SanteMusiqueV1, Main, Exploration, bibRecord, 000692

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

Identifieur interne : 000692 ( Main/Exploration ); précédent : 000691; suivant : 000693

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

Auteurs : Deborah R. Kaye [États-Unis] ; John Syrjamaki [États-Unis] ; Chad Ellimoottil [États-Unis] ; Edward W. Schervish [États-Unis] ; M Hugh Solomon [États-Unis] ; Susan Linsell [États-Unis] ; James E. Montie [États-Unis] ; David C. Miller [États-Unis] ; James M. Dupree [États-Unis]

Source :

Urology [ 1527-9995 ] ; 2018.

RBID : pubmed:29155190

Descripteurs français

KwdFr :
- Adulte d'âge moyen (MeSH), Humains (MeSH), Mâle (MeSH), Post-cure (statistiques et données numériques), Post-cure (économie), Programme clinique (MeSH), Prostatectomie (méthodes), Résultat thérapeutique (MeSH), Service hospitalier d'urgences (statistiques et données numériques), Service hospitalier d'urgences (économie), Services de soins à domicile (statistiques et données numériques), Services de soins à domicile (économie), Tumeurs de la prostate (chirurgie).
MESH :
- chirurgie : Tumeurs de la prostate.
- méthodes : Prostatectomie.
- statistiques et données numériques : Post-cure, Service hospitalier d'urgences, Services de soins à domicile.
- économie : Post-cure, Service hospitalier d'urgences, Services de soins à domicile.
- Adulte d'âge moyen, Humains, Mâle, Programme clinique, Résultat thérapeutique.

English descriptors

KwdEn :
- Aftercare (economics), Aftercare (statistics & numerical data), Critical Pathways (MeSH), Emergency Service, Hospital (economics), Emergency Service, Hospital (statistics & numerical data), Home Care Services (economics), Home Care Services (statistics & numerical data), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Prostatectomy (methods), Prostatic Neoplasms (surgery), Treatment Outcome (MeSH).
MESH :
- economics : Aftercare, Emergency Service, Hospital, Home Care Services.
- methods : Prostatectomy.
- statistics & numerical data : Aftercare, Emergency Service, Hospital, Home Care Services.
- surgery : Prostatic Neoplasms.
- Critical Pathways, Humans, Male, Middle Aged, Treatment Outcome.

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.

DOI: 10.1016/j.urology.2017.11.004
PubMed: 29155190
PubMed Central: PMC5856596

Affiliations:

