title: Comparing outcomes of care before and after implementation of the DRG-based prospective payment system.
abstract: 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 less than .05). Thirty-day mortality adjusted for sickness at admission was 1.1% lower than before (16.5% pre-PPS, 15.4% post-PPS; P less than .05), and 180-day adjusted mortality was essentially unchanged at 29.6% pre-vs 29.0% post-PPS (P less than .05). For patients admitted to the hospital from home, 4% more patients were not discharged home post-PPS than pre-PPS (P less than .05), and an additional 1% of patients had prolonged nursing home stays (P less than .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.
authors.affiliation: Health Program, RAND Corp, Santa Monica, Calif. 90406-2138.
authors.forename: K L
authors.initials: KL
authors.lastname: Kahn
authors.forename: E B
authors.initials: EB
authors.lastname: Keeler
authors.forename: M J
authors.initials: MJ
authors.lastname: Sherwood
authors.forename: W H
authors.initials: WH
authors.lastname: Rogers
authors.forename: D
authors.initials: D
authors.lastname: Draper
authors.forename: S S
authors.initials: SS
authors.lastname: Bentow
authors.forename: E J
authors.initials: EJ
authors.lastname: Reinisch
authors.forename: L V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: J
authors.initials: J
authors.lastname: Kosecoff
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D003953:Diagnosis-Related Groups; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D006278:Medicare; D009026:Mortality; D009735:Nursing Homes; D010359:Patient Readmission; D011366:Professional Review Organizations; D011445:Prospective Payment System; D011787:Quality of Health Care; D014481:United States