PD14-04 ROUTINE HOME HEALTH AFTER PROSTATECTOMY DOES NOT REDUCE ED VISITS OR CATHETER COMPLICATIONS

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You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2017PD14-04 ROUTINE HOME HEALTH AFTER PROSTATECTOMY DOES NOT REDUCE ED VISITS OR CATHETER COMPLICATIONS Deborah R. Kaye, John Syrjamaki, Chad Ellimootil, M Hugh Solomon, Thomas J. Maatman, Susan Linsell, Khurshid R. Ghani, David C. Miller, James E. Montie, James M. Dupree, and Michigan Urological Surgery Improvement Collaborative Deborah R. KayeDeborah R. Kaye More articles by this author , John SyrjamakiJohn Syrjamaki More articles by this author , Chad EllimootilChad Ellimootil More articles by this author , M Hugh SolomonM Hugh Solomon More articles by this author , Thomas J. MaatmanThomas J. Maatman More articles by this author , Susan LinsellSusan Linsell More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , David C. MillerDavid C. Miller More articles by this author , James E. MontieJames E. Montie More articles by this author , James M. DupreeJames M. Dupree More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.705AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Routine use of home health care after prostatectomy is a potential source of practice pattern variation and adds costs with unclear benefits. We evaluated the relationship between home health care use after prostatectomy and deviations from the usual care pathway and costs. METHODS We identified all men who underwent a laparoscopic radical prostatectomy from 04/01/2014 through 10/31/2015 in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We determined variation in home care use after prostatectomy by urology practice. We then compared the rates of ED visits and readmissions within 16 days of discharge, prolonged catheter use, catheter reinsertion rates, and price-standardized 90 day episode costs for those who did and did not receive home care. Routine home care was defined as home care initiated within 4 days of discharge among patient discharged without a drain. RESULTS We identified 647 patients meeting our inclusion criteria, of whom 13% received home health care. Patient and cancer characteristics were similar between cohorts (Table 1). Use of routine home care after prostatectomy varied from 0 to 53% across 33 practices in MUSIC (p=0.05). Unadjusted, patients with home care had increased rates of ED visits within 16 days (15.5% vs 6.9%, p<0.01), similar rates of catheter duration > 16 days (3.6% vs 3.0%, p=0.79) and need for catheter replacement (1.2% vs 2.5%, p=0.46), and a trend toward decreased readmissions rates (0 vs 4.1%, p=0.06). After controlling for patient and cancer characteristics, only the increased rate of ED visits remained significant (p<0.01). . Home health care cost an average of $1,000 per episode. Average total episode cost were $15,556 with home care and $13,788 without it. There were no differences in index hospitalization costs. CONCLUSIONS Routine home health care does not decrease ED visits or catheter complication rates. Its use is associated with increased 90-day episode costs. These data suggest that careful patient selection for home health care is necessary to improve the value of the service, as measured by cost, quality, and appropriateness. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e277-e278 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Deborah R. Kaye More articles by this author John Syrjamaki More articles by this author Chad Ellimootil More articles by this author M Hugh Solomon More articles by this author Thomas J. Maatman More articles by this author Susan Linsell More articles by this author Khurshid R. Ghani More articles by this author David C. Miller More articles by this author James E. Montie More articles by this author James M. Dupree More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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