Document Detail


Changes in sickness at admission following the introduction of the prospective payment system.
MedLine Citation:
PMID:  2120475     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We developed disease-specific measures of sickness at admission based on medical record data to study mortality of Medicare patients with one of five conditions (congestive heart failure, acute myocardial infarction, cerebrovascular accident, pneumonia, and hip fracture). We collected an average of 73 sickness variables per disease, but our final sickness-at-admission scales use, on average, 19 variables. These scales are publicly available, and explain 25% of the variance in 30-day postadmission mortality for patients with acute myocardial infarction, pneumonia, or cerebrovascular accident. Sickness at admission increased following the introduction of the prospective payment system (PPS). For our five diseases combined, the 30-day mortality to be expected because of sickness at admission was 1.0% higher in the 1985-1986 period than in the 1981-1982 period (16.4% vs 15.4%), and the expected 180-day mortality was 1.6% higher (30.1% vs 28.5%). Studies of the effects of PPS on mortality must take this increase in sickness at admission into account.
Authors:
E B Keeler; K L Kahn; D Draper; M J Sherwood; L V Rubenstein; E J Reinisch; J Kosecoff; R H Brook
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  264     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1990 Oct 
Date Detail:
Created Date:  1990-11-19     Completed Date:  1990-11-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1962-8     Citation Subset:  AIM; IM    
Affiliation:
Health Program, RAND Corp., Santa Monica, Calif. 90406-2138.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Comorbidity
Diagnosis-Related Groups
Hospitals / standards*
Humans
Patient Admission*
Prospective Payment System*
Regression Analysis
Severity of Illness Index*
United States
Comments/Corrections
Comment In:
JAMA. 1991 Mar 6;265(9):1112-3   [PMID:  1899895 ]
JAMA. 1990 Oct 17;264(15):1995-6   [PMID:  2120479 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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