Rubenstein L V, Kahn K L, Reinisch E J, Sherwood M J, Rogers W H, Kamberg C, Draper D, Brook R H
Health Program, RAND Corp., Santa Monica, Calif. 90406-2138.
JAMA. 1990 Oct 17;264(15):1974-9.
We measured quality of care before and after implementation of the prospective payment system. We developed a structured implicit review form and applied it to a sample of 1366 Medicare patients with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture who were hospitalized in 1981-1982 or 1985-1986. Very poor quality of care was associated with increased death rates 30 days after admission (17% with very good care died vs 30% with very poor care). The quality of medical care improved between 1981-1982 and 1985-1986 (from 25% receiving poor or very poor care to 12%), although more patients were judged to have been discharged too soon and in unstable condition (7% vs 4%). Except for discharge planning processes, the quality of hospital care has continued to improve for Medicare patients despite, or because of, the introduction of the prospective payment system with its accompanying professional review organization review.
我们测量了前瞻性支付系统实施前后的医疗质量。我们制定了一份结构化的隐性审查表格，并将其应用于1981 - 1982年或1985 - 1986年住院的1366名患有充血性心力衰竭、急性心肌梗死、肺炎、脑血管意外或髋部骨折的医疗保险患者样本。护理质量非常差与入院后30天死亡率增加相关（护理质量非常好的患者死亡率为17%，而护理质量非常差的患者死亡率为30%）。1981 - 1982年至1985 - 1986年期间医疗护理质量有所改善（接受差或非常差护理的患者比例从25%降至12%），尽管更多患者被判定出院过早且病情不稳定（7%对4%）。除出院计划流程外，尽管引入了前瞻性支付系统及其附带的专业审查组织审查，医疗保险患者的医院护理质量仍持续改善，或者说正因如此而得到改善。
