Birgitta Ljunggren1, Per-Olow Sjödén. 1. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. birgitta.ljunggren@hig.se
Abstract
OBJECTIVE: To evaluate the effects of the introduction of a payment system based on Diagnosis-Related Groups (DRG) on orthopedic patients' perceptions of quality of life after discharge. DESIGN: A prospective longitudinal study performed between 1992 and 1996. SETTING: Two surgical clinics in the County of Gävleborg, Sweden. STUDY PARTICIPANTS: The selection of patients was defined by surgical treatments/diagnoses, and by geographical area. Out of the 40 consecutively recruited patients per year from each hospital, >85% (n = 145 + 140 = 285) completed a questionnaire 1 week post-discharge, and >75% (n = 128 + 127 = 255) did so at a 6-week follow-up. MAIN OUTCOME MEASURE: The Swedish Health-Related Quality of Life Survey (SWED-QUAL) was used to assess quality of life. Straight factoral analyses of variance (ANOVAs) were performed to compare years of assessment in the same hospital/district. RESULTS: The results demonstrated no pattern of significant pre-post differences in patient-reported quality of life. In all years, most quality of life ratings were lower at 1 week compared with 6 weeks after discharge. These differences were probably the consequence of recently undergone surgery. CONCLUSION: The overall conclusion is that changes implemented in health care, including the DRGs, had no demonstrable impact on patient ratings of quality of life.
OBJECTIVE: To evaluate the effects of the introduction of a payment system based on Diagnosis-Related Groups (DRG) on orthopedic patients' perceptions of quality of life after discharge. DESIGN: A prospective longitudinal study performed between 1992 and 1996. SETTING: Two surgical clinics in the County of Gävleborg, Sweden. STUDY PARTICIPANTS: The selection of patients was defined by surgical treatments/diagnoses, and by geographical area. Out of the 40 consecutively recruited patients per year from each hospital, >85% (n = 145 + 140 = 285) completed a questionnaire 1 week post-discharge, and >75% (n = 128 + 127 = 255) did so at a 6-week follow-up. MAIN OUTCOME MEASURE: The Swedish Health-Related Quality of Life Survey (SWED-QUAL) was used to assess quality of life. Straight factoral analyses of variance (ANOVAs) were performed to compare years of assessment in the same hospital/district. RESULTS: The results demonstrated no pattern of significant pre-post differences in patient-reported quality of life. In all years, most quality of life ratings were lower at 1 week compared with 6 weeks after discharge. These differences were probably the consequence of recently undergone surgery. CONCLUSION: The overall conclusion is that changes implemented in health care, including the DRGs, had no demonstrable impact on patient ratings of quality of life.