The impact of the prospective payment system on the treatment of hip fractures in the elderly

Article Abstract:

The Medicare prospective payment system (PPS) began in October 1984 as a means of reducing patients' length of stay (LOS). Under this system, hospitals are reimbursed based on the amount of care a given condition is expected to require. Reducing LOS is perceived to be a critical factor in lowering the cost of medical care. It remains to be established if shorter hospital stays can be equated with a decline in the quality of care, and there are numerous investigations into the impact of PPS on the cost and quality of care. Some studies have suggested that quality of care may have deteriorated since the institution of PPS, but these studies have been flawed by small patient population sizes. This study reviewed the cases of 386 elderly Medicare patients with similar types of hip fractures admitted to a large private, not-for-profit, teaching hospital during the period 1981 through 1987. Of the 386 patient records reviewed, 190 were from the pre-PPS period and 196 were from the period following the initiation of the Medicare PPS. Hospital charges ranged from $1,328 to $34,052 in 1987 dollars. The average charge was $7,295 for the pre-PPS group and $7,565 for the post-PPS group. A hip fracture procedure charge attained a high of $8,189 in 1984 and subsequently dropped to $7,671 the following year. Taking the rate of inflation into account, the pre- and post-PPS difference in the average charge for treatment is negligible. The total LOS decreased by 24 percent and the time between admission and surgery decreased by 21 percent. Time in the physical therapy (PT) phase decreased from 10.0 days before PPS to 7.9 days after PPS, while the average number of PT treatments per day increased slightly after PPS began, from 1.2 to 1.4. The number of patients remaining in extended care facilities six months after discharge from the hospital following hip fracture surgery was 22.6 percent before PPS, versus the post-PPS figure of 19.9 percent. PPS-impact studies often take place in different types of hospitals, which may influence the outcome of studies and the manner in which the results are interpreted. PPS-impact studies must be conducted in different types of hospital settings, involving different types of physicians and patients, in order to provide complete answers concerning the impact of PPS on the quality of medical care.

Research, Analysis, Insurance claims adjustment, Hospital utilization, Hospital stays, Medicare, Prospective payment systems (Medical care)

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The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly

Article Abstract:

The number of elderly patients admitted to the hospital due to noncompliance with medication dosages or adverse drug reactions was assessed among 315 elderly patients. Compliance is the strict adherence of a patient to directions for taking medications. The causes, consequences, and predictors of hospital admissions due to noncompliance or adverse drug reactions were also examined. Thirty-six hospital admissions were due to noncompliance and 53 cases were due to adverse drug reactions. In addition, 103 of the 315 patients were previously shown to be noncompliant. Factors associated with noncompliance included: poor recall of medication regimen, seeing several physicians, female gender, moderate income category, use of many medications, and opinion that medications are expensive. Factors associated with adverse drug reactions included: use of many medications, higher costs of medications, receiving Medicaid, and not receiving home services. Thus, many elderly persons are admitted to the hospital for drug-related causes, including noncompliance. Certain factors can be used to identify elderly individuals who are at high risk of being admitted to the hospital as a result of drug noncompliance. The results also show that economic factors are important predictors of admissions due to drug noncompliance and adverse drug reactions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Drugs, Demographic aspects, Patient compliance, Adverse drug reactions

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A model of lifetime osteoporosis impact

Article Abstract:

Osteoporosis, or thinning of the bones, is largely a disease of postmenopausal women. People with osteoporosis sustain approximately 1.2 million fractures each year. These fractures are often of the hip, the spine, and the wrist. From 5 to 20 percent of hip fractures result in death. The yearly cost of osteoporosis has been estimated to be greater than 5 billion dollars. A computer model was designed to extrapolate from the known data on osteoporotic fractures. In a hypothetical population of 10,000 white American women, 5,431 would be expected to sustain 8,736 fractures during their lifetimes, with some women experiencing more than one fracture. A significant number of these women would be expected to experience a decline in their functional status as a direct result of their fractures. The total cost to the nation of these fractures is enormous, suggesting that public health measures designed to reduce the number of osteoporotic fractures could have tremendous benefit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Physiological aspects, Menopause, Osteoporosis, Fractures (Injuries), Fractures

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