title: Changes in the status of hospitalized stroke patients since inception of the prospective payment system in 1983.
abstract: OBJECTIVE
  To describe epidemiologically the changes in acute-care delivery services for stroke victims since the inception of the 1983 prospective payment system (PPS).
  
  
  METHODS
  A cross-sectional comparison of 2 acute-care hospitalized samples of stroke patients before and after implementation of PPS.
  
  
  METHODS
  Fifteen acute-care hospitals.
  
  
  METHODS
  A total of 1992 stroke patients discharged from 15 acute care hospitals in 1995-1996 were compared with 1665 patients studied in the same geographic area in 1981-1982.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Incidence rates, length of stay (LOS), discharge destinations, in-hospital transfers, and mortality.
  
  
  RESULTS
  Incidence rates between the 2 time periods remained similar (1.13-1.14/1000). Major changes between 1981-1982 and 1995-1996 included reengineering of hospitals to establish subacute units with an increased use of rehabilitation units, a 63% decrease in acute hospital LOS, a 44% increase in discharges to long-term care facilities, a 39% decrease in mortality, and a 5% decrease in discharge to home. Age (avg, 71y), gender, and living arrangements confounded discharge destinations. Significantly more men in 1995-1996 had strokes at younger ages, but overall 53% were women.
  
  
  CONCLUSIONS
  Institution of the PPS has dramatically influenced hospital LOS, location of treatment, and discharge destinations with no improvement in home discharges.
authors.affiliation: Department of Nursing, Xavier University, Cincinnati, OH 45207-7351, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schmidt
authors.forename: Lin
authors.initials: L
authors.lastname: Guo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Scheer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003710:Demography; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007350:Insurance, Hospitalization / Q000639:trends*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D017678:Sex Distribution; D020521:Stroke / Q000191:economics* / Q000453:epidemiology*