title: Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score.
abstract: We estimated the impact of alternative discharge strategies, following joint replacement (JR) surgery, on acute care readmission rates and the total cost of a continuum of care. Following surgery, patients were discharged to one of four destinations. Propensity scores were used to adjust costs and outcomes for potential bias in the assignment of discharge destinations. We demonstrated that the use of rehabilitation hospitals may lower readmission rates, but at a prohibitive incremental cost of each saved readmission, that patients discharged with home care had longer acute care stays than other patients, that the provision of home care services increased health system costs, and that acute care readmission rates were greatest among patients discharged with home care. Our study should be seen as one important stepping stone towards a full economic evaluation of the continuum of care for patients.
authors.affiliation: Institute for Clinical Evaluative Sciences, Ontario, Toronto, Canada. coyte@chass.utoronto.ca
authors.forename: P C
authors.initials: PC
authors.lastname: Coyte
authors.forename: W
authors.initials: W
authors.lastname: Young
authors.forename: R
authors.initials: R
authors.lastname: Croxford
mesh_terms: D000359:Aftercare / Q000191:economics; D019643:Arthroplasty, Replacement / Q000191:economics* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000191:economics*; D017281:Cost of Illness; D017050:Episode of Care; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009313:National Health Programs; D009864:Ontario; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000191:economics; D015983:Selection Bias; D016896:Treatment Outcome