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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

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The Integrated Comprehensive Care Program: A Novel Home Care Initiative After Major Thoracic Surgery.

Yaron Shargall¹, Wael C Hanna¹, Laura Schneider²

¹St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.

Seminars in Thoracic and Cardiovascular Surgery

|January 4, 2017

Summary

The Integrated Comprehensive Care (ICC) program reduced hospital stays and costs for thoracic surgery patients. This patient-centered approach improved outcomes without increasing readmissions.

Keywords:

Cohort study Homecare integrated nursing care post-discharge management post-discharge outcomes readmission, ER visit reduction

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Area of Science:

Health Services Research
Surgical Outcomes
Patient Care Coordination

Background:

Major thoracic surgery requires significant post-operative care.
Traditional home care models may not fully meet patient needs after complex procedures.
Integrating hospital and home care can optimize patient recovery and resource utilization.

Purpose of the Study:

To evaluate the effectiveness of the Integrated Comprehensive Care (ICC) program.
To compare ICC with traditional home care for patients undergoing major thoracic surgery.
To assess the impact of ICC on length of stay, costs, readmissions, and emergency room visits.

Main Methods:

Pilot retrospective cohort analysis comparing ICC patients with a historical control group.
Data collected included length of stay, hospital costs, readmissions, and ER visits.
Univariate logistic regression analysis stratified by resection degree and approach.

Main Results:

Shorter hospital stays observed in ICC patients undergoing video-assisted thoracoscopic surgery (VATS) lobar and sublobar resections.
Lower frequency of emergency room visits within 60 days for most ICC patient groups.
Significantly lower mean inpatient case costs for ICC VATS sublobar resections.
No significant differences in 60-day readmission rates between ICC and control cohorts.

Conclusions:

The hospital-based, post-discharge ICC program shows potential for improving efficiency and patient outcomes after major thoracic surgery.
ICC may lead to shorter hospital stays, reduced emergency room visits, and cost savings.
The program demonstrated no increase in adverse post-discharge outcomes, supporting its value in patient-centered care.