Selecting post-acute care settings after abdominal surgery: Are we getting it right? - 19/07/18

Doi : 10.1016/j.amjsurg.2017.08.043

Courtney J. Balentine ^a,^b,^⁎ , Glen Leverson ^c , David J. Vanness ^c , Sara Knight ^d , Janet Turan ^e , Cynthia J. Brown ^f,^g , Herb Chen ^a , Smita Bhatia ^b
^a Department of Surgery, University of Alabama at Birmingham, 1600 7th Ave South, Lowder Building Suite 500, Birmingham, AL 35233, United States
^b Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, United States
^c University of Wisconsin, 600 Highland Ave, Madison, WI 53792, United States
^d Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, United States
^e School of Public Health, University of Alabama at Birmingham, Birmingham, United States
^f Birmingham/Atlanta VA GRECC, Birmingham, AL, United States
^g Department of Medicine, Division of Gerontology, Geriatrics & Palliative Care, University of Alabama at Birmingham, Birmingham, United States

^∗Corresponding author. 1600 7th Avenue South, Lowder Building Suite 500, Birmingham, AL 35233, United States.1600 7th Avenue SouthLowder Building Suite 500BirminghamAL35233United States

Abstract

Background

We investigated whether variation in post-acute care (PAC) services could be explained by surgeons discharging clinically similar patients to different PAC destinations, including home health (HH), skilled nursing facilities (SNF), and inpatient rehabilitation (IR).

Methods

We studied patients having colectomy, pancreatectomy or hepatectomy in the 2008–2011 Nationwide Inpatient Sample. We used propensity matching to determine:

1. Proportion of patients discharged to SNF/IR who could be matched to clinically similar patients discharged with HH.

2. Potential cost savings from greater use of HH.

Results

30,843 patients were discharged with HH and 23,172 to SNF or IR. 14,163 (61%) SNF/IR patients could be matched to similar patients discharged with HH. Potential cost savings from increasing use of HH as an alternative to SNF/IR ranged from $2.5-$438 million annually.

Conclusions

There is considerable potential for reducing variation in PAC use and costs by better understanding how surgeons make decisions about PAC placement.

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Keywords : Post-acute care, Post-discharge care, Care transitions, Postoperative recovery, Cost-effectiveness

Plan

Propensity score matching to compare patient characteristics

Statistical analysis

Results

Patient characteristics

Potential cost savings from greater utilization of home health

Discussion

Implications for health systems

Limitations

Conclusions

Funding source

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Vol 216 - N° 2

P. 260-266 - août 2018 Retour au numéro

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Selecting post-acute care settings after abdominal surgery: Are we getting it right? - 19/07/18

Abstract

Background

Methods

Results

Conclusions

Plan

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