{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:37:36Z","timestamp":1788845856294,"version":"build-2803163510"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsmedizin Greifswald"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol. Res. Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple sclerosis (MS) is a chronic autoimmune disease imposing a substantial burden on healthcare systems. In Germany, MS care has been transitioning from inpatient to outpatient settings, driven by advances in disease-modifying therapies and evolving care infrastructure. Comprehensive data on inpatient utilisation trends and their determinants remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To analyse inpatient and day care admission patterns for people with MS (pwMS) in Germany between 2019 and 2024, examining trends by disease subtype, patient demographics, performed procedures, and regional distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Administrative data from the Institute for Hospital Remuneration (InEK) were analysed for inpatient cases coded under ICD-10-GM G35 (MS) from 2019 to 2024. Cases were stratified by MS subdiagnosis (G35.X). Regional analysis incorporated population density data from Destatis and hospital listings from the Bundes-Klinik-Atlas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nationwide inpatient MS admissions declined by 28%, from 45,067 cases in 2019 to 32,670 in 2024, while day care cases rose from 4,127 to 5,627. Regional variation in inpatient case reduction was substantial, ranging from \u2212\u200911 to -59%. Declines were greatest for secondary progressive MS (37%) and primary progressive MS (31%). The average inpatient stay duration did not increase for admissions coded for first manifestation but did increase for all other disease courses. Diagnostic procedures dominated cases coded for first manifestation. Between 2019 and 2024, inpatient procedure rates per admission increased across most categories, and day care utilisation shifted markedly towards anti-CD20 immunotherapy administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inpatient MS care in Germany is declining substantially, with increasing day care utilisation partially compensating for this shift. Marked regional disparities and rising case complexity highlight the need for standardised outpatient care expansion and unified reimbursement frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42466-026-00507-2","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:22:25Z","timestamp":1782487345000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Inpatient care for people with multiple sclerosis - a secondary data analysis in Germany between 2019 and 2024"],"prefix":"10.1186","volume":"8","author":[{"given":"Sarah Mai","family":"Viebahn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Nothnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Raths","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Krohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn","family":"Br\u00fcggemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Herr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"S\u00fc\u00dfe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Fl\u00f6el","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjalf","family":"Ziemssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Fle\u00dfa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Grothe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"10422","key":"507_CR1","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S0140-6736(23)01473-3","volume":"403","author":"D Jakimovski","year":"2024","unstructured":"Jakimovski, D., et al. (2024). Multiple sclerosis. Lancet, 403(10422), 183\u2013202. https:\/\/doi.org\/10.1016\/S0140-6736(23)01473-3","journal-title":"Lancet"},{"issue":"8","key":"507_CR2","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1001\/jama.2020.26858","volume":"325","author":"MP McGinley","year":"2021","unstructured":"McGinley, M. P., Goldschmidt, C. H., & Rae-Grant, A. D. (2021). Diagnosis and treatment of multiple sclerosis: a review. Journal Of The American