论文信息 - Assessing clinical instability at discharge. The clinician's responsibility.

Assessing clinical instability at discharge. The clinician's responsibility.

A great deal of attention has been given to what should be hospital policies when a patient is admitted to the hospital. Who should see the patient? At what time after admission? What should constitute an admission history and physical? Very little attention, however, has been paid to determining when it is safe to send a patient home from the hospital. In addition, precious few randomized trials have been performed that use clinical criteria to compare outcomes following discharge for those people who had the "customary" length of stay vs a "medically correct" length of stay. 1,2 A little over a year ago, we wrote a series of articles 3-10 about the impact of diagnosis related group (DRG)—based prospective payment on quality of care for Medicare patients hospitalized with one of five conditions: congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, and hip fracture. Our data source was a

K. Kahn | R. Brook | J. Kosecoff

[1] D Draper,et al. Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. , 1990, JAMA.

[2] D Draper,et al. Changes in sickness at admission following the introduction of the prospective payment system. , 1990, JAMA.

[3] E. Keeler,et al. Quality of care before and after implementation of the DRG-based prospective payment system. A summary of effects. , 1990, JAMA.

[4] D Draper,et al. Studying the effects of the DRG-based prospective payment system on quality of care. Design, sampling, and fieldwork. , 1990, JAMA.

[5] E. Keeler,et al. The effects of the DRG-based prospective payment system on quality of care for hospitalized Medicare patients. An introduction to the series. , 1990, JAMA.

[6] D Draper,et al. Prospective payment system and impairment at discharge. The 'quicker-and-sicker' story revisited. , 1990, JAMA.

[7] D Draper,et al. Changes in quality of care for five diseases measured by implicit review, 1981 to 1986. , 1990, JAMA.

[8] D Draper,et al. Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. , 1990, JAMA.

[9] A. Creese,et al. Randomised controlled trial of early discharge for inguinal hernia and varicose veins. , 1978, Journal of epidemiology and community health.