Prospective Payment System and Impairment at Discharge

The 'Quicker-And-Sicker' Story Revisited

Published in: JAMA, The Journal of the American Medical Association, v. 264, no. 15, Oct. 17, 1990, p. 1980-1983

Posted on RAND.org on January 01, 1990

by Jacqueline Kosecoff, Katherine L. Kahn, William H. Rogers, Ellen J. Reinisch, Marjorie J. Sherwood, Lisa V. Rubenstein, David Draper, Carol P. Roth, Carole Chew, Robert H. Brook

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Since the introduction of the prospective payment system (PPS), anecdotal evidence has accumulated that patients are leaving the hospital quicker and sicker. The authors of this study developed valid measures of discharge impairment and measured these levels in a nationally representative sample of patients with one of five conditions prior to and following the PPS implementation. Instability at discharge (important clinical problems usually first occurring prior to discharge) predicted the likelihood of postdischarge deaths. At 90 days postdischarge, 16% of patients discharged unstable were dead vs. 10% of patients discharged stable. After the PPS introduction, instability increased primarily among patients discharged home. Prior to the PPS, 10% of patients discharged home were unstable; after the PPS was implemented, 15% were discharged unstable, a 43% relative change. Efforts to monitor the effect of this increase in discharge instability on health should be implemented.

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