COMPARING OUTCOMES OF CARE BEFORE AND AFTER IMPLEMENTATION OF THE DRG-BASED PROSPECTIVE PAYMENT SYSTEM
COMPARING OUTCOMES OF CARE BEFORE AND AFTER IMPLEMENTATION OF THE DRG-BASED PROSPECTIVE PAYMENT SYSTEM
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DOI：
10.1001/jama.264.15.1984
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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：
KAHN, KL;KEELER, EB;BROOK, RH
我们在1981年至1982年和1985年至1986年因五种疾病之一住院的14,012名医疗保险患者的全国代表性样本中，比较了引入基于诊断相关组（DRG）的前瞻性支付系统（PPS）前后的患者结局。对于五种疾病的合并，住院时间下降了24%，住院死亡率从16.1%下降到12.6%（P <0.05）。入院时经疾病校正的30天死亡率比治疗前低1.1%（PPS前16.5%，PPS后15.4%; P <0.05），180天校正死亡率基本不变，PPS前为29.6%，PPS后为29.0%（P <0.05）。对于从家中入院的患者，PPS后没有出院回家的患者比PPS前多4%（P <0.05），另外1%的患者延长了护理之家的停留时间（P <0.05）。PPS的引入与住院医疗保险患者的结局恶化无关。然而，由于我们的PPS后数据来自1985年和1986年，我们建议保持临床监测，以确保预期支付的变化不会对患者结局产生负面影响。
We compared patient outcomes before and after the introduction of the diagnosis related groups (DRG)-based prospective payment system (PPS) in a nationally representative sample of 14,012 Medicare patients hospitalized in 1981 through 1982 and 1985 through 1986 with one of five diseases. For the five diseases combined, length of stay dropped 24% and in-hospital mortality declined from 16.1% to 12.6% after the PPS was introduced (P < .05). Thirty-day mortality adjusted for sickness at admission was 1.1% lower than before (16.5% pre-PPS, 15.4% post-PPS; P < .05),and 180-day adjusted mortality was essentially unchanged at 29.6% pre- vs 29.0% post-PPS (P < .05). For patients admitted to the hospital from home, 4% more patients were not discharged home post-PPS than pre-PPS (P < .05), and an additional 1% of patients had prolonged nursing home stays (P < .05). The introduction of the PPS was not associated with a worsening of outcome for hospitalized Medicare patients. However, because our post-PPS data are from 1985 and 1986, we recommend that clinical monitoring be maintained to ensure that changes in prospective payment do not negatively affect patient outcome.