Medical Association, 325(8), 765\u2013779. https:\/\/doi.org\/10.1001\/jama.2020.26858","journal-title":"Journal Of The American Medical Association"},{"issue":"4","key":"507_CR3","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1002\/ana.24747","volume":"80","author":"Team","year":"2016","unstructured":"University of California San Francisco MS-EPIC, Team, et al. (2016). Long-term evolution of multiple sclerosis disability in the treatment era. Annals Of Neurology, 80(4), 499\u2013510. https:\/\/doi.org\/10.1002\/ana.24747","journal-title":"Annals Of Neurology"},{"issue":"13","key":"507_CR4","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1177\/1352458516687402","volume":"23","author":"R Capra","year":"2017","unstructured":"Capra, R., et al. (2017). Assessing long-term prognosis improvement as a consequence of treatment pattern changes in MS. Multiple Sclerosis (Houndmills, Basingstoke, England), 23(13), 1757\u20131761. https:\/\/doi.org\/10.1177\/1352458516687402","journal-title":"Multiple Sclerosis (Houndmills, Basingstoke, England)"},{"issue":"10","key":"507_CR5","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1001\/jamaneurol.2021.2738","volume":"78","author":"T Spelman","year":"2021","unstructured":"Spelman, T., et al. (2021). Treatment escalation vs immediate initiation of highly effective treatment for patients with relapsing-remitting multiple sclerosis: data from 2 different national strategies. JAMA Neurol, 78(10), 1197\u20131204. https:\/\/doi.org\/10.1001\/jamaneurol.2021.2738","journal-title":"JAMA Neurol"},{"issue":"8","key":"507_CR6","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1136\/jnnp.2006.090365","volume":"77","author":"G Kobelt","year":"2006","unstructured":"Kobelt, G., et al. (2006). Costs and quality of life of patients with multiple sclerosis in Europe. Journal Of Neurology, Neurosurgery And Psychiatry, 77(8), 918\u2013926. https:\/\/doi.org\/10.1136\/jnnp.2006.090365","journal-title":"Journal Of Neurology, Neurosurgery And Psychiatry"},{"issue":"3","key":"507_CR7","doi-asserted-by":"publisher","first-page":"205521732311878","DOI":"10.1177\/20552173231187810","volume":"9","author":"P Dillon","year":"2023","unstructured":"Dillon, P., et al. (2023). The socioeconomic impact of disability progression in multiple sclerosis: a retrospective cohort study of the German NeuroTransData (NTD) registry. Mult Scler J Exp Transl Clin, 9(3), 20552173231187810. https:\/\/doi.org\/10.1177\/20552173231187810","journal-title":"Mult Scler J Exp Transl Clin"},{"issue":"2 Suppl","key":"507_CR8","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/1352458517708141","volume":"23","author":"P Flachenecker","year":"2017","unstructured":"Flachenecker, P., Kobelt, G., Berg, J., Capsa, D., & Gannedahl, M. (2017). New insights into the burden and costs of multiple sclerosis in Europe: results for Germany. Multiple Sclerosis (Houndmills, Basingstoke, England), 23(2 Suppl), 78\u201390. https:\/\/doi.org\/10.1177\/1352458517708141","journal-title":"Multiple Sclerosis (Houndmills, Basingstoke, England)"},{"issue":"4","key":"507_CR9","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1007\/s00415-019-09676-4","volume":"267","author":"NH Ness","year":"2020","unstructured":"Ness, N. H., et al. (2020). Differentiating societal costs of disability worsening in multiple sclerosis. Journal Of Neurology, 267(4), 1035\u20131042. https:\/\/doi.org\/10.1007\/s00415-019-09676-4","journal-title":"Journal Of Neurology"},{"issue":"8","key":"507_CR10","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1177\/1352458517694432","volume":"23","author":"G Kobelt","year":"2017","unstructured":"Kobelt, G., Thompson, A., Berg, J., Gannedahl, M., & Eriksson, J. (2017). New insights into the burden and costs of multiple sclerosis in Europe. Multiple Sclerosis (Houndmills, Basingstoke, England), 23(8), 1123\u20131136. https:\/\/doi.org\/10.1177\/1352458517694432","journal-title":"Multiple Sclerosis (Houndmills, Basingstoke, England)"},{"issue":"2","key":"507_CR11","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1080\/14737167.2022.1987218","volume":"22","author":"D