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首页> 外文期刊>Health services research: HSR >Impact of the Medicare Short Stay Transfer Policy on patients undergoing major orthopedic surgery.
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Impact of the Medicare Short Stay Transfer Policy on patients undergoing major orthopedic surgery.

机译：《 Medicare短期住院治疗转移政策》对接受大整形外科手术的患者的影响。

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OBJECTIVE: To examine the impact of the Short Stay Transfer Policy (SSTP) on practice patterns. DATA SOURCES: This study uses data from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review (MEDPAR) file, Home Health Standard Analytical File, 1999 Provider of Service file, and data from the 2000 United States Census. STUDY DESIGN: An interrupted time-series analysis was used to examine the length of stay (LOS) and probability of "early" discharge to post acute care (PAC). DATA COLLECTION: Separate 100 percent samples of all fee-for-service Medicare recipients undergoing either elective joint replacement (JR) surgery or surgical management of hip fracture (FX) between January 1, 1996 and December 31, 2000 were selected. PRINCIPAL FINDINGS: Prior to implementation of the SSTP. LOS had been falling by 0.37 and 0.30 days per year for JR and FX patients respectively. After implementation of the SSTP, there was an immediate increase in LOS by 0.20 and 0.17 days, respectively. Thereafter, LOS remained flat. The proportion of patients discharged "early" to PAC had been rising by 4.4 and 2.6 percentage points per year for JR and FX patients respectively, to a peak of 28.8 percent and 20.4 percent early PAC utilization in September 1998. Immediately after implementation of the SSTP, there was a 4.3 and 3.0 percentage point drop in utilization of "early" PAC. Thereafter utilization of early PAC increased at a much slower rate (for JR) or remained flat (for FX). There was significant regional variation in the magnitude of response to the policy. CONCLUSION: Implementation of the SSTP reduced the financial incentive to discharge patients early to PAC. This was accomplished primarily through longer LOS without meaningful change in PAC utilization. With the recent expansion of the SSTP to 29 DRGs (representing 34 percent of all discharges), these findings have important implications regarding patient care.
机译：目的：研究短期停留转移政策（SSTP）对实践模式的影响。数据来源：本研究使用的数据来自医疗保险和医疗补助服务中心的医疗保险提供者分析和审查（MEDPAR）文件，家庭健康标准分析文件，1999年服务提供者文件以及2000年美国人口普查数据。研究设计：中断时间序列分析用于检查住院时间（LOS）和急性护理后（PAC）的“早期”出院率。数据收集：在1996年1月1日至2000年12月31日之间接受选择性关节置换（JR）手术或髋部骨折手术（FX）手术的所有有偿医疗保险接受者中，分别抽取100％的样本。主要发现：在实施SSTP之前。 JR和FX患者的LOS每年分别下降0.37天和0.30天。实施SSTP后，LOS分别立即增加0.20天和0.17天。此后，LOS保持平稳。 JR和FX病人“早”出PAC的比例每年分别上升4.4和2.6个百分点，在1998年9月早期PAC使用率达到峰值28.8％和20.4％。SSTP实施后立即，“早期” PAC的利用率分别下降了4.3和3.0个百分点。此后，早期PAC的利用率以非常慢的速度增长（对于JR）或保持平稳（对于FX）。对政策的反应程度在地区上有很大差异。结论：SSTP的实施降低了将患者尽早送往PAC的经济诱因。这主要是通过更长的LOS来实现的，而PAC利用率没有显着变化。随着SSTP最近扩展到29个DRG（占所有出院的34％），这些发现对患者护理具有重要意义。

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