[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.158.81.119. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
October 17, 1990

Prospective Payment System and Impairment at DischargeThe `Quicker-and-Sicker' Story Revisited

Author Affiliations

From Value Health Sciences Inc, Santa Monica, Calif (Dr Kosecoff and Mss Roth and Chew); the Health Program of the RAND Corp, Santa Monica, Calif (Drs Kahn, Rogers, Sherwood, Rubenstein, Draper, and Brook, and Ms Reinisch); and the Departments of Medicine (Drs Kosecoff, Kahn, Rubenstein, and Brook) and Health Services (Drs Kosecoff and Brook), UCLA.

From Value Health Sciences Inc, Santa Monica, Calif (Dr Kosecoff and Mss Roth and Chew); the Health Program of the RAND Corp, Santa Monica, Calif (Drs Kahn, Rogers, Sherwood, Rubenstein, Draper, and Brook, and Ms Reinisch); and the Departments of Medicine (Drs Kosecoff, Kahn, Rubenstein, and Brook) and Health Services (Drs Kosecoff and Brook), UCLA.

JAMA. 1990;264(15):1980-1983. doi:10.1001/jama.1990.03450150080035
Abstract

Since the introduction of the prospective payment system (PPS), anecdotal evidence has accumulated that patients are leaving the hospital "quicker and sicker." We 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 110% 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.

(JAMA. 1990;264:1980-1983)

×