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Health Serv Res. 1990 February; 24(6): 713–728.
PMCID: PMC1065597

Changes in case mix and outcomes of readmissions to nursing homes between 1980 and 1984.


This study compares the personal characteristics, measures of functional status/case mix, and immediate discharge outcomes of two cohorts of nursing home patients (1980 and 1984). All of these patients had a prior history of nursing home care and all were readmitted to skilled nursing facilities from hospitals. In 1984, readmissions were more disabled, more debilitated, and significantly less likely to return home. They were almost twice as likely to be rehospitalized within 30 days of discharge from the hospital (26.7 percent versus 48.9 percent). Analyses showed poorer health status and an increased proportion of nursing home deaths and rehospitalizations in the 1984 group to be a function of time (1984 versus 1980) rather than of insurance coverage (Medicare versus other). Nursing home readmissions appear to be quite sensitive to cost-containment efforts, and they may require additional hospital days to stabilize their conditions in an effort to reduce the rate of hospital readmissions and the overall cost of care.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Eggers PW. Prospective payment system and quality: early results and research strategy. Health Care Financ Rev. 1987 Dec;Spec No:29–37. [PubMed]
  • Fitzgerald JF, Fagan LF, Tierney WM, Dittus RS. Changing patterns of hip fracture care before and after implementation of the prospective payment system. JAMA. 1987 Jul 10;258(2):218–221. [PubMed]
  • Guterman S, Dobson A. Impact of the Medicare prospective payment system for hospitals. Health Care Financ Rev. 1986 Spring;7(3):97–114. [PubMed]
  • Iglehart JK. Early experience with prospective payment of hospitals. N Engl J Med. 1986 May 29;314(22):1460–1464. [PubMed]
  • Keeler EB, Kane RL, Solomon DH. Short- and long-term residents of nursing homes. Med Care. 1981 Mar;19(3):363–370. [PubMed]
  • Lewis MA, Leake B, Leal-Sotelo M, Clark V. The initial effects of the prospective payment system on nursing home patients. Am J Public Health. 1987 Jul;77(7):819–821. [PubMed]
  • Lewis MA, Leake B, Clark V, Leal-Sotelo M. Case mix and outcomes of nursing home patients. The importance of prior nursing home care and admission from home versus hospital. Med Care. 1989 Apr;27(4):376–385. [PubMed]
  • Lewis MA, Kane RL, Cretin S, Clark V. The immediate and subsequent outcomes of nursing home care. Am J Public Health. 1985 Jul;75(7):758–762. [PubMed]
  • Lewis MA, Cretin S, Kane RL. The natural history of nursing home patients. Gerontologist. 1985 Aug;25(4):382–388. [PubMed]
  • Lyles YM. Impact of Medicare diagnosis-related groups (DRGs) on nursing homes in the Portland, Oregon metropolitan area. J Am Geriatr Soc. 1986 Aug;34(8):573–578. [PubMed]
  • Meiners MR, Coffey RM. Hospital DRGs and the need for long-term care services: an empirical analysis. Health Serv Res. 1985 Aug;20(3):359–384. [PMC free article] [PubMed]
  • Sager MA, Easterling DV, Kindig DA, Anderson OW. Changes in the location of death after passage of Medicare's prospective payment system. A national study. N Engl J Med. 1989 Feb 16;320(7):433–439. [PubMed]
  • Sager MA, Leventhal EA, Easterling DV. The impact of Medicare's prospective payment system on Wisconsin nursing homes. JAMA. 1987 Apr 3;257(13):1762–1766. [PubMed]
  • Shaughnessy PW, Kramer AM, Schlenker RE, Polesovsky MB. Nursing home case-mix differences between Medicare and non-Medicare and between hospital-based and freestanding patients. Inquiry. 1985 Summer;22(2):162–177. [PubMed]
  • Williams S. Prospective payment under Medicare: what are its effects? J Gen Intern Med. 1986 Sep-Oct;1(5):342–343. [PubMed]
  • Zimmer JG, Eggert GM, Treat A, Brodows B. Nursing homes as acute care providers. A pilot study of incentives to reduce hospitalizations. J Am Geriatr Soc. 1988 Feb;36(2):124–129. [PubMed]

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