Schriefer","year":"2022","unstructured":"Schriefer, D., Haase, R., Ness, N. H., & Ziemssen, T. (2022). Cost of illness in multiple sclerosis by disease characteristics \u2013 a review of reviews. Expert Rev Pharmacoecon Outcomes Res, 22(2), 177\u2013195. https:\/\/doi.org\/10.1080\/14737167.2022.1987218","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"5","key":"507_CR12","doi-asserted-by":"publisher","first-page":"363","DOI":"10.2165\/11532230-000000000-00000","volume":"28","author":"H Naci","year":"2010","unstructured":"Naci, H., Fleurence, R., Birt, J., & Duhig, A. (2010). Economic burden of multiple sclerosis: a systematic review of the literature. Pharmacoeconomics, 28(5), 363\u2013379. https:\/\/doi.org\/10.2165\/11532230-000000000-00000","journal-title":"Pharmacoeconomics"},{"issue":"3","key":"507_CR13","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s42451-023-00562-y","volume":"6","author":"P Berlit","year":"2023","unstructured":"Berlit, P., & Timmermann, L. (2023). Strukturwandel im Gesundheitswesen \u2013 Herausforderung und Chance f\u00fcr die Neurologie! DGNeurologie, 6(3), 185\u2013187. https:\/\/doi.org\/10.1007\/s42451-023-00562-y","journal-title":"DGNeurologie"},{"key":"507_CR14","doi-asserted-by":"publisher","first-page":"175628642412378","DOI":"10.1177\/17562864241237857","volume":"17","author":"S Papukchieva","year":"2024","unstructured":"Papukchieva, S., et al. (2024). Shifting from the treat-to-target to the early highly effective treatment approach in patients with multiple sclerosis \u2013 real-world evidence from Germany. Therapeutic Advances In Neurological Disorders, 17, 17562864241237857. https:\/\/doi.org\/10.1177\/17562864241237857","journal-title":"Therapeutic Advances In Neurological Disorders"},{"key":"507_CR15","unstructured":"Institut f\u00fcr das Entgeltsystem im Krankenhaus GmbH (Apr 2025). InEK DatenBrowser. https:\/\/datenbrowser.inek.org\/. Accessed 16."},{"key":"507_CR16","unstructured":"Gemeinsamer Bundesausschuss (2024). Referenzdatenbank der Qualit\u00e4tsberichte der Krankenh\u00e4user. https:\/\/qb-referenzdatenbank.g-ba.de\/#\/suche. Accessed 4 Jun 2025."},{"key":"507_CR17","unstructured":"Bundesministerium f\u00fcr Gesundheit (2024). Bundes-Klinik-Atlas. https:\/\/bundes-klinik-atlas.de\/. Accessed 4 Jun 2025."},{"key":"507_CR18","doi-asserted-by":"publisher","DOI":"10.20364\/VA-17.09","author":"J Holstiege","year":"2017","unstructured":"Holstiege, J., Steffen, A., Goffrier, B., & B\u00e4tzing, J. (2017). Epidemiology of multiple sclerosis \u2013 a population-based, Germany-wide study. Versorgungsatlas Report No. https:\/\/doi.org\/10.20364\/VA-17.09. 17\/09.","journal-title":"Versorgungsatlas Report No"},{"key":"507_CR19","doi-asserted-by":"publisher","first-page":"103534","DOI":"10.1016\/j.msard.2022.103534","volume":"59","author":"J Holstiege","year":"2022","unstructured":"Holstiege, J., et al. (2022). Trends in administrative prevalence of multiple sclerosis and utilization patterns of disease modifying drugs in Germany. Mult Scler Relat Disord, 59, 103534. https:\/\/doi.org\/10.1016\/j.msard.2022.103534","journal-title":"Mult Scler Relat Disord"},{"issue":"10","key":"507_CR20","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1001\/jamaneurol.2024.2876","volume":"81","author":"J Graf","year":"2024","unstructured":"Graf, J., Akmatov, M. K., Meuth, S. G., Tremlett, H., & Holstiege, J. (2024). Updated multiple sclerosis incidence, 2015\u20132022. JAMA Neurol, 81(10), 1100\u20131102. https:\/\/doi.org\/10.1001\/jamaneurol.2024.2876","journal-title":"JAMA Neurol"},{"key":"507_CR21","doi-asserted-by":"publisher","first-page":"624790","DOI":"10.1155\/2014\/624790","volume":"2014","author":"MT Halpern","year":"2014","unstructured":"Halpern, M. T., et al. (2014). Factors associated with neurologists\u2019 provision of MS patient care. Mult Scler Int, 2014, 624790. https:\/\/doi.org\/10.1155\/2014\/624790","journal-title":"Mult Scler Int"},{"key":"507_CR22","doi-asserted-by":"publisher","first-page":"205520762311529","DOI":"10.1177\/20552076231152989","volume":"9","author":"L Masanneck","year":"2023","unstructured":"Masanneck, L., et