Quality of Care for Depressed Elderly Pre-Post Prospective Payment System

Using data from the RAND Prospective Payment/Quality of Care Study, examines whether quality of care changed for depressed, elderly hospitalized patients before and after implementation of the PPS. It asks if the economic incentives inherent in different ways of delivering psychiatric care in the post-PPS period (i.e., when hospitals either had no psychiatric unit, had an exempt psychiatric unit, or had a nonexempt unit), and whether the patient was on a medical or psychiatric ward, resulted in differences in quality of care. The general findings were that quality of care increased over time, and that for most measures of quality of care, the level of improvement did not differ significantly across different types of hospitals or ward placement. In nonexempt psychiatric units and in hospitals without psychiatric units, the intensity of the use of therapeutic services (rehabilitation, occupation, recreation therapy) increased over time so that the level of services in these units approached the level of services in exempt psychiatric units. Several outcomes of care improved over time. The degree of improvement in the rate of inpatient medical and psychiatric complications and other outcomes was significantly greater for psychiatric units that were exempt post-PPS than for nonexempt treatment locations. The findings of this study have implications for designing policies intended to affect the amount of services patients consume.