Lagoe R J, Lauko S J
Arch Phys Med Rehabil. 1985 Nov;66(11):773-6.
Development of a hospital prospective payment system (PPS) for Medicare patients based on diagnosis related groups (DRGs) should generate renewed interest in acute care utilization by stroke patients. Within the PPS, these patients are classified as DRG 14--specific cerebrovascular disorders except transient ischemic attacks. Hospitals are paid a relatively fixed rate for each Medicare patient within this category. In order to investigate patterns of inpatient care for this DRG, hospital utilization patterns in four United States metropolitan areas with a variety of acute and long-term care utilization characteristics were compared. The study involved a total of 4,593 discharges in DRG 14. Hospital discharge and admission rates and mean stays of the four sample populations were evaluated. Data demonstrated that discharge and admission rates of the four areas in this DRG were similar. However, the results also indicated that mean stays for DRG 14 varied by over 100%. These differences could not be explained by differences in age level and payor status of sample populations. Some variations appeared to be related to limitations in the availability of nursing home beds for posthospital care stroke patients. These results suggest that efforts to improve the efficiency of hospital care for stroke patients under DRGs must increasingly focus on long-term care services.
基于诊断相关分组（DRGs）为医疗保险患者开发医院前瞻性支付系统（PPS），应会重新激发人们对中风患者急性护理利用率的兴趣。在PPS系统中，这些患者被归类为DRG 14——特定脑血管疾病（短暂性脑缺血发作除外）。对于该类别中的每位医疗保险患者，医院会获得相对固定的费用。为了研究该DRG的住院护理模式，比较了美国四个具有不同急性和长期护理利用特征的大都市地区的医院利用模式。该研究总共涉及DRG 14中的4593例出院病例。评估了四个样本群体的医院出院率、入院率和平均住院时间。数据表明，该DRG中四个地区的出院率和入院率相似。然而，结果还表明，DRG 14的平均住院时间差异超过100%。这些差异无法用样本群体的年龄水平和付款人状况的差异来解释。一些差异似乎与中风患者出院后护理的养老院床位供应有限有关。这些结果表明，在DRGs下提高中风患者医院护理效率的努力必须越来越关注长期护理服务。
