To gain insight into the possible consequences of prospective payment for university hospitals, we studied 2025 admissions to the faculty and community services of a university hospital, measuring differences in case mix, costs, and mortality in the hospital. The faculty service had more of the patients with costly diagnoses, but even after adjustment for diagnosis-related groups (DRGs), costs were 11 per cent higher on the faculty service (95 per cent confidence limits, 4 to 18 per cent). The percentage differential was greatest for diagnostic costs. The differential was particularly large--70 per cent (95 per cent confidence limits, 33 to 107 per cent)--for patients with a predicted probability of death of 0.25 or greater. The in-hospital mortality rate was significantly lower on the faculty service after adjustment for case mix and patient characteristics (P less than 0.05); the difference was particularly large for patients in the high-death-risk category. Comparison of a matched sample of 51 pairs of admissions from the high-death-risk category confirmed the above results with respect to costs and in-hospital mortality, but follow-up revealed that the survival rates were equal for the two services at nine months after discharge. The effect of prospective payment on the cost of care will be closely watched; we conclude that is will also be important to monitor the effect on outcomes, including hospital mortality rates.
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(1998). Outcomes and Resource Utilization for Patients with Prolonged Critical Illness Managed by University-based or Community-based Subspecialists. Am. J. Respir. Crit. Care Med.
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: e13-e13
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Rosenthal, G. E., Harper, D. L., Quinn, L. M., Cooper, G. S.
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Wall, T. C., Fargason Jr, C. A., Johnson, V. A.
(1997). Comparison of Inpatient Charges Between Academic and Nonacademic Services in a Children's Hospital. Pediatrics
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[Abstract][Full Text]
Scholer, S. J., Pituch, K., Orr, D. P., Clark, D., Dittus, R. S.
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150: 1154-1159
[Abstract]
Esserman, L., Belkora, J., Lenert, L.
(1995). Potentially Ineffective Care: A New Outcome to Assess the Limits of Critical Care. JAMA
274: 1544-1551
[Abstract]
Flood, A. B.
(1994). The Impact of Organizational and Managerial Factors on the Quality of Care in Health Care Organizations. Med Care Res Rev
51: 381-428
Fleming, S. T.
(1990). The Relationship between the Cost and Quality of Hospital Care: A Review of the Literature. Med Care Res Rev
47: 487-502
Iezzoni, L. I., Shwartz, M., Moskowitz, M. A., Ash, A. S., Sawitz, E., Burnside, S.
(1990). Illness Severity and Costs of Admissions at Teaching and Nonteaching Hospitals. JAMA
264: 1426-1431
[Abstract]
Roos, L. L., Fisher, E. S., Sharp, S. M., Newhouse, J. P., Anderson, G., Bubolz, T. A.
(1990). Postsurgical Mortality in Manitoba and New England. JAMA
263: 2453-2458
[Abstract]
Rich, E. C., Gifford, G., Luxenberg, M., Dowd, B.
(1990). The Relationship of House Staff Experience to the Cost and Quality of Inpatient Care. JAMA
263: 953-957
[Abstract]
Buchwald, D., Komaroff, A. L., Cook, E. F., Epstein, A. M.
(1989). Indirect Costs for Medical Education: Is There a July Phenomenon?. Arch Intern Med
149: 765-768
[Abstract]
Flancbaum, L., Brolin, R. E., Kirzecky, M., Mast, B. A., Smith, C. E., Kenler, H. A., Wallis, E. M., Mackenzie, J. W.
(1988). Diagnosis-Related Group Impact of Nutrition Support in Cardiac Surgery Patients. JPEN J Parenter Enteral Nutr
12: 473-477
[Abstract]
Hainer, B. L., Lawler, F. H.
(1988). Comparison of Critical Care Provided by Family Physicians and General Internists. JAMA
260: 354-358
[Abstract]
Siegler, M., Shiedermayer, D. L.
(1987). Should Fluid and Nutritional Support Be Withheld from Terminally Ill Patients?: Tube feeding in hospice settings. AM J HOSP PALLIAT CARE
4: 32-35
Wachtel, T., Moulton, A. W., Pezzullo, J., Hamolsky, M.
(1986). Inpatient Management Protocols to Reduce Health Care Costs. Med Decis Making
6: 101-107
[Abstract]
Bone, R. C., Field, T., Butler, P. W.
(1986). Prospective Payment Guidelines for the Critically Ill Patient: Time for Reassessment. J Intensive Care Med
1: 2-3
Greenberg, L. W.
(1985). Diagnosis-Related Groups: Their Potential Impact on Pediatric Resident Training. Arch Pediatr Adolesc Med
139: 524-526
[Abstract]
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