Northwestern University, Chicago, Illinois 60611, USA.
Med Care Res Rev. 2010 Apr;67(2):149-72. doi: 10.1177/1077558709341064. Epub 2009 Jul 28.
When Medicare implemented a prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs) in 2002, a lack of organizational research on IRFs hampered the ability to predict how providers would modify their behavior in response to the PPS. This study consists of 36 key informant interviews that examined the experiences of nine IRFs in the lead-up to and aftermath of the IRF-PPS. Drawing on earlier work by Oliver, the authors develop a taxonomy of the new organizational practices that IRFs adopted in response to the changing payment system. A model of key organizational and environmental characteristics that predict the adoption of these practices based on an IRF's willingness and/or capacity to comply with institutional pressure is then proposed. The proposed model can also be applied to other regulatory changes affecting IRFs.
当医疗保险制度于 2002 年对住院康复机构（IRF）实施前瞻性支付制度（PPS）时，由于缺乏对 IRF 的组织研究，阻碍了预测提供者将如何根据 PPS 调整其行为的能力。本研究包括 36 次关键知情者访谈，考察了九家 IRF 在引入和引入后应对 IRF-PPS 的经验。借鉴 Oliver 的早期研究，作者为 IRF 采用的新组织实践开发了一个分类法，以应对不断变化的支付系统。然后提出了一个基于 IRF 遵守制度压力的意愿和/或能力来预测这些实践采用的关键组织和环境特征的模型。该拟议模型还可以应用于影响 IRF 的其他监管变化。