al. (2023). Driving time-based identification of gaps in specialised care coverage: an example of neuroinflammatory diseases in Germany. Digit Health, 9, 20552076231152989. https:\/\/doi.org\/10.1177\/20552076231152989","journal-title":"Digit Health"},{"key":"507_CR23","doi-asserted-by":"publisher","unstructured":"Korsukewitz, C., M\u00e4urer, M., & Wiendl, H. (2022). MS-Versorgung heute und Vision f\u00fcr die Zukunft- eine Rolle f\u00fcr die ASV? NeuroTransmitter 33(12):32\u201337. https:\/\/doi.org\/10.1007\/s15016-022-2998-1","DOI":"10.1007\/s15016-022-2998-1"},{"key":"507_CR24","doi-asserted-by":"crossref","unstructured":"M\u00e4urer, M., & Multiple Sklerose Therapie Konsensus Gruppe. (2023). Ambulante spezialfach\u00e4rztliche Versorgung (ASV) f\u00fcr die Multiple Sklerose. DGNeurologie. https:\/\/www.springermedizin.de\/dgneurologie-6-2023\/26256002","DOI":"10.1007\/s42451-023-00594-4"},{"key":"507_CR25","doi-asserted-by":"publisher","unstructured":"Voigt, I., et al. (2026). MS360\u00b0: a conceptual digital-first, data-driven hybrid care framework for personalised multiple sclerosis management. NPJ Digit Med, 9(1). https:\/\/doi.org\/10.1038\/s41746-026-02461-4","DOI":"10.1038\/s41746-026-02461-4"},{"key":"507_CR26","doi-asserted-by":"publisher","unstructured":"Eyding, J., et al. (2019). Inpatient TIA and stroke care in adult patients in Germany \u2013 retrospective. Neurol Res Pract , 1 , 39. analysis of nationwide administrative data sets of 2011 to 2017. https:\/\/doi.org\/10.1186\/s42466-019-0044-y","DOI":"10.1186\/s42466-019-0044-y"},{"key":"507_CR27","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s42466-022-00192-x","volume":"4","author":"R Scherbaum","year":"2022","unstructured":"Scherbaum, R., et al. (2022). COVID-19 outcomes in hospitalized Parkinson\u2019s disease patients in two pandemic waves in 2020: a nationwide cross-sectional study from Germany. Neurol Res Pract, 4, 27. https:\/\/doi.org\/10.1186\/s42466-022-00192-x","journal-title":"Neurol Res Pract"},{"key":"507_CR28","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s42466-021-00140-1","volume":"3","author":"H Wiendl","year":"2021","unstructured":"Wiendl, H., Gold, R., Zipp, F., & Multiple Sclerosis Therapy Consensus Group. (2021). Multiple Sclerosis Therapy Consensus Group (MSTCG): answers to the discussion questions. Neurol Res Pract, 3, 44.https:\/\/doi.org\/10.1186\/s42466-021-00140-1","journal-title":"Neurol Res Pract"}],"container-title":["Neurological Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42466-026-00507-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42466-026-00507-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42466-026-00507-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:22:32Z","timestamp":1782487352000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42466-026-00507-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["507"],"URL":"https:\/\/doi.org\/10.1186\/s42466-026-00507-2","relation":{},"ISSN":["2524-3489"],"issn-type":[{"value":"2524-3489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"assertion":[{"value":"27 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No informed consent or ethical approval was required for this study because completely anonymized data were used. The latest Good Practice in Secondary Data Analysis recommendations (version 3; 2012\/14) of the German Working Group for the Survey and Utilisation of Secondary Data (with representatives from the German Society for Social Medicine and Prevention and the German Society for Epidemiology) and the Working Group for Epidemiological Methods (with representatives from the German Society for Epidemiology, the German Society for Medical Informatics, Biometry and Epidemiology and the German Society for Social Medicine and Prevention) state in their respective Guideline 1 that \u201c\u2026 recommendation to consult with an ethics committee need not apply to secondary data analyses if all the data protection provisions on pseudoanonymization of all personal data are fulfilled and no link to primary data is intended.\u201d","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"51"}}