title: Prospective payment system and impairment at discharge. The 'quicker-and-sicker' story revisited.
abstract: Since the introduction of the prospective payment system (PPS), anecdotal evidence has accumulated that patients are leaving the hospital "quicker and sicker." We developed valid measures of discharge impairment and measured these levels in a nationally representative sample of patients with one of five conditions prior to and following the PPS implementation. Instability at discharge (important clinical problems usually first occurring prior to discharge) predicted the likelihood of postdischarge deaths. At 90 days postdischarge, 16% of patients discharged unstable were dead vs 10% of patients discharged stable. After the PPS introduction, instability increased primarily among patients discharged home. Prior to the PPS, 10% of patients discharged home were unstable; after the PPS was implemented, 15% were discharged unstable, a 43% relative change. Efforts to monitor the effect of this increase in discharge instability on health should be implemented.
authors.affiliation: Value Health Sciences Inc, Santa Monica, Calif. 90404.
authors.forename: J
authors.initials: J
authors.lastname: Kosecoff
authors.forename: K L
authors.initials: KL
authors.lastname: Kahn
authors.forename: W H
authors.initials: WH
authors.lastname: Rogers
authors.forename: E J
authors.initials: EJ
authors.lastname: Reinisch
authors.forename: M J
authors.initials: MJ
authors.lastname: Sherwood
authors.forename: L V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: D
authors.initials: D
authors.lastname: Draper
authors.forename: C P
authors.initials: CP
authors.lastname: Roth
authors.forename: C
authors.initials: C
authors.lastname: Chew
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality; D006620:Hip Fractures / Q000401:mortality; D006761:Hospitals / Q000592:standards; D006801:Humans; D010351:Patient Discharge; D011014:Pneumonia / Q000401:mortality; D011445:Prospective Payment System; D011787:Quality of Health Care; D012044:Regression Analysis; D012720:Severity of Illness Index; D014481:United States