Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy
To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments. We identified all men who underwent a robotic radical prostatectomy from April 1, 2014, to October 31, 2015, in the Michigan Urological Surgery Improvement Collabo...
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| Veröffentlicht in: | Urology (Ridgewood, N.J.) N.J.), 2018-02, Vol.112, p.74-79 |
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| container_title | Urology (Ridgewood, N.J.) |
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| creator | Kaye, Deborah R. Syrjamaki, John Ellimoottil, Chad Schervish, Edward W. Solomon, M. Hugh Linsell, Susan Montie, James E. Miller, David C. Dupree, James M. |
| description | To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.
We identified all men who underwent a robotic radical prostatectomy from April 1, 2014, to October 31, 2015, in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We calculated rates of “routine” home care use after prostatectomy by urology practice. We defined “routine” home care as home care initiated within 4 days of discharge among patients discharged without a pelvic drain. We then compared emergency department (ED) visits, readmissions, prolonged catheter use, catheter reinsertion rates, and 90-day episode payments, in unadjusted and using a propensity-adjusted analysis, for those who did and did not receive home care.
We identified 647 patients, of whom 13% received routine home health care. At the practice level, the use of routine home care after prostatectomy varied from 0% to 53% (P = .05) (mean: 3.6%, median: 0%). Unadjusted, patients with routine home care had increased ED visits within 16 days (15.5% vs 6.9%, P 16 days (3.6% vs 3.0%, P = .79) and need for catheter replacement (1.2% vs 2.5%, P = .46), and a trend toward decreased readmissions (0% vs 4.1%, P = .06). Only the increased ED visits remained significant in adjusted analyses (P |
| doi_str_mv | 10.1016/j.urology.2017.11.004 |
| format | Article |
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We identified all men who underwent a robotic radical prostatectomy from April 1, 2014, to October 31, 2015, in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We calculated rates of “routine” home care use after prostatectomy by urology practice. We defined “routine” home care as home care initiated within 4 days of discharge among patients discharged without a pelvic drain. We then compared emergency department (ED) visits, readmissions, prolonged catheter use, catheter reinsertion rates, and 90-day episode payments, in unadjusted and using a propensity-adjusted analysis, for those who did and did not receive home care.
We identified 647 patients, of whom 13% received routine home health care. At the practice level, the use of routine home care after prostatectomy varied from 0% to 53% (P = .05) (mean: 3.6%, median: 0%). Unadjusted, patients with routine home care had increased ED visits within 16 days (15.5% vs 6.9%, P <.01), similar rates of catheter duration for >16 days (3.6% vs 3.0%, P = .79) and need for catheter replacement (1.2% vs 2.5%, P = .46), and a trend toward decreased readmissions (0% vs 4.1%, P = .06). Only the increased ED visits remained significant in adjusted analyses (P <.01). Home health had an average payment of $1000 per episode.
Thirteen percent of patients received routine home health care after prostatectomy, without improved outcomes. These findings suggest that patients do not routinely require home health care to improve short-term outcomes following radical prostatectomy, however, the appropriate use of home health care should be evaluated further.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2017.11.004</identifier><identifier>PMID: 29155190</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aftercare - economics ; Aftercare - statistics & numerical data ; Critical Pathways ; Emergency Service, Hospital - economics ; Emergency Service, Hospital - statistics & numerical data ; Home Care Services - economics ; Home Care Services - statistics & numerical data ; Humans ; Male ; Middle Aged ; Prostatectomy - methods ; Prostatic Neoplasms - surgery ; Treatment Outcome</subject><ispartof>Urology (Ridgewood, N.J.), 2018-02, Vol.112, p.74-79</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-f4bdafd42a46853db732dfa213b9bd51927141934356d28e2b5cae5eaa46f1d93</citedby><cites>FETCH-LOGICAL-c467t-f4bdafd42a46853db732dfa213b9bd51927141934356d28e2b5cae5eaa46f1d93</cites><orcidid>0000-0002-3868-6920 ; 0000-0002-4290-9648</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urology.2017.11.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29155190$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kaye, Deborah R.</creatorcontrib><creatorcontrib>Syrjamaki, John</creatorcontrib><creatorcontrib>Ellimoottil, Chad</creatorcontrib><creatorcontrib>Schervish, Edward W.</creatorcontrib><creatorcontrib>Solomon, M. Hugh</creatorcontrib><creatorcontrib>Linsell, Susan</creatorcontrib><creatorcontrib>Montie, James E.</creatorcontrib><creatorcontrib>Miller, David C.</creatorcontrib><creatorcontrib>Dupree, James M.</creatorcontrib><creatorcontrib>Michigan Urological Surgery Improvement Collaborative and the Michigan Value Collaborative</creatorcontrib><title>Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.
