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Coping with DRGs--a nursing home's experience.

D D Tresch1, E H Duthie, H W Gruchow

  • 1Medical College of Wisconsin, Milwaukee.

The American Journal of the Medical Sciences
|November 1, 1989
PubMed
Summary
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The implementation of Diagnostic Related Groups (DRGs) significantly increased nursing home admissions and discharges. This shift also led to a rise in acute hospital transfers within 30 days for nursing home patients.

Area of Science:

  • Healthcare Management
  • Geriatric Care
  • Health Economics

Background:

  • Prospective Payment System (PPS) based on Diagnostic Related Groups (DRGs) revolutionized hospital operations.
  • The impact of DRGs on nursing home patient flow and care needs remained less understood.

Purpose of the Study:

  • To assess the effect of DRG implementation on nursing home patient activity.
  • To analyze changes in admissions, acute hospital transfers, and discharges post-DRGs.

Main Methods:

  • A retrospective study analyzing data from a Veterans Administration teaching nursing home.
  • Data collection covered one year pre-DRG implementation and three consecutive years post-DRG implementation.
  • Key metrics included patient admissions, 30-day acute hospital transfers, and 30-day discharges.

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Main Results:

  • Nursing home admissions increased sevenfold from 1983 (36 patients) to 1986 (average 23.8 patients/month).
  • The rate of patients requiring acute hospital transfer within 30 days rose, reaching approximately 27% in 1986.
  • Discharges from the nursing home also increased, with an average of two patients per month discharged within 30 days post-DRGs, compared to none pre-DRGs.

Conclusions:

  • DRG implementation significantly altered nursing home patient demographics and care patterns.
  • Increased patient acuity and shorter lengths of stay in nursing homes are suggested by the data.
  • Healthcare policy changes like DRGs have profound downstream effects on post-acute care settings.