QUALITY OF CARE FOR DEPRESSED ELDERLY PRE-POST-PROSPECTIVE PAYMENT SYSTEM - DIFFERENCES IN RESPONSE ACROSS TREATMENT SETTINGS

We evaluated the quality of care for depressed elderly patients (n=2,7 46) hospitalized in general medical hospitals (n = 297) before or afte r implementation of Medicare's Prospective Payment System, focusing on whether the response to time period differed for hospitals that in th e post-PPS period had no psychiatric unit, an exempt psychiatric unit, or a nonexempt unit, and by ward placement within hospitals with psyc hiatric units. Quality of care increased over time, and for most measu res of quality of care the level of improvement did not differ signifi cantly across different types of hospitals or by ward placement. The i ntensity of use of therapeutic services, such as rehabilitation, occup ation, or recreation therapy, increased over time, particularly in non exempt psychiatric units and hospitals without psychiatric units, such that these locations caught up some over time in the level of use of these services to the level for exempt psychiatric units. Several outc omes of care improved over time, and the degree of improvement in the rate of inpatient medical and psychiatric complications and other outc omes was significantly greater for psychiatric units that were exempt post-PPS than for nonexempt treatment locations.