We identified all men who underwent a robotic radical prostatectomy from April 1, 2014, to October 31, 2015, in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We calculated rates of “routine” home care use after prostatectomy by urology practice. We defined “routine” home care as home care initiated within 4 days of discharge among patients discharged without a pelvic drain. We then compared emergency department (ED) visits, readmissions, prolonged catheter use, catheter reinsertion rates, and 90-day episode payments, in unadjusted and using a propensity-adjusted analysis, for those who did and did not receive home care.
We identified 647 patients, of whom 13% received routine home health care. At the practice level, the use of routine home care after prostatectomy varied from 0% to 53% (P = .05) (mean: 3.6%, median: 0%). Unadjusted, patients with routine home care had increased ED visits within 16 days (15.5% vs 6.9%, P <.01), similar rates of catheter duration for >16 days (3.6% vs 3.0%, P = .79) and need for catheter replacement (1.2% vs 2.5%, P = .46), and a trend toward decreased readmissions (0% vs 4.1%, P = .06). Only the increased ED visits remained significant in adjusted analyses (P <.01). Home health had an average payment of $1000 per episode.
Thirteen percent of patients received routine home health care after prostatectomy, without improved outcomes. These findings suggest that patients do not routinely require home health care to improve short-term outcomes following radical prostatectomy, however, the appropriate use of home health care should be evaluated further.</description><subject>Aftercare - economics</subject><subject>Aftercare - statistics & numerical data</subject><subject>Critical Pathways</subject><subject>Emergency Service, Hospital - economics</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Home Care Services - economics</subject><subject>Home Care Services - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prostatectomy - methods</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Treatment Outcome</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFuEzEQhi0EoqHwCCAfuexie21vfAFVgVKkSlQROVtee7ZxtLtObSfVvj2uEio4cRlLM9_8M54fofeU1JRQ-WlXH2IYwv1cM0LbmtKaEP4CLahgbaWUEi_RghBFKs6UuEBvUtoRQqSU7Wt0wRQVgiqyQA-bBDj0eB0O2U-Ab8JYApghb_HKRMBmcvgrHL3JPkwJX8cwlhzeTDaM-8Fbk8HhNdhwhDjjO5O3j2bGV32GiNfGFWDAdzGkXECbwzi_Ra96MyR4d34v0eb626_VTXX78_uP1dVtZblsc9XzzpnecWa4XIrGdW3DXG8YbTrVubI8aymnquGNkI4tgXXCGhBgCt9Tp5pL9Pmkuz90IzgLU45m0PvoRxNnHYzX_1Ymv9X34ajFUkihZBH4eBaI4eEAKevRJwvDYCYIh6SpkpJz2fC2oOKE2vLTFKF_HkOJfrJL7_TZLv1kl6ZUF7tK34e_d3zu-uNPAb6cACiXOnqIOlkPkwXnYzmndsH_Z8RvvPCsOg</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Kaye, Deborah R.</creator><creator>Syrjamaki, John</creator><creator>Ellimoottil, Chad</creator><creator>Schervish, Edward W.</creator><creator>Solomon, M. Hugh</creator><creator>Linsell, Susan</creator><creator>Montie, James E.</creator><creator>Miller, David C.</creator><creator>Dupree, James M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3868-6920</orcidid><orcidid>https://orcid.org/0000-0002-4290-9648</orcidid></search><sort><creationdate>20180201</creationdate><title>Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy</title><author>Kaye, Deborah R. ; Syrjamaki, John ; Ellimoottil, Chad ; Schervish, Edward W. ; Solomon, M. Hugh ; Linsell, Susan ; Montie, James E. ; Miller, David C. ; Dupree, James M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-f4bdafd42a46853db732dfa213b9bd51927141934356d28e2b5cae5eaa46f1d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aftercare - economics</topic><topic>Aftercare - statistics & numerical data</topic><topic>Critical Pathways</topic><topic>Emergency Service, Hospital - economics</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Home Care Services - economics</topic><topic>Home Care Services - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prostatectomy - methods</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kaye, Deborah R.