title: The impact of the prospective payment system: perceived changes in the nature of practice and clinical education.
abstract: OBJECTIVE
  Health care financing for teaching hospitals has undergone significant change in the past decade. This report describes changes in physical therapy practice and clinical education in three New England hospitals from 1984 to 1988.
  
  
  METHODS
  Hospital administrators, physical therapy managers, and clinical educators (N = 18) from the three teaching hospitals participated in this descriptive study.
  
  
  METHODS
  Demographic, environmental, and participant interview data were gathered and examined to identify changes during this period.
  
  
  RESULTS
  Perceived changes in practice include growth in specialized knowledge; increased emphasis on health care quality, efficiency, and accountability; new ethical dilemmas for practitioners; and a changing physical therapy role with new professional development opportunities. Perceived changes associated with clinical education were increased student performance expectations, unchanged resources for clinical education, greater emphasis on student self-directedness, and continued high valuing of this setting for physical therapy clinical education.
  
  
  CONCLUSIONS
  These results indicate significant change in the role of the physical therapist within these settings and suggest how these changes influence the clinical education of physical therapy students in these teaching hospitals.
authors.affiliation: Department of Physical Therapy, School of Allied Health Sciences, University of Vermont, Burlington 05405-0068.
authors.forename: M J
authors.initials: MJ
authors.lastname: Emery
mesh_terms: D002983:Clinical Competence; D003625:Data Collection; D003710:Demography; D006740:Hospital Administrators; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D007858:Learning; D007902:Length of Stay; D010351:Patient Discharge; D010814:Physical Therapy Department, Hospital / Q000458:organization & administration; D026741:Physical Therapy Modalities / Q000193:education / Q000639:trends*; D011364:Professional Practice / Q000639:trends*; D011445:Prospective Payment System; D013663:Teaching / Q000379:methods