Cost Effectiveness of a Novel Attempt to Reduce Readmission after Ileostomy Creation

Abstract

Background and Objectives:Dehydration is a common complication after ileostomy creation and is the most frequent reason for postoperative readmission to the hospital. We sought to determine the clinical and economic impact of an outpatient intervention to decrease readmissions for dehydration after ileostomy creation.Methods:All new ileostomates from 09/2011 through 10/2012 at the University of Florida were enrolled to receive an ileostomy education and management protocol and a daily telephone call for 3 weeks after discharge. Counseling and medication adjustments were provided, with a satisfaction survey at the end. Outcomes of these patients were compared to those in a historical control cohort. A cost analysis was conducted to calculate the savings to the hospital.Results:Thirty-eight patients were enrolled. All patients required telephone counseling, and the mean satisfaction score rating was 4.69, on a scale of 1 to 5. The readmission rate for dehydration within 30 days of discharge decreased significantly from 65% before intervention to 16% (5/32 patients) after intervention (P = .002). The length of readmission hospital stay decreased from a mean of 4.2 days before the introduction of the intervention to 3 days after. Cost analysis revealed that the actual total hospital cost of dehydration-specific readmission decreased from $88,858 to $25,037, a saving of $63,821.Conclusion:A standardized ileostomy pathway with comprehensive patient education and outpatient telephone follow-up is cost effective, has a positive influence on patient satisfaction, and reduces dehydration-related readmission rates.

Telehealth and patient satisfaction: a systematic review and narrative analysis

“…Telehealth can provide a high-quality service, increase access to care, 19 42 46 48 increase self-awareness 31 34 35 38 and item powers patients to manage their chronic conditions. 13 21 23 28 31 32 48 Healthcare organisations should embrace telehealth because it decreases missed appointments, 44 is a good modality for education, 15 34 44 decreases wait times, 16 43 48 49 decreases readmissions 9 21 and improves medication adherence. 13 38 44 But most importantly, policymakers need to help legislation catch up with the technology by enabling additional means of reimbursement for telehealth because the modality improves outcomes, 8 9 11 13 15–18 20–26 31–33 38–41 47 50 which improves public health.…”

Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable

“…However, readmission rates for ileostomates are reported to be as high as 65% and often are not stated in the literature. 5 We have published our efforts to reduce the readmission rate in this patient population. 5 Other centers have reported success with different novel outpatient approaches to the same concern.…”

“… 5 We have published our efforts to reduce the readmission rate in this patient population. 5 Other centers have reported success with different novel outpatient approaches to the same concern. 13 However, with the intensification of financial pressure on health care systems to avoid readmission after the enactment of the Affordable Care Act of 2010, an objective method of predicting readmissions in this population was needed.…”

“…Although historical readmission rates for colorectal surgery range from 10% to 30%, they are much higher (up to 65%) in patients with a new ileostomy. 3 – 5 Complications, such as bowel obstruction, surgical site infection (SSI), intra-abdominal abscess, dehydration, and stoma-related complications, have been found to be responsible for most readmissions after ileostomy creation. 6 The unique challenges of this population are exacerbated by fast-track protocols; early discharge of new ileostomates continues to elicit concern for readmission risk and associated morbidity.…”

Editorial. Telemedicine for elective neurosurgical routine follow-up care: a promising patient-centered and cost-effective alternative to in-person clinic visits

“…At the other extreme, telemedicine may be well ac-cepted and cost-effective for urban, developed-country, high-income, tech-savvy populations who value enhanced convenience and the reduced travel burden. 8 This new telemedicine cost-effectiveness study for post-neurosurgical follow-up care is one of a small handful of studies for specialty surgery, 1,5,12 and considerably more studies are needed to overcome a dearth of evidence. Moving telemedicine into the mainstream requires shifting its evidence base from promising toward generalizable to address decision-maker and policymaker information needs.…”