Lyles Y M
J Am Geriatr Soc. 1986 Aug;34(8):573-8. doi: 10.1111/j.1532-5415.1986.tb05762.x.
To evaluate the impact of the Medicare Prospective Payment System (PPS) on nursing homes, resident census and staffing data from 78 Portland, Oregon nursing homes were compiled from annual reports filed with the state. Between fiscal years (FYs) 1983 and 1984, (before and after initiation of the Medicare PPS), there was no significant change in the total number of patient-days, but there was a 20.5% increase in the total number of deaths and a significant increase in average facility adjusted death rates (P = .004). Between the previous FYs 1982 and 1983, the total number of deaths had risen only 8.3%, and the average facility adjusted death rate had no significant change. Since initiation of diagnosis-related groups (DRGs), these nursing homes also made sizeable increases in their adjusted full-time registered nurse employment rate, and reported fewer patients reimbursed by Medicare. These same nursing homes were surveyed in spring, 1985 to determine the impact of Medicare DRGs in more qualitative terms. Of the 51 nursing homes (66%) responding, more than half reported increased severity of illness, shorter length of stay, increased prevalence of clinical problems, and increased use of medical supplies. In addition, more than half of the respondents reported increased frequency of requests for Friday and weekend admissions, admission of patients too sick for the facility, and physician phone consultation. These findings indicate that Portland, Oregon nursing homes experienced increased patient severity of illness, explained at least in part by earlier hospital discharge, following DRGs.
为评估医疗保险预付费系统（PPS）对养老院的影响，从向俄勒冈州提交的年度报告中收集了俄勒冈州波特兰市78家养老院的居民普查和人员配置数据。在1983财年和1984财年之间（医疗保险PPS启动前后），患者住院天数总数没有显著变化，但死亡总数增加了20.5%，且机构调整后的平均死亡率显著上升（P = 0.004）。在1982财年和1983财年之间，死亡总数仅上升了8.3%，机构调整后的平均死亡率没有显著变化。自诊断相关组（DRG）启动以来，这些养老院调整后的全职注册护士就业率也大幅提高，且医疗保险报销的患者数量减少。1985年春季对这些相同的养老院进行了调查，以更定性地确定医疗保险DRG的影响。在回复的51家养老院（66%）中，超过一半报告患者病情严重程度增加、住院时间缩短、临床问题患病率增加以及医疗用品使用增加。此外，超过一半的受访者报告周五和周末入院请求增加、收治病情过重不适宜该机构的患者以及医生电话咨询增加。这些发现表明，俄勒冈州波特兰市的养老院患者病情严重程度增加，这至少部分是由于DRG实施后医院提前出院所致。
