The Medicare prospective payment theory as applied to the management of patient care outcomes

This work concerns the effect of a case manager at hospital discharge on nursing home placement. Further, this research explored the impact that gender, marital status, housing level at admission and health status had as predictors of nursing home placement at hospital discharge. This research was designed to describe the critical point of hospital discharge to develop causal hypotheses and new options for moving Medicare patients to appropriate, least costly, least restrictive environments. Finally, discharge planners' perceptions of their hospitals' services were evaluated.

The study concludes that: (1) housing at admission, age, marital status and gender are predictors of hospital discharge to nursing homes; (2) hospitals vary in their housing placements of elderly Medicare patients at discharge; (3) there were significant differences in the level of housing independence eight weeks after hospital discharge between patients receiving case management and those receiving typical discharge planning practices; and (4) discharge planners perceive their hospitals' services to be less comprehensive in the areas of housing referral and housing follow-up than in any other area. This exploratory study suggests that using a case management approach after hospital discharge could result in a 21 percent decrease in the number of elderly patients remaining in the nursing home eight weeks after discharge, which is a potential annual savings of $3 million in Colorado's nursing home costs.