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首页> 外文学位 >Post-acute care practice patterns after major orthopedic surgery: The impact of the Balanced Budget Act of 1997.
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Post-acute care practice patterns after major orthopedic surgery: The impact of the Balanced Budget Act of 1997.

机译：大型骨科手术后的急性后护理实践模式：1997年平衡预算法的影响。

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摘要

In an attempt to control rapidly escalating Medicare post-acute care (PAC) expenditures, Congress implemented the Balanced Budget Act of 1997. Under this act, Medicare implemented several policies targeted at PAC. Beginning October 1, 1998 Medicare discounted payments to hospitals that discharged patients early (prior to the geometric mean length of stay) to PAC agencies. Beginning October 1, 1997, Medicare implemented sharp reductions in the Home Health (HH) per-visit limit on aggregate payments and instituted per-beneficiary limits. These restrictions were relaxed October 1, 1998 prior to implementing a prospective payment plan in October 1, 2000.; Using interrupted time series analysis patients undergoing either elective joint replacement surgery (JR) or surgical repair of hip fracture (FX) between January 1, 1996 and December 31, 2001 were studied.; After implementation of the Short Stay Transfer Policy, the trend towards shorter length of stay ended and the proportion of patients discharged early to PAC dropped. For-profit hospitals responded more briskly. Although there was significant regional variation with respect to response to the policy and fiscal impact from the policy, there were no detectable differential effects by patient socio-demographic or clinical characteristics.; After implementation of the HH interim payment policy, there were reductions in probability of selection of HH care as a venue of PAC and the number of visits conditional upon being selected for HH care. After implementation of the prospective payment system, there were reductions in the conditional number of visits provided. There were sharper reductions in conditional utilization for older patients, women, patient receiving state aid or patients receiving their care at for-profit hospitals.; Amongst JR patients, the sharp reductions noted in the HH care market were somewhat offset by increased utilization of rehabilitation hospitals. During the study years, there were no detectable changes in hospital readmission rates after elective joint replacement surgery. Amongst FX patients, after implementation of the Balanced Budget Act, there were significant reductions in HH and skilled nursing care. While there was a significant increase in the proportion of hospital readmissions over the 6-year study period, there was no clear association with policy implementation or changes in PAC utilization.
机译：为了控制急速上升的Medicare急诊护理（PAC）支出，国会实施了1997年的“平衡预算法案”。在此法案下，Medicare实施了一些针对PAC的政策。从1998年10月1日开始，Medicare降低了向PAC机构尽早（在几何平均住院时间之前）出院患者的医院的付款。从1997年10月1日开始，Medicare大幅降低了每次支付总费用的家庭健康（HH）每次访问限额，并制定了每个受益人限额。 1998年10月1日放宽了这些限制，然后在2000年10月1日实施了预期的付款计划。使用间断时间序列分析，研究了在1996年1月1日至2001年12月31日之间接受选择性关节置换手术（JR）或髋关节骨折手术（FX）手术的患者。实施“短期住院转诊政策”后，住院时间缩短的趋势结束了，提早出院到PAC的患者比例下降了。营利性医院的反应更为活跃。尽管在应对政策和政策对财政的影响方面存在很大的地区差异，但患者的社会人口统计学或临床特征并未发现可察觉的不同影响。实施HH临时付款政策后，选择HH护理作为PAC场所的可能性降低了，并且选择了接受HH护理的条件下的就诊次数也有所减少。实施预期付款制度后，有条件就诊次数有所减少。老年患者，妇女，接受国家援助的患者或在营利性医院接受治疗的患者的有条件利用急剧减少。在JR患者中，HH护理市场上出现的大幅下降在一定程度上被康复医院利用率的提高所抵消。在研究期间，选择性关节置换手术后医院的再入院率没有可检测到的变化。在FX患者中，实施《平衡预算法》后，HH和熟练护理的人数明显减少。尽管在为期6年的研究期内，住院再住院的比例显着增加，但与政策实施或PAC使用率的变化之间没有明显关联。

著录项

  • 作者

    FitzGerald, John Dermot.;

  • 作者单位

    University of California, Los Angeles.;

  • 授予单位 University of California, Los Angeles.;
  • 学科 Health Sciences Public Health.; Health Sciences Health Care Management.; Health Sciences Medicine and Surgery.
  • 学位 Ph.D.
  • 年度 2005
  • 页码 177 p.
  • 总页数 177
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;预防医学、卫生学;
  • 关键词

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