Changes in the status of hospitalized stroke patients since inception of the prospective payment system in 1983

Abstract

Schmidt SM, Guo L, Scheer SJ. Changes in the status of hospitalized stroke patients since inception of the prospective payment system in 1983. Arch Phys Med Rehabil 2002;83:894-8. Objective: To describe epidemiologically the changes in acute-care delivery services for stroke victims since the inception of the 1983 prospective payment system (PPS). Design: A cross-sectional comparison of 2 acute-care hospitalized samples of stroke patients before and after implementation of PPS. Setting: Fifteen acute-care hospitals. Participants: A total of 1992 stroke patients discharged from 15 acute care hospitals in 1995–1996 were compared with 1665 patients studied in the same geographic area in 1981–1982. Interventions: Not applicable. Main Outcome Measures: Incidence rates, length of stay (LOS), discharge destinations, in-hospital transfers, and mortality. Results: Incidence rates between the 2 time periods remained similar (1.13–1.14/1000). Major changes between 1981–1982 and 1995–1996 included reengineering of hospitals to establish subacute units with an increased use of rehabilitation units, a 63% decrease in acute hospital LOS, a 44% increase in discharges to long-term care facilities, a 39% decrease in mortality, and a 5% decrease in discharge to home. Age (avg, 71y), gender, and living arrangements confounded discharge destinations. Significantly more men in 1995–1996 had strokes at younger ages, but overall 53% were women. Conclusions: Institution of the PPS has dramatically influenced hospital LOS, location of treatment, and discharge destinations with no improvement in home discharges. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation