Trends in Elderly Hospitalization and Readmission Rates for a Geographically Defined Population: Pre‐ and Post‐Prospective Payment

Abstract

To address the paucity of patient-level data regarding the effectiveness of Medicare's prospective payment system (PPS), we conducted a population-based study of inpatient hospitalizations among individually identified elderly residents of Olmsted County, Minnesota, 1970-1987. A 4.3% increase in total days of care/1000 population from 2,652/1,000 in 1970 to 2,766/1,000 in 1980 was followed by a 9.8% decline from 1980 to 1987 (2,495/1,000). The decline was due primarily to a 13.4% decrease in mean length stay (9.7 days in 1980 to 8.4 days in 1987). The number of hospitalizations/1,000 Olmsted County elderly in 1980 was already below 1987 U.S. figures and did not exhibit the decline evidenced nationally between 1980 and 1987. A 4.6% decline in the proportion of county residents age 65-74 years who were hospitalized (174/1,000 in 1980 to 166/1,000 in 1987) was offset by an 8.3% increase for persons age greater than or equal to 75 (252/1,000 to 273/1,000) and by a 5.7% increase in the number of hospitalizations per individual hospitalized for persons age 65-74 years (1.34 to 1.42). Using a time-dependent Cox model, which adjusted for differences in patients characteristics between years, there was a significantly higher risk of readmission within 14 days in 1987 vs 1980 (hazard ratio (HR) = 1.33, 95% confidence interval (CI) = 1.05-1.70). The difference between years was no longer evident at 30 or 60 days (HR = 0.84, 95% CI = 0.63-1.11 between 15 and 30 days; HR = 1.12, 95% CI = 0.84-1.49 between 31 and 60 days). This study suggests that initial effects of PPS on utilization may be temporary and that more research is needed to appreciate the impact of cost-containment on patient outcome.

The Impact of Aging and Chronic Disease on Use of Hospital and Outpatient Services in a Large HMO: 1971–1991

“…Ghali et al 13 attributed the increase to improved survival resulting from better medical treatment of ischemic heart disease, hypertension, and congestive heart failure itself, particularly the introduction of angiotension‐converting enzyme (ACE) inhibitors. As in our study, Anderson and Pulcins 15 noted a concurrent decline in admissions for ischemic heart disease from 1979 to 1989.…”

“…Based on overall membership data, we found that hospitalization rates rose through the early 1980s and declined abruptly beginning in 1984, undoubtedly because of the introduction of the Prospective Payment System by Medicare. Similar abrupt effects of prospective payment have been observed nationally 15 . Both the early rise and the later decline in hospital rates are included in the period covered by the 1980–88 cohort.…”

Demographic and clinical variation of adult intensive care unit utilization from a geographically defined population

“…In 2000, the U.S. census reported the population of Olmsted County as 124,277, with 50.9% female residents, 90.3% white, and 10.7% aged Ն65 yrs. Rates of utilization of medical services in Olmsted County, including hospitalizations, have been previously reported using this database (13).…”

Direct Medical Costs Attributable to Osteoporotic Fractures

“…Utilization and billing data systems for the two practice groups and the three affiliated hospitals have been linked to allow 'capture' of all inpatient and outpatient activity delivered by these providers to the residents of Olmsted County [23,24]. To derive the total costs of fracture care, unit costs for each health service and procedure provided to every individual in our study population were estimated.…”