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Le document en format XML

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<term>Aftercare (statistics & numerical data)</term>
<term>Critical Pathways (MeSH)</term>
<term>Emergency Service, Hospital (economics)</term>
<term>Emergency Service, Hospital (statistics & numerical data)</term>
<term>Home Care Services (economics)</term>
<term>Home Care Services (statistics & numerical data)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Prostatectomy (methods)</term>
<term>Prostatic Neoplasms (surgery)</term>
<term>Treatment Outcome (MeSH)</term>
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<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Post-cure (statistiques et données numériques)</term>
<term>Post-cure (économie)</term>
<term>Programme clinique (MeSH)</term>
<term>Prostatectomie (méthodes)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Service hospitalier d'urgences (statistiques et données numériques)</term>
<term>Service hospitalier d'urgences (économie)</term>
<term>Services de soins à domicile (statistiques et données numériques)</term>
<term>Services de soins à domicile (économie)</term>
<term>Tumeurs de la prostate (chirurgie)</term>
</keywords>
<keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr"><term>Tumeurs de la prostate</term>
</keywords>
<keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Aftercare</term>
<term>Emergency Service, Hospital</term>
<term>Home Care Services</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Prostatectomy</term>
</keywords>
<keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Prostatectomie</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Aftercare</term>
<term>Emergency Service, Hospital</term>
<term>Home Care Services</term>
</keywords>
<keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Post-cure</term>
<term>Service hospitalier d'urgences</term>
<term>Services de soins à domicile</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Prostatic Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Post-cure</term>
<term>Service hospitalier d'urgences</term>
<term>Services de soins à domicile</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Critical Pathways</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Humains</term>
<term>Mâle</term>
<term>Programme clinique</term>
<term>Résultat thérapeutique</term>
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<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>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.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2018</Year>
<Month>12</Month>
<Day>11</Day>
</DateCompleted>
<DateRevised><Year>2019</Year>
<Month>02</Month>
<Day>01</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1527-9995</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>112</Volume>
<PubDate><Year>2018</Year>
<Month>Feb</Month>
</PubDate>
</JournalIssue>
<Title>Urology</Title>
<ISOAbbreviation>Urology</ISOAbbreviation>
</Journal>
<ArticleTitle>Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy.</ArticleTitle>
<Pagination><MedlinePgn>74-79</MedlinePgn>
</Pagination>
<ELocationID EIdType="pii" ValidYN="Y">S0090-4295(17)31191-3</ELocationID>
<ELocationID EIdType="doi" ValidYN="Y">10.1016/j.urology.2017.11.004</ELocationID>
<Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To evaluate the statistical association between routine home health use after prostatectomy, short-term surgical outcomes, and payments.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="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.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="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.</AbstractText>
<AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">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.</AbstractText>
<CopyrightInformation>Copyright © 2017 Elsevier Inc. All rights reserved.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kaye</LastName>
<ForeName>Deborah R</ForeName>
<Initials>DR</Initials>
<AffiliationInfo><Affiliation>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.</Affiliation>
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<Author ValidYN="Y"><LastName>Syrjamaki</LastName>
<ForeName>John</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ellimoottil</LastName>
<ForeName>Chad</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Value Collaborative, Ann Arbor, MI.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Schervish</LastName>
<ForeName>Edward W</ForeName>
<Initials>EW</Initials>
<AffiliationInfo><Affiliation>Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Michigan Institute of Urology, Detroit, MI.</Affiliation>
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<ForeName>M Hugh</ForeName>
<Initials>MH</Initials>
<AffiliationInfo><Affiliation>Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.</Affiliation>
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<ForeName>Susan</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.</Affiliation>
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<ForeName>James E</ForeName>
<Initials>JE</Initials>
<AffiliationInfo><Affiliation>Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Miller</LastName>
<ForeName>David C</ForeName>
<Initials>DC</Initials>
<AffiliationInfo><Affiliation>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.</Affiliation>
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<Initials>JM</Initials>
<AffiliationInfo><Affiliation>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.</Affiliation>
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<Acronym>CA</Acronym>
<Agency>NCI NIH HHS</Agency>
<Country>United States</Country>
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<Grant><GrantID>T32 CA180984</GrantID>
<Acronym>CA</Acronym>
<Agency>NCI NIH HHS</Agency>
<Country>United States</Country>
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<Month>11</Month>
<Day>16</Day>
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<MedlineTA>Urology</MedlineTA>
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<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
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<QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName>
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<MeshHeading><DescriptorName UI="D011471" MajorTopicYN="N">Prostatic Neoplasms</DescriptorName>
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<Day>19</Day>
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<PubMedPubDate PubStatus="revised"><Year>2017</Year>
<Month>11</Month>
<Day>02</Day>
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<PubMedPubDate PubStatus="accepted"><Year>2017</Year>
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<ArticleIdList><ArticleId IdType="pubmed">18837657</ArticleId>
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</Reference>
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<name sortKey="Dupree, James M" sort="Dupree, James M" uniqKey="Dupree J" first="James M" last="Dupree">James M. Dupree</name>
<name sortKey="Ellimoottil, Chad" sort="Ellimoottil, Chad" uniqKey="Ellimoottil C" first="Chad" last="Ellimoottil">Chad Ellimoottil</name>
<name sortKey="Linsell, Susan" sort="Linsell, Susan" uniqKey="Linsell S" first="Susan" last="Linsell">Susan Linsell</name>
<name sortKey="Miller, David C" sort="Miller, David C" uniqKey="Miller D" first="David C" last="Miller">David C. Miller</name>
<name sortKey="Montie, James E" sort="Montie, James E" uniqKey="Montie J" first="James E" last="Montie">James E. Montie</name>
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Use of Routine Home Health Care and Deviations From an Uncomplicated Recovery Pathway After Radical Prostatectomy.

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

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