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

Abstract

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.