Changing patterns of hip fracture care before and after implementation of the prospective payment system.
Changing patterns of hip fracture care before and after implementation of the prospective payment system.
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实施前瞻性支付系统前后髋部骨折护理模式的变化。
DOI：
10.1001/jama.1987.03400020060031
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
R. Dittus
中科院分区：
文献类型：
--
作者：
J. F. Fitzgerald;L. Fagan;W. Tierney;R. Dittus
我们检验了这样的假设：自前瞻性支付系统（PPS）实施以来，因髋部骨折住院的老年患者住院时间更短、护理强度更低，并且更频繁地被送入机构。我们以盲法方式回顾了 1981 年至 1985 年市立医院收治的老年髋部骨折患者的图表。实施 PPS 之前接受治疗的患者的人口统计学和临床特征与实施后接受治疗的患者相似。实施PPS后，平均住院时间从16.6天减少到10.3天，平均接受物理治疗次数从9.7次减少到4.9次。与此同时，出院到疗养院的患者比例有所增加（21% 至 48%），出院后 6 个月内接受疗养院护理的患者比例也有所增加（13% 至 39%）。长期安置在疗养院的人数增加表明，老年髋部骨折患者的护理质量可能已经恶化。
We tested the hypothesis that since the implementation of the prospective payment system (PPS), elderly patients hospitalized for hip fractures receive shorter, less care-intensive hospitalizations and are more frequently institutionalized. In blinded fashion, we reviewed the charts of elderly patients with hip fractures admitted to a municipal hospital from 1981 through 1985. Demographic and clinical characteristics of patients treated before implementation of the PPS were similar to patients treated thereafter. After implementation of the PPS, the mean length of hospitalization fell from 16.6 to 10.3 days, and the mean number of physical therapy sessions received decreased from 9.7 to 4.9. Concomitantly, the proportion of patients discharged to a nursing home increased (21% to 48%), as did the proportion receiving nursing home care at six months after discharge (13% to 39%). This increase in long-term nursing home placement suggests that the quality of care for elderly patients with hip fractures may have deteriorated.