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October 17, 1990JAMA

In-hospital mortality declined from 16.1% to 12.6% (P < .05) and 30-day adjusted mortality was 1.1% lower (16.5% pre-PPS vs 15.4% post-PPS; P < .05) after PPS introduction.

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Why the study?

Does the introduction of the DRG-based prospective payment system (PPS) worsen outcomes in hospitalized Medicare patients?

Population

14,012 Medicare patients hospitalized with one of five diseases, nationally representative sample.

Comparison

Diagnosis related groups-based prospective… vs Care before the introduction of the DRG-based…

Design

Cohort

Follow-up

180 days

Authors

KKKatherine L. Kahn

Discussion

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Member takes

Overview

PPS introduction was not associated with mortality harm in Medicare patients; observational data leaves causal effects and nursing home utilization open.

Structured PICO

Does the introduction of the DRG-based prospective payment system (PPS) worsen outcomes in hospitalized Medicare patients?

P
Population
14,012 Medicare patients hospitalized with one of five diseases, nationally representative sample.
I
Intervention
Diagnosis related groups (DRG)-based prospective payment system (PPS) (hospitalized 1985 through 1986)
C
Comparator
Care before the introduction of the DRG-based prospective payment system (hospitalized 1981 through 1982)
O
Outcome
In-hospital mortality and length of stayhard clinical

The introduction of the DRG-based prospective payment system was not associated with worsened mortality outcomes for hospitalized Medicare patients, though it slightly increased the rate of prolonged nursing home stays.

Limitations

  • Post-PPS data are limited to 1985 and 1986, requiring ongoing clinical monitoring

Cite This Study

Katherine L. Kahn (1990) studied this question.

synapsesocial.com/papers/69d56b3975589c71d767c977https://doi.org/10.1001/jama.1990.03450150084036
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