PMID: 2507614Oct 1, 1989Paper

The impact of the diagnosis-related groups/prospective payment system on nutrition needs in home health and extended-care facilities

Journal of the American Dietetic Association
M J Sandall, L K Massey

Abstract

The effect of the diagnosis-related groups (DRG)/prospective payment system (PPS) on the health status complexity and nutrition needs of patients was studied in home health and five extended-care facilities in Spokane, WA. Three periods were studied: pre-DRG (1982), early DRG implementation (1984), and full DRG implementation (1986). The complexity of patient health status and nutrition needs was measured in three areas: number of total diagnoses, nutrition-related diagnoses, and diet modifications per patient. In home health care, those variables increased significantly from a mean of 4.35 diagnoses per patient in 1982 to 6.12 in 1986, from 1.31 nutrition-related diagnoses per patient in 1982 to 1.99 in 1986, and from 6% of patients with four or more diet modifications in 1982 to 16% in 1986. The complexity of patient health status in extended-care facilities remained stable, with a mean of 6.06 diagnoses per patient in 1982 vs. 5.87 in 1986, 1.84 nutrition-related diagnoses per patient vs. 1.73, and 14% of patients having two or more diet modifications in 1982 vs. 11% in 1986. A consistent odds ratio of 2.06 was observed between number of diagnoses and diet modifications per patient, indicating a direct relationship.

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