Carroll N V, Erwin W G
Department of Pharmacy and Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond 23298.
Am J Hosp Pharm. 1990 Oct;47(10):2251-4.
Health status, nondrug treatment, and drug use were compared for patients discharged from hospitals to seven long-term-care facilities (LTCFs) in Pennsylvania before and after implementation of the prospective-pricing system (PPS) for hospitalized Medicare patients. Data were collected from medical records of LTCF patients for August 1982 through July 1983 (pre-PPS) and August 1985 through July 1986 (post-PPS). Patients in the post-PPS group (n = 297) had greater numbers of illnesses and more serious illnesses on admission to the LTCFs and were more likely to be readmitted to hospitals than pre-PPS patients (n = 312). Patients in the post-PPS group required more nondrug treatments such as urinary catheters, nutritional supplements, and oxygen and received significantly more drug therapy. The cost of drugs was 50% higher in the PPS group. The post-PPS patients admitted to the LTCFs apparently required more posthospital drug and non-drug therapy than the pre-PPS patients. Any system for prospective pricing in LTCFs should take into account the increases in costs for providing long-term care, including drug therapy, that have occurred since prospective pricing for hospitalized patients began.
在宾夕法尼亚州对住院医疗保险患者实施前瞻性定价系统（PPS）前后，比较了出院至七个长期护理机构（LTCF）的患者的健康状况、非药物治疗和药物使用情况。数据收集自1982年8月至1983年7月（PPS实施前）以及1985年8月至1986年7月（PPS实施后）LTCF患者的病历。PPS实施后组的患者（n = 297）在入住LTCF时疾病数量更多且病情更严重，比PPS实施前组的患者（n = 312）更有可能再次住院。PPS实施后组的患者需要更多诸如导尿管、营养补充剂和氧气等非药物治疗，并且接受的药物治疗显著更多。PPS组的药物成本高出50%。入住LTCF的PPS实施后患者显然比PPS实施前患者需要更多出院后的药物和非药物治疗。LTCF中的任何前瞻性定价系统都应考虑自住院患者前瞻性定价开始以来提供长期护理（包括药物治疗）的成本增加情况。
