Variation in postacute care utilization after complex surgery

Balentine, Courtney J.; Mason, Meredith C.; Richardson, Peter J.; Kougias, Panagiotis; Bakaeen, Faisal G.; Naik, Aanand D.; Berger, David H.; Anaya, Daniel A.

doi:10.1016/j.jss.2018.04.052

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…This series attempts to better understand at a macro level the previously described over-morbidity associated with skilled care facilities. 1,5,11,12 In line with previous investigations, the present study demonstrated higher rates of overall and specific surgical and medical complications associated with post-acute skilled care after riskadjustment for demographic, peri-and postoperative risk profiles. Subgroup analysis of three different skilled care settings revealed a particularly higher rate associated with the small group of patients transferred to separate acute care (Fig.…”

Section: Discussionsupporting

confidence: 91%

How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.

Aziz¹,

Grass²,

Behm

et al. 2021

The American Journal of Surgery

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Section: Discussionsupporting

confidence: 91%

How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.

Aziz¹,

Grass²,

Behm

et al. 2021

The American Journal of Surgery

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“…[23] The likelihood of requiring post-acute care after surgery increases steadily with age and becomes even more probable in patients who experience postoperative complications or who have preexisting functional deficits. [21,[24][25] There is ongoing debate over how to best deliver post-acute care for older surgical patients and how to determine when patients are likely to benefit from care at home versus in skilled nursing or inpatient rehabilitation facilities. Some older patients are likely to benefit from time in a rehabilitation hospital or skilled nursing facility before they return home, particularly if they have significant functional deficits and lack adequate social support.…”

Section: Continued Care After Hospital Dischargementioning

confidence: 99%

A Surgeon’s Guide to Treating Older Patients With Colorectal Cancer

Kim

Lee

Skinner

et al. 2019

Curr Colorectal Cancer Rep

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Purpose of review: Review strategies to improve outcomes of colorectal cancer treatment in older patients. Recent findings: Older colorectal patients face many barriers to recovery during their initial inpatient stay following surgery and after leaving the hospital. In addition to the risk of inpatient morbidity and mortality, older patients are more likely to require post-acute care services, to face nutritional deficits, and to experience complications of chemoradiation. Summary: In order to improve outcomes for older patients with colorectal cancer, it is important for surgeons to recognize their unique needs and to develop plans to address them. The involvement of a multidisciplinary team with geriatric experience can guide planning for surgery, the immediate postoperative recovery, and long-term survivorship.

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“…Despite controlling for these patient-and hospital-level covariates, persistent variation in hospital use of PAC facilities has been demonstrated among a variety of medical and surgical populations. 14,15,32 Our study further emphasizes the need to better understand the drivers of this unexplained variation because the repercussions of unexplained variation are multifold. Our study showed that, overall, 20% of trauma patients are discharged to IRF, but this likely represents a mix of both underutilization and overutilization of this important resource.…”

mentioning

confidence: 85%

“…8,12 Unfortunately, hospital use of PAC facilities remains highly variable, despite controlling for several patient-, clinical-, and hospital-level factors. 10,[13][14][15][16][17] Equity in discharge to a PAC facility is of critical importance in the trauma population, where individuals are commonly affected during their most productive years of life and where discharge to an inpatient rehabilitation facility (IRF) is associated with improved postinjury functional status, quality of life, and 1-year survival. 2,4,18 The importance of this benefit at the individual and population level is reflected in the Centers for Medicare & Medicaid Services "60% rule," which stipulates that IRFs must have at least 60% of patients with 1 of 13 primary diagnoses, of which 5 are injury-related (spinal cord injury, femur/hip fracture, brain injury, burns, and major multiple trauma).…”

mentioning

confidence: 99%

Hospital effects drive variation in access to inpatient rehabilitation after trauma

Lussiez

Montgomery

Sangji

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Postacute care rehabilitation is critically important to recover after trauma, but many patients do not have access. A better understanding of the drivers behind inpatient rehabilitation facility (IRF) use has the potential for major cost-savings as well as higher-quality and more equitable patient care. We sought to quantify the variation in hospital rates of trauma patient discharge to inpatient rehabilitation and understand which factors (patient vs. injury vs. hospital level) contribute the most. METHODS:We performed a retrospective cohort study of 668,305 adult trauma patients admitted to 900 levels I to IV trauma centers between 2011 and 2015 using the National Trauma Data Bank. Participants were included if they met the following criteria: age >18 years, Injury Severity Score of ≥9, identifiable injury type, and who had one of the Centers for Medicare & Medicaid Services preferred diagnoses for inpatient rehabilitation under the "60% rule." RESULTS:The overall risk-and reliability-adjusted hospital rates of discharge to IRF averaged 18.8% in the nonelderly adult cohort (18-64 years old) and 23.4% in the older adult cohort (65 years or older). Despite controlling for all patient-, injury-, and hospital-level factors, hospital discharge of patients to IRF varied substantially between hospital quintiles and ranged from 9% to 30% in the nonelderly adult cohort and from 7% to 46% in the older adult cohort. Proportions of total variance ranged from 2.4% (patient insurance) to 12.1% (injury-level factors) in the nonelderly adult cohort and from 0.3% (patient-level factors) to 26.0% (unmeasured hospital-level factors) in the older adult cohort. CONCLUSION:Among a cohort of injured patients with diagnoses that are associated with significant rehabilitation needs, the hospital at which a patient receives their care may drive a patient's likelihood of recovering at an IRF just as much, if not more, than their clinical attributes.

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Variation in postacute care utilization after complex surgery

Cited by 10 publications

References 21 publications

How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.

How skilled are skilled facilities? Post-discharge complications after colorectal cancer surgery in the U.S.

A Surgeon’s Guide to Treating Older Patients With Colorectal Cancer

Hospital effects drive variation in access to inpatient rehabilitation after trauma

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