Selecting post-acute care settings after abdominal surgery: Are we getting it right?

Area of Science:

• Healthcare Management
• Surgical Outcomes
• Health Services Research

Background:

• Investigated variation in post-acute care (PAC) services.
• Examined if surgeons discharge clinically similar patients to different PAC destinations (home health [HH], skilled nursing facilities [SNF], inpatient rehabilitation [IR]).

Purpose of the Study:

• Determine the proportion of patients discharged to SNF/IR who could have been discharged to HH.
• Estimate potential cost savings from increased HH utilization.

Main Methods:

• Studied patients undergoing colectomy, pancreatectomy, or hepatectomy (2008-2011 Nationwide Inpatient Sample).
• Utilized propensity matching to compare patient groups and assess PAC destination choices.

Main Results:

• 30,843 patients discharged to HH and 23,172 to SNF/IR.
• 61% of SNF/IR patients could be matched to similar patients discharged to HH.
• Potential annual cost savings from increased HH use ranged from $2.5 to $438 million.

Conclusions:

• Significant potential exists to reduce PAC use variation and costs.
• Understanding surgeon decision-making in PAC placement is crucial for optimization.