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

摘要: We measured quality of care before and after implementation the prospective payment system. developed a structured implicit review form applied it to sample 1366 Medicare patients with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture who were hospitalized in 1981-1982 1985-1986. Very poor was associated increased death rates 30 days admission (17% very good died vs 30% care). The medical improved between 1985-1986 (from 25% receiving 12%), although more judged have been discharged too soon unstable condition (7% 4%). Except for discharge planning processes, hospital has continued improve despite, because of, introduction system its accompanying professional organization review. ( JAMA . 1990;264:1974-1979)