A Summary of the Effects of DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients

by Allyson Ross Davies, Harris Montgomery Allen, Willard G. Manning, Susan A. Holtby, Howard L. Bailit, John E. Ware, Katherine L. Kahn, David Draper, Emmett B. Keeler, William H. Rogers, et al.


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This Note comprises reprints of eight articles that originally appeared in JAMA, The Journal of the American Medical Association, Vol. 264, No. 15, October 17, 1990. The series of articles reports on the findings of a four-year evaluation, begun in 1985, of the effects on quality of care of the diagnosis-related-groups-based prospective payment system. The study used a clinically detailed review of the medical record supplemented by data on postdischarge outcomes drawn from the files of the Health Care Financing Administration and fiscal intermediaries to (1) compare outcomes of care after adjustment for sickness at admission, (2) assess the process of in-hospital care and relationships between processes and outcomes, and (3) assess status at discharge for a nationally representative sample of patients hospitalized before and after prospective payment was implemented.

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