Home Hospital for Surgery

Bryan, Ava Ferguson; Levine, David M.; Tsai, Thomas C.

doi:10.1001/jamasurg.2021.0597

Cited by 22 publications

(24 citation statements)

References 6 publications

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“…Therefore, supporting rural hospitals may be a key component of strategies to ensure access to subspecialist care in rural areas. More innovative solutions, such as home hospital for surgery, where acute perioperative care is provided at home, may also increase care in geographically underserved areas, but further study is needed as this has been primarily implemented in urban areas 33,34 . Although both of these strategies may relieve the total travel burden, a limitation to both of these strategies is that while patients can have consultation closer to home, they would still need to travel long distances for any surgical procedures that were indicated.…”

Section: Discussionmentioning

confidence: 99%

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Herb

Holmes

Stitzenberg

2022

The Journal of Rural Health

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Purpose We evaluated temporal trends in rural‐urban disparities of the surgeon supply among surgeons commonly treating patients with cancer. Methods We performed a retrospective observational study of county‐level workforce changes from 2004 to 2017 using the Area Health Resource File. We calculated physician density (providers/100,000 population) for each specialty by rural and urban counties using the 2003 Rural‐Urban Commuting Codes (RUCC), and evaluated percent changes in the rural‐urban disparity in physician density. Secondary analyses evaluated these changes by Census region. Additionally, Gini indices were calculated by year and RUCC to evaluate the workforce inequality within rural areas. Findings Total surgical specialist density declined in rural areas from 16 to 14 per 100,000 population, and declined slightly from 33 to 31 per 100,000 population in urban areas, for a rural‐urban disparity increase of 8% (95% CI 5%,10%). Among specific specialties, the percentage increase in the rural‐urban workforce supply disparity was largest for colorectal surgeons and general surgeons at 66% (95% CI 51%,80%) and 72% (95% CI 58%,86%), respectively, although absolute changes were small. Regional heterogeneity of the workforce was higher for rural areas than urban areas. Conclusions Changes in the rural‐urban physician workforce disparities over time are dependent upon specialty, region, and local community factors. This highlights how surgical workforce policy should be oriented to the local area circumstances.

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Section: Discussionmentioning

confidence: 99%

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Herb

Holmes

Stitzenberg

2022

The Journal of Rural Health

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“…Our findings suggesting stable and low volumes of outpatient bariatric surgical procedures suggests that widespread insurance denials of inpatient bariatric surgical coverage would be detrimental to patient access as the overwhelming majority of bariatric surgical procedures remain in the inpatient setting. Alternative solutions to maximize inpatient bed capacity while maintaining appropriate postoperative monitoring and care of patients may need to instead rely on acute hospital care at home (“home hospital”) programs [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Inpatient and Outpatient Utilization of Bariatric Surgery

et al. 2022

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Background During the COVID-19 pandemic, deferral of inpatient elective surgical procedures served as a primary mechanism to increase surge inpatient capacity. Given the benefit of bariatric surgery on treating obesity and associated comorbidities, decreased access to bariatric surgery may have long-term public health consequences. Understanding the extent of the disruption of the COVID-19 pandemic to bariatric surgery will help health systems plan for appropriate access. Materials and methods This is an observational cohort study using the PINC AI Healthcare Database from 1/1/2019–6/31/2021. A Poisson regression model with patient characteristics and hospital-fixed effects was used to assess the relative monthly within-hospital reduction in surgical encounters, variations by race and ethnicity, and shift from inpatient to outpatient procedures. A multivariate linear probability model was used to assess the change in 30-day readmissions from 2020 and 2021 compared to 2019. Results Among 309 hospitals, there were 46,539 bariatric procedures conducted in 2019 with a 14.8% reduction in volume to 39,641 procedures in 2020. There were 22,642 bariatric procedures observed from January to June of 2021. The most pronounced decrease in volume occurred in April with an 89.7% relative reduction from 2019. Black and Hispanic patients were more likely to receive bariatric surgery after the height of the pandemic compared to white patients. A clinically significant shift from inpatient to outpatient bariatric surgical procedures was not observed. Relative to 2019, there were no significant differences in bariatric surgical readmission rates. Conclusion During the pandemic there was a sizable decrease in bariatric surgical volume. There did not appear to be disparities in access to bariatric surgery for minority patients. We did not observe a meaningful shift toward outpatient bariatric surgical procedures. Post-pandemic, monitoring is needed to assess if hospitals have been able to meet the demand for bariatric surgical procedures. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09655-3.

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“…The critical need for surge capacity for acute hospital care engendered by the COVID-19 pandemic has resulted in dissemination of the Home Hospital (HH) model of care. Building on this model of care delivery, the Centers for Medicare & Medicaid Services (CMS) offered hospitals the Acute Hospital Care at Home waiver in November 2020 1 . As of October 26, 2021, CMS had approved 186 hospitals in 33 states for this program 2 .…”

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confidence: 99%

“…Originally implemented for acute medical conditions, HH has proven to be a safe and value-based care-delivery model for a variety of medical conditions, ranging from heart failure to chronic obstructive pulmonary disease exacerbations 1,4 . A recent randomized controlled trial (RCT) of HH in the United States showed that HH patients had 38% lower costs and fewer 30-day readmissions, and spent less time sedentary 3 .…”

mentioning

confidence: 99%

“…Furthermore, HH could prevent halts in elective surgery during crises such as the current COVID-19 pandemic. The patient profile of orthopaedic surgery inpatients matches that of patients who are most likely to benefit from HH—namely, those who are prone to functional decline, delirium, and nosocomial infections 1,3 . In addition, some orthopaedic patients are admitted primarily for services such as physical therapy, postoperative pain management, or postoperative nausea and vomiting.…”

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confidence: 99%

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Home Hospital for Orthopaedic Surgery

Karhade

Chen

Makhni

et al. 2021

Journal of Bone and Joint Surgery

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Home Hospital (HH) is a clinical service involving the delivery of acute inpatient care in the home setting.Acute care services provided via HH include continuous telemonitoring, intravenous fluids and medications, nursing care, point-of-care imaging and laboratory tests, and in-person and virtual clinician visits. Despite offering an inpatient level of care, HH has lower fixed costs and less overhead than conventional hospital settings and offers rapid scalability. Originally implemented for acute medical conditions, HH has proven to be a safe and value-based care-delivery model for a variety of medical conditions, ranging from heart failure to chronic obstructive pulmonary disease exacerbations. For surgical conditions, HH represents an opportunity to reduce adverse hospital-acquired conditions, improve patient and caregiver satisfaction, and decrease cost. The patient profile of orthopaedic surgery inpatients matches that of patients who are most likely to benefit from HH-namely, those who are prone to functional decline, delirium, and nosocomial infections. A focus on surgeon leadership, quality and safety, and digital health with collection of patient-reported outcome measures (PROMs) will ensure that the potential of HH is realized as implementation and widespread rollout proceed.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G792).

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Home Hospital for Surgery

Cited by 22 publications

References 6 publications

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Impact of the COVID-19 Pandemic on Inpatient and Outpatient Utilization of Bariatric Surgery

Home Hospital for Orthopaedic Surgery

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