpflegehelfer/-innen), 20 Pflegekräfte der Qualifikationsgruppe Sonstige Berufe und als Pflegepersonal Gesamt 150 Pflegekräfte übermittelt.\nVon den 30 Pflegehilfskräften sowie Weiteren und Sonstigen Fachkräften (= 30 + 0) können zunächst einmal 12,5 Pflegekräfte berücksichtigt werden (= 12,5% x 100). Von den übrigen 17,5 Pflegehilfskräften können nun noch weitere 11,5 Pflegekräfte (= 6% x 100 bei Sonstige Berufe + 5,5% x 100 bei Ohne Berufsabschluss) einbezogen werden, womit die Anrechnungsmöglichkeiten maximal ausgeschöpft sind. Damit gehen 124 Pflegekräfte (= 100 + 12,5 + 6 + 5,5) der insgesamt 150 Pflegekräfte in die Berechnung des Pflegepersonalquotienten ein."]
["• Krankenhaus B habe 100 Pflegefachkräfte (davon 90 Gesundheits- und Krankenpfleger/-innen, 5 Gesundheits- und Kinderkrankenpfleger/-innen, 5 Altenpfleger/-innen und 0 Akademischer Pflegeabschluss), 10 Pflegehilfskräfte (davon 10 Krankenpflegehelfer-/innen und 0 Altenpflegehelfer/-innen), 15 Weitere und Sonstige Fachkräfte, 15 Pflegekräfte der Qualifikationsgruppe Sonstige Berufe, 10 Pflegekräfte der Qualifikationsgruppe Ohne Berufsabschluss und als Pflegepersonal Gesamt 150 Pflegekräfte übermittelt.\nVon den 25 Pflegehilfskräften sowie Weiteren und Sonstigen Fachkräften (= 10 + 15) können zunächst einmal 12,5 Pflegekräfte berücksichtigt werden (= 12,5% x 100). Von den übrigen 12,5 Pflegehilfskräften sowie Weiteren und Sonstigen Fachkräften können nun noch weitere 11,5 Pflegekräfte (= 6% x 100 bei Sonstige Berufe + 5,5% x 100 bei Ohne Berufsabschluss) einbezogen werden, womit die Anrechnungsmöglichkeiten maximal ausgeschöpft sind. Somit gehen 124 Pflegekräfte (= 100 + 12,5 + 6 + 5,5) der insgesamt 150 Pflegekräfte in die Berechnung des Pflegepersonalquotienten ein."]
["• Krankenhaus C habe 100 Pflegefachkräfte (davon 85 Gesundheits- und Krankenpfleger/-innen, 0 Gesundheits- und Kinderkrankenpfleger/-innen, 10 Altenpfleger/-innen und 5 Akademischer Pflegeabschluss), 0 Pflegehilfskräfte, 5 Weitere und Sonstige Fachkräfte (davon 5 Medizinische Fachangestellte, 0 Zahnmedizinische Fachangestellte, 0 Anästhesietechnische Assistenten/-innen, 0 Notfallsanitäter/-innen und Rettungsassistent/-innen, 0 Pflegeassistenten/-innen, 0 Sozialassistenten/-innen), 10 Pflegekräfte der Qualifikationsgruppe Sonstige Berufe, 35 Pflegekräfte der Qualifikationsgruppe Ohne Berufsabschluss und als Pflegepersonal Gesamt 150 Pflegekräfte übermittelt.\nVon den 5 Pflegehilfskräften sowie Weiteren und Sonstigen Fachkräften (= 0 + 5) werden alle 5 Pflegekräfte berücksichtigt, da die Anzahl kleiner als 12,5 (= 12,5% x 100) ist. Von den 10 Pflegekräften der Qualifikationsgruppe Sonstige Berufe können zunächst 6 Pflegekräfte (= 6% x 100) berücksichtigt werden. Von den übrigen 4 Pflegekräften der Qualifikationsgruppe Sonstige Berufe und den 35 Pflegekräften ohne Berufsabschluss können nun noch 5,5 Pflegekräfte (= 5,5% x 100) berücksichtigt werden. Insgesamt gehen 116,5 Pflegekräfte (= 100 + 5 + 6 + 5,5) der 150 Pflegekräfte in die Berechnung des Pflegepersonalquotienten ein."]
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["Gemäß § 137j Absatz 1 Satz 10 SGB V hat das InEK in der Veröffentlichung zusätzlich standortbezogen auch die prozentuale Zusammensetzung des Pflegepersonals nach Berufsbezeichnungen auszuweisen.\nBeispielsweise würde für Krankenhaus A im obigen Beispiel der Anteil von Gesundheits- und Krankenpfleger/-innen mit 60,0% (= 90 / 150), Gesundheits- und Kinderkrankenpfleger/-innen mit 3,3% (= 5 / 150), Altenpfleger/-innen mit 3,3% (= 5 / 150), Krankenpflegehelfer-/innen mit 13,3% (= 20 / 150), Altenpflegehelfer/-innen mit 6,7% (= 10 / 150), Sonstige Berufe mit 13,3% (= 20 / 150) und der Anteil der Berufsbezeichnungen Akademischer Pflegeabschluss, Medizinische Fachangestellte, Zahnmedizinische Fachangestellte, Anästhesietechnische Assistenten/-innen, Notfallsanitäter/-innen und Rettungsassistent/-innen, Pflegeassistenten/-innen, Sozialassistenten/-innen und Ohne Berufsabschluss jeweils mit 0,0% angegeben werden."]
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["Was bedeutet ein Kehrwert des Pflegepersonalquotienten von z.B. 50?"]
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["Der Kehrwert des Pflegepersonalquotienten setzt nach der Definition des Pflegepersonalquotienten die Pflegelast eines Krankenhausstandortes ins Verhältnis zur Anzahl der (berücksichtigten) Pflegekräfte des Krankenhauses, die „Einheit“ des Kehrwertes des Pflegepersonalquotienten ist somit Pflegelast-Bewertungsrelationen je Pflegekraft. Eine Pflegelast-Bewertungsrelation von 1,0 entspricht der durchschnittlichen Pflegelast eines Falls in Deutschland (im Datenjahr 2023).\nEin Kehrwert des Pflegepersonalquotienten von 50 (bzw. ein Pflegepersonalquotient von 1/50 = 0,02) bedeutet damit, vereinfacht gesagt, dass an diesem Krankenhausstandort bezogen auf das Datenjahr 2023 einer Pflegekraft rechnerisch 50 Fälle mit durchschnittlicher Pflegelast gegenüberstanden. In der Realität können das auch weniger als 50 Fälle gewesen sein, die dann im Schnitt eine überdurchschnittliche Pflegelast von > 1,0 aufgewiesen haben, oder mehr als 50 Fälle, die im Schnitt eine unterdurchschnittliche Pflegelast < 1,0 aufgewiesen haben.\n"]

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["Veröffentlichung der vergleichenden Zusammenstellung der Pflegepersonalquotienten gemäß § 137j Absatz 1 Satz 9 SGB V im Jahr 2024"]
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[{"$nulls":7},"Prozentuale Zusammensetzung des Pflegepersonals (Pflege am Bett)"]
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