title: Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system.
abstract: We developed explicit process criteria and scales for Medicare patients hospitalized with congestive heart failure, myocardial infarction, pneumonia, cerebrovascular accident, and hip fracture. We applied the process scales to a nationally representative sample of 14,012 patients hospitalized before and after the implementation of the diagnosis related group-based prospective payment system. For the four medical diseases, a better process of care resulted in lower mortality rates 30 days after admission. Patients in the upper quartile of process scores had a 30-day mortality rate 5% lower than that of patients in the lower quartile. The process of care improved after the introduction of the prospective payment system; eg, better nursing care after the introduction of the prospective payment system was associated with an expected decrease in 30-day mortality rates in pneumonia patients of 0.8 percentage points, and better physician cognitive performance was associated with an expected decrease in 30-day mortality rates of 0.4 percentage points. Overall, process improvements across all four medical conditions were associated with a 1 percentage point reduction in 30-day mortality rates after the introduction of the prospective payment system.
authors.affiliation: Health Program, RAND Corp., Santa Monica, CA 90406-2138.
authors.forename: K L
authors.initials: KL
authors.lastname: Kahn
authors.forename: W H
authors.initials: WH
authors.lastname: Rogers
authors.forename: L V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: M J
authors.initials: MJ
authors.lastname: Sherwood
authors.forename: E J
authors.initials: EJ
authors.lastname: Reinisch
authors.forename: E B
authors.initials: EB
authors.lastname: Keeler
authors.forename: D
authors.initials: D
authors.lastname: Draper
authors.forename: J
authors.initials: J
authors.lastname: Kosecoff
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care / Q000592:standards; D003953:Diagnosis-Related Groups; D006302:Health Services Research; D006299:Health Services for the Aged / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008722:Methods; D011445:Prospective Payment System; D011787:Quality of Health Care