Wylie C M, Flashner B A
Med Care. 1979 Jun;17(6):607-17. doi: 10.1097/00005650-197906000-00005.
The Hospital Admission and Surveillance Program (HASP) was a pre-PSRO program in Illinois. Established in February 1972, its objective was to reduce the cost of care given to Medicaid beneficiaries in that state. HASP approved length of stay (L.O.S.) on a prospective only basis, so that all Medicaid patients were reported promptly on admission. During 1972, the Illinois Medicaid program was rapidly expanding in patient volume, but not in scope of services. This study compares patients admitted to 46 hospitals in Illinois before and after the establishment of HASP. To adjust for changes in case mix between the two periods, each patient was matched for age, diagnosis and illness severity with patients in an appropriate comparison group. The complex process of matching raised the likelihood that changes in L.O.S. were caused by HASP's activities and not by other factors. L.O.S. fell significantly more for Medicaid than for non-Medicaid patients. In addition, the mix of diagnoses changed more markedly for Medicaid than non-Medicaid patients, emphasizing the need for case mix adjustments in this before-and-after study. Some findings suggest that the "post-HASP" admissions had the greater need for hospital care; this trend affected both Medicaid and non-Medicaid patients, however, The combined evidence suggests that concurrent review, as implemented by HASP, helped shorten L.O.S. in 1972. Whether quality of care changed was not studied.
医院入院与监测项目（HASP）是伊利诺伊州在医师服务审查组织（PSRO）项目之前实施的一个项目。该项目于1972年2月设立，其目标是降低该州医疗补助受益人的护理成本。HASP仅前瞻性地批准住院时长（L.O.S.），以便在所有医疗补助患者入院时及时进行报告。1972年期间，伊利诺伊州医疗补助项目的患者数量迅速增加，但服务范围并未扩大。本研究比较了HASP设立前后伊利诺伊州46家医院收治的患者情况。为了调整两个时期病例组合的变化，将每名患者与适当对照组中的患者在年龄、诊断和疾病严重程度方面进行匹配。匹配这一复杂过程增加了住院时长的变化是由HASP的活动而非其他因素导致的可能性。医疗补助患者的住院时长下降幅度明显大于非医疗补助患者。此外，与非医疗补助患者相比，医疗补助患者的诊断组合变化更为显著，这凸显了在这项前后对照研究中进行病例组合调整的必要性。一些研究结果表明，“HASP之后”入院的患者对医院护理的需求更大；然而，这一趋势对医疗补助患者和非医疗补助患者均有影响。综合证据表明，HASP实施的同期审查在1972年有助于缩短住院时长。但未对护理质量是否发生变化进行研究。
