John P Nabagiez1, Masood A Shariff2, William J Molloy2, Seleshi Demissie3, Joseph T McGinn2. 1. Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York. Electronic address: jnabagiez@northwell.edu. 2. Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York. 3. Biostatistics Unit, Feinstein Institute for Medical Research at Staten Island University Hospital, Northwell Health, Staten Island, New York.
Abstract
BACKGROUND: A physician assistant home care (PAHC) program providing house calls was initiated to reduce hospital readmissions after adult cardiac surgery. The purpose of our study was to compare 30-day PAHC and pre-PAHC readmission rate, length of stay, and cost. METHODS: Patients who underwent adult cardiac surgery in the 48 months from September 2008 through August 2012 were retrospectively reviewed using pre-PAHC patients as the control group. Readmission rate, length of stay, and health care cost, as measured by hospital billing, were compared between groups matched with propensity score. RESULTS: Of the 1,185 patients who were discharged directly home, 155 (13%) were readmitted. Total readmissions for the control group (n = 648) was 101 patients (16%) compared with the PAHC group (n = 537) total readmissions of 54 (10%), a 38% reduction in the rate of readmission (p = 0.0049). Propensity score matched groups showed a rate reduction of 41% with 17% (62 of 363) for the control compared with 10% (37 of 363) for the PAHC group (p = 0.0061). The average hospital bill per readmission was $39,100 for the control group and $56,600 for the PAHC group (p = 0.0547). The cost of providing home visits was $25,300 for 363 propensity score matched patients. CONCLUSIONS: The PAHC program reduced the 30-day readmission rate by 41% for propensity score matched patients. Analysis demonstrated a savings of $977,500 at a cost of $25,300 over 2 years, or $39 in health care saved, in terms of hospital billing, for every $1 spent. Therefore, a home visit by a cardiac surgical physician assistant is a cost-effective strategy to reduce readmissions after cardiac surgery.
BACKGROUND: A physician assistant home care (PAHC) program providing house calls was initiated to reduce hospital readmissions after adult cardiac surgery. The purpose of our study was to compare 30-day PAHC and pre-PAHC readmission rate, length of stay, and cost. METHODS:Patients who underwent adult cardiac surgery in the 48 months from September 2008 through August 2012 were retrospectively reviewed using pre-PAHCpatients as the control group. Readmission rate, length of stay, and health care cost, as measured by hospital billing, were compared between groups matched with propensity score. RESULTS: Of the 1,185 patients who were discharged directly home, 155 (13%) were readmitted. Total readmissions for the control group (n = 648) was 101 patients (16%) compared with the PAHC group (n = 537) total readmissions of 54 (10%), a 38% reduction in the rate of readmission (p = 0.0049). Propensity score matched groups showed a rate reduction of 41% with 17% (62 of 363) for the control compared with 10% (37 of 363) for the PAHC group (p = 0.0061). The average hospital bill per readmission was $39,100 for the control group and $56,600 for the PAHC group (p = 0.0547). The cost of providing home visits was $25,300 for 363 propensity score matched patients. CONCLUSIONS: The PAHC program reduced the 30-day readmission rate by 41% for propensity score matched patients. Analysis demonstrated a savings of $977,500 at a cost of $25,300 over 2 years, or $39 in health care saved, in terms of hospital billing, for every $1 spent. Therefore, a home visit by a cardiac surgical physician assistant is a cost-effective strategy to reduce readmissions after cardiac surgery.
Authors: Nicoleta Stoicea; Tian You; Andrew Eiterman; Clifton Hartwell; Victor Davila; Stephen Marjoribanks; Cristina Florescu; Sergio Daniel Bergese; Barbara Rogers Journal: Front Cardiovasc Med Date: 2017-11-27
Authors: George Theocharis; Spyridon G Barbas; Theodore Spiropoulos; Petroula E Stamouli; Dimitrios N Perdikis; Matthew E Falagas Journal: BMC Health Serv Res Date: 2018-04-27 Impact factor: 2.655