IMPACT OF DRGS ON PUBLIC HOME HEALTH NURSING SERVICES

在美国，医疗保健服务的预期支付 各州已经破坏了大部分现有的医疗保健系统。 电流 关于诊断相关组（DRGs）的研究几乎只涉及 急性护理环境。 研究结果通常得出结论，医院 病人出院后，住院时间较短， states. 可以预见，这些变化将对 社区（院外）卫生保健系统。 尽管如此， 这一区域明显缺失。 需要审查从一个 社区视角至关重要。 早期记录的变化 社区服务需求和随之而来的资源消耗将 促进资源开发和分配的适当调整。 卫生服务适应新的患者群体是至关重要的， 保持最佳的社区健康。 特别是公共服务提供者， 必须迅速注意服务提供响应，因为他们几乎没有 或者没有对需求的控制。 这项拟议中的研究将检查公共卫生部门的出院后之家 两组健康患者特征（Medicare和非Medicare） 在两个时间段（DRG前一年和DRG后一年）。 卫生部门将根据地区、地区老年人百分比、 公共卫生护士与人口的比例以及农村化。 实地工作人员将 从大约3000份卫生部门记录中提取的编码数据。 数据将 反映患者预后所指示的护理资源消耗， 护理量、护理强度和护理效果。 差异 这些指标将在不同群体和不同时期之间进行分析。 分析将控制农村、老年人百分比和公众 保健护士/人口比率。 还将审查区域差异。 拟议研究的结果将对以下方面产生重大影响： 机构结构和职能的变化。 例如，工作人员分配或 根据需求的变化， 护理资源的数量或强度。 增加不满意 成果也可以表明需要作出的改变。 如果大幅度增加， 记录每次访问的平均资源消耗， 质疑历史成本基础，这已被用来制定 预期支付系统。

The move to prospective payment for health care services in the United States has disrupted much of the established health care system. Current research on Diagnosis RElated Groups (DRGs) deals almost exclusively with acute care settings. Study findings generally conclude that hospital patients are discharged after shorter lengths of stay and in less healthy states. Predictably, changes such as these will have an impact on the community (extra-hospital) health care system. Nonetheless, research in this area is conspicuously absent. The need for examining changes from a community perspective is critical. Early documentation of changes in community service demands and consequent resource consumption will facilitate appropriate adjustments in resource development and allocation. Health service adaptation to new patient populations is crucial to maintaining optimal community health. Public providers, in particular, must attent quickly to service provision responses since they have little or no control over demand. The proposed study will examine public health department post-hospital home health patient characteristics of two groups (Medicare and non-Medicare) during two time periods (one year before DRGs and one year after DRGs). Health departments will be selected based on region, area percent elderly, public health nurse to population ratio, and rurality. Field staff will code data from approximately 3000 health department records. The data will reflect nursing resource consumption as indicated by patient prognosis, quantity of nursing care, intensity of care and outcome. Differences in these indicators will be analyzed between groups and between time periods. Analyses will be controlled for rurality, percent elderly, and public health nurse/population ratio. Regional variation will also be examined. The findings of the proposed study will have significant implications for agency structural and functional changes. For example, staff allocation or service complement may be re-designed based on changes in demand for quantity or intensity of nursing resources. Increases in unsatisfactory outcomes can also signal needed changes. If significant increases in the average resource consumption per visit are documented, it will bring into question the historical cost base which has been used to develop the prospective payment system.