Impact of prospective payment and discharge location on the outcome of hip fracture.
OBJECTIVE
To determine the impact of prospective payment by diagnosis-related groups (DRGs) on length of stay in the hospital, ambulatory status, and level of post-hospital care needed for patients hospitalized with hip fracture.


METHODS
Retrospective chart review of a consecutive series of cases before and after the reference date of implementation of the prospective payment system (PPS).


METHODS
Academic, tertiary-care hospital.


METHODS
181 patients 69 years of age or older admitted with International Classification of Diseases (ICD) or DRG codes for hip fracture.


RESULTS
Length of stay was shorter by 1.37 days in the post-PPS era (p = 0.05). Poorer discharge ambulation was found in the post-PPS group (p = 0.089). At one year, differences in ambulation and nursing home residence were found to be related not to the implementation of PPS, but rather to the nursing home to which the patient was discharged. Patients discharged to a facility with active physical rehabilitation were less likely to remain institutionalized (p = 0.0025) than those in "ordinary" nursing homes and ambulated more independently (p = 0.05).


CONCLUSIONS
The PPS did not have a significant long-term impact on hip fracture outcome. Post-hospital care may be of crucial importance to the future quality of life of hip fracture patients.
Gerety
M B
MB
University of Texas Health Sciences Center, San Antonio.
Soderholm-Difatte
V
V
Winograd
C H
CH
D000359:Aftercare / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003953:Diagnosis-Related Groups; D005260:Female; D006620:Hip Fractures / Q000191:economics* / Q000534:rehabilitation; D006707:Homes for the Aged; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011445:Prospective Payment System