Quality of care before and after implementation of the DRG-based prospective payment system. A summary of effects

W. H. Rogers, D. Draper, K. L. Kahn, E. B. Keeler, L. V. Rubenstein, J. Kosecoff and R. H. Brook
Health Program, RAND Corp, Santa Monica, Calif. 90406-2138.

In this series we have described changes in the quality of care that have occurred in the treatment of hospitalized elderly Medicare patients with one of five conditions between 1981-1982 and 1985-1986. In this article we report on a mortality analysis, patient and hospital subgroup comparisons, and time series studies we have conducted in an attempt to determine whether changes in quality of care can be linked causally to the introduction of the prospective payment system. Based on these analyses we conclude that (1) mortality following hospitalization has been unaffected by the introduction of the prospective payment system, and improvements in in-hospital processes of care that began prior to the prospective payment system have continued after its introduction, but (2) the prospective payment system has increased the likelihood that a patient will be discharged home in an unstable condition. We recommend that efforts to correct this problem be intensified and that clinical monitoring of the impact of the prospective payment system continue as hospital cost-containment pressures intensify.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting
Hensen et al.
Eur J Public Health 2008;18:85-91.
ABSTRACT | FULL TEXT  

Duration of length of stay in pneumonia: influence of clinical factors and hospital type
Menendez et al.
Eur Respir J 2003;22:643-648.
ABSTRACT | FULL TEXT  

Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001
Jencks et al.
JAMA 2003;289:305-312.
ABSTRACT | FULL TEXT  

Temporal Trends in Outcomes of Older Patients With Pneumonia
Metersky et al.
Arch Intern Med 2000;160:3385-3391.
ABSTRACT | FULL TEXT  

The Effect of Medicare's Payment System for Rehabilitation Hospitals on Length of Stay, Charges, and Total Payments
Chan et al.
NEJM 1997;337:978-985.
ABSTRACT | FULL TEXT  

What Is Outcomes Research and What Can It Tell Us?
Slater
Eval Health Prof 1997;20:243-264.
ABSTRACT  

Racial Differences in the Utilization of Inpatient Rehabilitation Services Among Elderly Stroke Patients
Horner et al.
Stroke 1997;28:19-25.
ABSTRACT | FULL TEXT  

Inference and Hierarchical Modeling in the Social Sciences
Draper
JOURNAL OF EDUCATIONAL AND BEHAVIORAL STATISTICS 1995;20:115-147.
ABSTRACT  

The Impact of Organizational and Managerial Factors on the Quality of Care in Health Care Organizations
Flood
Med Care Res Rev 1994;51:381-428.
 

Possible Influence of the Prospective Payment System on the Assignment of Discharge Diagnoses for Coronary Heart Disease
Assaf et al.
NEJM 1993;329:931-935.
ABSTRACT | FULL TEXT  

Quality Assurance in the Department of Pediatrics: An Application of Quality Management
Joiner and Nelson
American Journal of Medical Quality 1993;8:152-160.
ABSTRACT  

Some Reasoned Utopian Proposals for National Health System Reform in the United States
ROSENAU
American Behavioral Scientist 1993;36:871-886.
ABSTRACT  

The Initial Impact of the Medicare Prospective Payment System on U.S. Health Care: A Review of the Literature
Feinglass and Holloway
Med Care Res Rev 1991;48:91-115.
 

EFFECT OF THE PROSPECTIVE PAYMENT SYSTEM ON QUALITY OF CARE
JWatch General 1990;1990:2-2.
FULL TEXT