Gillen Robert, Tennen Howard, McKee Tara
Department of Psychology, Sunnyview Hospital and Rehabilitation Center, Schenectady, New York 12308, USA.
Am J Phys Med Rehabil. 2007 May;86(5):356-63. doi: 10.1097/PHM.0b013e31804a7e2f.
To examine the impact of the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS) on outcomes in a stroke rehabilitation program.
An analysis was performed on a database including 945 stroke patients admitted to an inpatient stroke rehabilitation program 5 yrs before implementation of the IRF PPS and 3.5 yrs after implementation. Patients were classified with regard to stroke location (left vs. right), level of cognitive impairment, presence/absence of unilateral neglect, and level of depressive symptomatology. Functional status was evaluated at time of admission and discharge by functional independence measure (FIM). Other outcome measures included length of stay (LOS) and discharge destination. The impact of IRF PPS on LOS, progress in rehabilitation, and discharge destination was examined via univariate analyses of covariance and logistic regression.
Patients admitted after implementation of the IRF PPS had shorter LOS but made less progress, had lower functional levels at discharge, and had higher rates of institutional discharge.
Although associated with decreased LOS, implementation of the IRF PPS was associated with decreased functional gains, lower discharge FIM levels, and higher rates of institutional discharge. Cost savings associated with the PPS must be considered in light of these untoward outcomes.
探讨医疗保险住院康复机构（IRF）前瞻性支付系统（PPS）对中风康复项目结局的影响。
对一个数据库进行分析，该数据库包括在IRF PPS实施前5年和实施后3.5年入住住院中风康复项目的945例中风患者。患者根据中风部位（左侧与右侧）、认知障碍程度、是否存在单侧忽视以及抑郁症状程度进行分类。在入院时和出院时通过功能独立性测量（FIM）评估功能状态。其他结局指标包括住院时间（LOS）和出院去向。通过协方差单因素分析和逻辑回归研究IRF PPS对LOS、康复进展和出院去向的影响。
IRF PPS实施后入院的患者住院时间较短，但康复进展较小，出院时功能水平较低，机构出院率较高。
尽管IRF PPS的实施与住院时间缩短有关，但与功能改善减少、出院FIM水平较低以及机构出院率较高有关。鉴于这些不良结局，必须考虑与PPS相关的成本节约。
