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Urology. 2018 Feb;112:74-79. doi: 10.1016/j.urology.2017.11.004. Epub 2017 Nov 16.

Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy.

Author information

1
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI. Electronic address: kayed@med.umich.edu.
2
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.
3
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Michigan Institute of Urology, Detroit, MI.
4
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
5
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
6
Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.

Abstract

OBJECTIVE:

To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

PMID:
29155190
PMCID:
PMC5856596
DOI:
10.1016/j.urology.2017.11.004
[Indexed for MEDLINE]
Free PMC Article

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