TY  - JOUR
T1  - MEasuring quality of care with explicit process criteria before and after implementation of the drg-based prospective payment system
AU  - Kahn KL, Rogers WH, Rubenstein LV, et al
Y1  - 1990/10/17
N1  - 10.1001/jama.1990.03450150069033
JO  - JAMA
SP  - 1969
EP  - 1973
VL  - 264
IS  - 15
N2  - We developed explicit process criteria and scales for Medicare patients hospitalized with congestive heart failure, myocardial infarction, pneumonia, cerebrovascular accident, and hip fracture. We applied the process scales to a nationally representative sample of 14 012 patients hospitalized before and after the implementation of the diagnosis related group—based prospective payment system. For the four medical diseases, a better process of care resulted in lower mortality rates 30 days after admission. Patients in the upper quartile of process scores had a 30-day mortality rate 5% lower than that of patients in the lower quartile. The process of care improved after the introduction of the prospective payment system; eg, better nursing care after the introduction of the prospective payment system was associated with an expected decrease in 30-day mortality rates in pneumonia patients of 0.8 percentage points, and better physician cognitive performance was associated with an expected decrease in 30-day mortality rates of 0.4 percentage points. Overall, process improvements across all four medical conditions were associated with a 1 percentage point reduction in 30-day mortality rates after the introduction of the prospective payment system.(JAMA. 1990;264:1969-1973)
SN  - 0098-7484
M3  - doi: 10.1001/jama.1990.03450150069033
UR  - http://dx.doi.org/10.1001/jama.1990.03450150069033
ER  -