title: The impact of the diagnosis-related groups/prospective payment system on nutrition needs in home health and extended-care facilities.
abstract: The effect of the diagnosis-related groups (DRG)/prospective payment system (PPS) on the health status complexity and nutrition needs of patients was studied in home health and five extended-care facilities in Spokane, WA. Three periods were studied: pre-DRG (1982), early DRG implementation (1984), and full DRG implementation (1986). The complexity of patient health status and nutrition needs was measured in three areas: number of total diagnoses, nutrition-related diagnoses, and diet modifications per patient. In home health care, those variables increased significantly from a mean of 4.35 diagnoses per patient in 1982 to 6.12 in 1986, from 1.31 nutrition-related diagnoses per patient in 1982 to 1.99 in 1986, and from 6% of patients with four or more diet modifications in 1982 to 16% in 1986. The complexity of patient health status in extended-care facilities remained stable, with a mean of 6.06 diagnoses per patient in 1982 vs. 5.87 in 1986, 1.84 nutrition-related diagnoses per patient vs. 1.73, and 14% of patients having two or more diet modifications in 1982 vs. 11% in 1986. A consistent odds ratio of 2.06 was observed between number of diagnoses and diet modifications per patient, indicating a direct relationship.
authors.affiliation: Spokane Community College, Washington 99207.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sandall
authors.forename: L K
authors.initials: LK
authors.lastname: Massey
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003953:Diagnosis-Related Groups / Q000191:economics*; D004035:Diet Therapy; D004750:Enteral Nutrition; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000706:statistics & numerical data*; D006699:Home Care Services; D006801:Humans; D009751:Nutritional Requirements; D011445:Prospective Payment System; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D014861:Washington