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Hintergrund
Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat.
Fragestellung
Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern?
Material und Methoden
Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat.
Ergebnisse
Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt.
Diskussion
Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken.
Virtual reality and related media and communication technologies have a growing
impact on professional application fields and our daily life. Virtual environments
have the potential to change the way we perceive ourselves and how we interact
with others. In comparison to other technologies, virtual reality allows for the
convincing display of a virtual self-representation, an avatar, to oneself and also to
others. This is referred to as user embodiment. Avatars can be of varying realism
and abstraction in their appearance and in the behaviors they convey. Such userembodying
interfaces, in turn, can impact the perception of the self as well as
the perception of interactions. For researchers, designers, and developers it is of
particular interest to understand these perceptual impacts, to apply them to therapy,
assistive applications, social platforms, or games, for example. The present thesis
investigates and relates these impacts with regard to three areas: intrapersonal
effects, interpersonal effects, and effects of social augmentations provided by the
simulation.
With regard to intrapersonal effects, we specifically explore which simulation
properties impact the illusion of owning and controlling a virtual body, as well
as a perceived change in body schema. Our studies lead to the construction of
an instrument to measure these dimensions and our results indicate that these
dimensions are especially affected by the level of immersion, the simulation latency,
as well as the level of personalization of the avatar.
With regard to interpersonal effects we compare physical and user-embodied social
interactions, as well as different degrees of freedom in the replication of nonverbal
behavior. Our results suggest that functional levels of interaction are maintained,
whereas aspects of presence can be affected by avatar-mediated interactions, and
collaborative motor coordination can be disturbed by immersive simulations.
Social interaction is composed of many unknown symbols and harmonic patterns
that define our understanding and interpersonal rapport. For successful virtual
social interactions, a mere replication of physical world behaviors to virtual environments
may seem feasible. However, the potential of mediated social interactions
goes beyond this mere replication. In a third vein of research, we propose and
evaluate alternative concepts on how computers can be used to actively engage in
mediating social interactions, namely hybrid avatar-agent technologies. Specifically,
we investigated the possibilities to augment social behaviors by modifying and
transforming user input according to social phenomena and behavior, such as nonverbal
mimicry, directed gaze, joint attention, and grouping. Based on our results
we argue that such technologies could be beneficial for computer-mediated social
interactions such as to compensate for lacking sensory input and disturbances in
data transmission or to increase aspects of social presence by visual substitution or
amplification of social behaviors.
Based on related work and presented findings, the present thesis proposes the
perspective of considering computers as social mediators. Concluding from prototypes
and empirical studies, the potential of technology to be an active mediator of social
perception with regard to the perception of the self, as well as the perception of
social interactions may benefit our society by enabling further methods for diagnosis,
treatment, and training, as well as the inclusion of individuals with social disorders.
To this regard, we discuss implications for our society and ethical aspects. This
thesis extends previous empirical work and further presents novel instruments,
concepts, and implications to open up new perspectives for the development of
virtual reality, mixed reality, and augmented reality applications.