Abstract
We reviewed the three-month hospital readmission rates of 410 patients ages 70 years or older discharged alive with a first time diagnosis of congestive heart failure during the period January 1983-June 1986. The mean age was 79.8 years, 59.5 per cent were women. Mean length of initial hospital stay decreased from 10.8 days in 1983 to 7.8 days in 1986. One hundred-nineteen patients (29 per cent) were rehospitalized at least once within three months of initial discharge. The readmission rates by year were: 1983, 40.0 per cent; 1984, 27.5 per cent; 1985, 21.4 per cent; 1986, 23.2 per cent. During this same interval, the percentage of patients referred for home health care services increased from 3.3 per cent in 1983 to 13.0 per cent in 1984, 5.8 per cent in 1985, and 12.5 per cent in 1986. Thus, decreased length of hospital stay was associated with a parallel decline in early readmission rate and increased utilization of home health care services. Although this study has important methodologic limitations, the data suggest that shorter hospital stays under the DRG system are not necessarily associated with an increased rate of early rehospitalization.
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Selected References
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- Anderson G. F., Steinberg E. P. Hospital readmissions in the Medicare population. N Engl J Med. 1984 Nov 22;311(21):1349–1353. doi: 10.1056/NEJM198411223112105. [DOI] [PubMed] [Google Scholar]
- Avorn J. Benefit and cost analysis in geriatric care. Turning age discrimination into health policy. N Engl J Med. 1984 May 17;310(20):1294–1301. doi: 10.1056/NEJM198405173102005. [DOI] [PubMed] [Google Scholar]
- Berenson R. A., Pawlson L. G. The Medicare Prospective Payment System and the care of the frail elderly. J Am Geriatr Soc. 1984 Nov;32(11):843–848. doi: 10.1111/j.1532-5415.1984.tb06301.x. [DOI] [PubMed] [Google Scholar]
- Butler P. W., Bone R. C., Field T. Technology under Medicare diagnosis-related groups prospective payment. Implications for medical intensive care. Chest. 1985 Feb;87(2):229–234. doi: 10.1378/chest.87.2.229. [DOI] [PubMed] [Google Scholar]
- Champlin L. DRGs: putting the squeeze on your older patients? Geriatrics. 1985 Jul;40(7):77–81. [PubMed] [Google Scholar]
- Fleg J. L. CHF: reflections on current management of the older patient. Geriatrics. 1986 Sep;41(9):71-3, 76-8, 81. [PubMed] [Google Scholar]
- Gersh B. J., Kronmal R. A., Frye R. L., Schaff H. V., Ryan T. J., Gosselin A. J., Kaiser G. C., Killip T., 3rd Coronary arteriography and coronary artery bypass surgery: morbidity and mortality in patients ages 65 years or older. A report from the Coronary Artery Surgery Study. Circulation. 1983 Mar;67(3):483–491. doi: 10.1161/01.cir.67.3.483. [DOI] [PubMed] [Google Scholar]
- Gooding J., Jette A. M. Hospital readmissions among the elderly. J Am Geriatr Soc. 1985 Sep;33(9):595–601. doi: 10.1111/j.1532-5415.1985.tb06315.x. [DOI] [PubMed] [Google Scholar]
- Gosney M., Tallis R. Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital. Lancet. 1984 Sep 8;2(8402):564–567. doi: 10.1016/s0140-6736(84)90775-x. [DOI] [PubMed] [Google Scholar]
- Iglehart J. K. Early experience with prospective payment of hospitals. N Engl J Med. 1986 May 29;314(22):1460–1464. doi: 10.1056/NEJM198605293142228. [DOI] [PubMed] [Google Scholar]