</creatorcontrib><creatorcontrib>Syrjamaki, John</creatorcontrib><creatorcontrib>Ellimoottil, Chad</creatorcontrib><creatorcontrib>Schervish, Edward W.</creatorcontrib><creatorcontrib>Solomon, M. Hugh</creatorcontrib><creatorcontrib>Linsell, Susan</creatorcontrib><creatorcontrib>Montie, James E.</creatorcontrib><creatorcontrib>Miller, David C.</creatorcontrib><creatorcontrib>Dupree, James M.</creatorcontrib><creatorcontrib>Michigan Urological Surgery Improvement Collaborative and the Michigan Value Collaborative</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kaye, Deborah R.</au><au>Syrjamaki, John</au><au>Ellimoottil, Chad</au><au>Schervish, Edward W.</au><au>Solomon, M. Hugh</au><au>Linsell, Susan</au><au>Montie, James E.</au><au>Miller, David C.</au><au>Dupree, James M.</au><aucorp>Michigan Urological Surgery Improvement Collaborative and the Michigan Value Collaborative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>112</volume><spage>74</spage><epage>79</epage><pages>74-79</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><abstract>To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.
We identified all men who underwent a robotic radical prostatectomy from April 1, 2014, to October 31, 2015, in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We calculated rates of “routine” home care use after prostatectomy by urology practice. We defined “routine” home care as home care initiated within 4 days of discharge among patients discharged without a pelvic drain. We then compared emergency department (ED) visits, readmissions, prolonged catheter use, catheter reinsertion rates, and 90-day episode payments, in unadjusted and using a propensity-adjusted analysis, for those who did and did not receive home care.
We identified 647 patients, of whom 13% received routine home health care. At the practice level, the use of routine home care after prostatectomy varied from 0% to 53% (P = .05) (mean: 3.6%, median: 0%). Unadjusted, patients with routine home care had increased ED visits within 16 days (15.5% vs 6.9%, P <.01), similar rates of catheter duration for >16 days (3.6% vs 3.0%, P = .79) and need for catheter replacement (1.2% vs 2.5%, P = .46), and a trend toward decreased readmissions (0% vs 4.1%, P = .06). Only the increased ED visits remained significant in adjusted analyses (P <.01). Home health had an average payment of $1000 per episode.
Thirteen percent of patients received routine home health care after prostatectomy, without improved outcomes. These findings suggest that patients do not routinely require home health care to improve short-term outcomes following radical prostatectomy, however, the appropriate use of home health care should be evaluated further.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29155190</pmid><doi>10.1016/j.urology.2017.11.004</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-3868-6920</orcidid><orcidid>https://orcid.org/0000-0002-4290-9648</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Urology (Ridgewood, N.J.), 2018-02, Vol.112, p.74-79 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aftercare - economics Aftercare - statistics & numerical data Critical Pathways Emergency Service, Hospital - economics Emergency Service, Hospital - statistics & numerical data Home Care Services - economics Home Care Services - statistics & numerical data Humans Male Middle Aged Prostatectomy - methods Prostatic Neoplasms - surgery Treatment Outcome |
| title | Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy |
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