Courtney J Balentine1, Glen Leverson2, David J Vanness3, Sara Knight4, Janet Turan5, Cynthia J Brown6, Herb Chen7, Smita Bhatia8. 1. Department of Surgery, University of Alabama at Birmingham, 1600 7th Ave South, Lowder Building Suite 500, Birmingham, AL 35233, United States; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, United States. Electronic address: cbalentine@uabmc.edu. 2. University of Wisconsin, 600 Highland Ave, Madison, WI 53792, United States. Electronic address: leverson@surgery.wisc.edu. 3. University of Wisconsin, 600 Highland Ave, Madison, WI 53792, United States. Electronic address: dvanness@wisc.edu. 4. Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, United States. Electronic address: sjknight@uab.edu. 5. School of Public Health, University of Alabama at Birmingham, Birmingham, United States. Electronic address: jmturan@uab.edu. 6. Birmingham/Atlanta VA GRECC, Birmingham, AL, United States; Department of Medicine, Division of Gerontology, Geriatrics & Palliative Care, University of Alabama at Birmingham, Birmingham, United States. Electronic address: cynthiabrown@uabmc.edu. 7. Department of Surgery, University of Alabama at Birmingham, 1600 7th Ave South, Lowder Building Suite 500, Birmingham, AL 35233, United States. Electronic address: herbchen@uab.edu. 8. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, United States. Electronic address: sbhatia@peds.uab.edu.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Entities:
Keywords:
Care transitions; Cost-effectiveness; Post-acute care; Post-discharge care; Postoperative recovery
Authors: Allison M Gustavson; Rebecca S Boxer; Amy Nordon-Craft; Robin L Marcus; Andrea Daddato; Jennifer E Stevens-Lapsley Journal: Phys Ther J Policy Adm Leadersh Date: 2018-08