CHANGES IN QUALITY OF CARE FOR 5 DISEASES MEASURED BY IMPLICIT REVIEW, 1981 TO 1986
CHANGES IN QUALITY OF CARE FOR 5 DISEASES MEASURED BY IMPLICIT REVIEW, 1981 TO 1986
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DOI：
10.1001/jama.264.15.1974
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发表时间：
1990-10-17
影响因子：
120.7
通讯作者：
BROOK, RH
中科院分区：
文献类型：
--
作者：
RUBENSTEIN, LV;KAHN, KL;BROOK, RH
我们测量了实施预期支付系统前后的护理质量。我们开发了一个结构化的隐式回顾表，并将其应用于1366例在1981-1982年或1985-1986年住院的充血性心力衰竭、急性心肌梗死、肺炎、脑血管意外或髋部骨折的医疗保险患者的样本。极差的护理质量与入院后30天的死亡率增加相关（17%的护理非常好，30%的护理非常差）。在1981-1982年和1985-1986年期间，医疗服务的质量有所改善（从25%接受较差或极差的医疗服务降至12%），尽管更多的病人被判定为过早出院和病情不稳定（7%对4%）。除了出院计划过程，医疗保险患者的医院护理质量继续改善，尽管或因为引入了前瞻性支付系统及其伴随的专业审查组织审查。
We measured quality of care before and after implementation of the prospective payment system. We developed a structured implicit review form and applied it to a sample of 1366 Medicare patients with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture who were hospitalized in 1981-1982 or 1985-1986. Very poor quality of care was associated with increased death rates 30 days after admission (17% with very good care died vs 30% with very poor care). The quality of medical care improved between 1981-1982 and 1985-1986 (from 25% receiving poor or very poor care to 12%), although more patients were judged to have been discharged too soon and in unstable condition (7% vs 4%). Except for discharge planning processes, the quality of hospital care has continued to improve for Medicare patients despite, or because of, the introduction of the prospective payment system with its accompanying professional review organization review.