[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.146.179.146. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
October 17, 1990

Changes in Quality of Care for Five Diseases Measured by Implicit Review, 1981 to 1986

Author Affiliations

From the Health Program of the RAND Corp, Santa Monica, Calif (Drs Rubenstein, Kahn, Sherwood, Rogers, Draper, and Brook and Mss Reinisch and Kamberg); and the Departments of Medicine (Drs Rubenstein, Kahn, and Brook) and Health Services (Dr Brook), UCLA.

From the Health Program of the RAND Corp, Santa Monica, Calif (Drs Rubenstein, Kahn, Sherwood, Rogers, Draper, and Brook and Mss Reinisch and Kamberg); and the Departments of Medicine (Drs Rubenstein, Kahn, and Brook) and Health Services (Dr Brook), UCLA.

JAMA. 1990;264(15):1974-1979. doi:10.1001/jama.1990.03450150074034
Abstract

We measured quality of care before and after implementation of the prospective payment system. We developed a structured implicit review form and applied it to a sample of 1366 Medicare patients with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture who were hospitalized in 1981-1982 or 1985-1986. Very poor quality of care was associated with increased death rates 30 days after admission (17% with very good care died vs 30% with very poor care). The quality of medical care improved between 1981-1982 and 1985-1986 (from 25% receiving poor or very poor care to 12%), although more patients were judged to have been discharged too soon and in unstable condition (7% vs 4%). Except for discharge planning processes, the quality of hospital care has continued to improve for Medicare patients despite, or because of, the introduction of the prospective payment system with its accompanying professional review organization review.

(JAMA. 1990;264:1974-1979)

×