- Knoebel S. B. The effect of cost containment on the practice of cardiology: predictions. Am J Cardiol. 1985 Aug 23;56(5):32C–34C. doi: 10.1016/s0002-9149(85)80006-0. [DOI] [PubMed] [Google Scholar]
- Lamy P. P. The elderly and drug interactions. J Am Geriatr Soc. 1986 Aug;34(8):586–592. doi: 10.1111/j.1532-5415.1986.tb05764.x. [DOI] [PubMed] [Google Scholar]
- Montague N. T., 3rd, Kouchoukos N. T., Wilson T. A., Bennett A. L., 3rd, Knott H. W., Lochridge S. K., Erath H. G., Jr, Clayton O. W. Morbidity and mortality of coronary bypass grafting in patients 70 years of age and older. Ann Thorac Surg. 1985 Jun;39(6):552–557. doi: 10.1016/s0003-4975(10)61997-2. [DOI] [PubMed] [Google Scholar]
- Omenn G. S., Conrad D. A. Implications of DRGs for clinicians. N Engl J Med. 1984 Nov 15;311(20):1314–1317. doi: 10.1056/NEJM198411153112011. [DOI] [PubMed] [Google Scholar]
- Ouslander J. G. Drug therapy in the elderly. Ann Intern Med. 1981 Dec;95(6):711–722. doi: 10.7326/0003-4819-95-6-711. [DOI] [PubMed] [Google Scholar]
- Raizner A. E., Hust R. G., Lewis J. M., Winters W. L., Jr, Batty J. W., Roberts R. Transluminal coronary angioplasty in the elderly. Am J Cardiol. 1986 Jan 1;57(1):29–32. doi: 10.1016/0002-9149(86)90946-x. [DOI] [PubMed] [Google Scholar]
- Rhodes R. S., Krasniak C. L., Jones P. K. Factors affecting length of hospital stay for femoropopliteal bypass. Implications of the DRGs. N Engl J Med. 1986 Jan 16;314(3):153–157. doi: 10.1056/NEJM198601163140305. [DOI] [PubMed] [Google Scholar]
- Rich M. W., Sandza J. G., Kleiger R. E., Connors J. P. Cardiac operations in patients over 80 years of age. J Thorac Cardiovasc Surg. 1985 Jul;90(1):56–60. [PubMed] [Google Scholar]
- Rock R. C. Assuring quality of care under DRG-based prospective payment. Med Decis Making. 1985;5(1):31–34. doi: 10.1177/0272989X8500500108. [DOI] [PubMed] [Google Scholar]
- Rosko M. D., Broyles R. W. The impact of the New Jersey all-payer DRG system. Inquiry. 1986 Spring;23(1):67–75. [PubMed] [Google Scholar]
- Satinsky J. D. Chronic heart failure in the elderly: vasodilator therapy. Angiology. 1983 Aug;34(8):509–516. doi: 10.1177/000331978303400802. [DOI] [PubMed] [Google Scholar]
- Shock N. W. Systems physiology and aging: introduction. Fed Proc. 1979 Feb;38(2):161–162. [PubMed] [Google Scholar]
- Sorlie P. D., Gold E. B. The effect of physician terminology preference on coronary heart disease mortality: an artifact uncovered by the 9th revision ICD. Am J Public Health. 1987 Feb;77(2):148–152. doi: 10.2105/ajph.77.2.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stern R. S., Epstein A. M. Institutional responses to prospective payment based on diagnosis-related groups. Implications for cost, quality, and access. N Engl J Med. 1985 Mar 7;312(10):621–627. doi: 10.1056/NEJM198503073121005. [DOI] [PubMed] [Google Scholar]
- Williams S. V. The impact of DRG-based prospective payment on clinical decision making. Med Decis Making. 1985;5(1):23–29. doi: 10.1177/0272989X8500500106. [DOI] [PubMed] [Google Scholar]
- Zook C. J., Moore F. D. High-cost users of medical care. N Engl J Med. 1980 May 1;302(18):996–1002. doi: 10.1056/NEJM198005013021804. [DOI] [PubMed] [Google Scholar]