title: The Integrated Comprehensive Care Program: A Novel Home Care Initiative After Major Thoracic Surgery.
abstract: The objective of the study was to evaluate the Integrated Comprehensive Care (ICC) program, a novel health system integration initiative that coordinates home care and hospital-based clinical services for patients undergoing major thoracic surgery relative to traditional home care delivery. Methods included a pilot retrospective cohort analysis that compared the intervention cohort (ICC), composed of all patients undergoing major thoracic surgery in the 2012-2013 fiscal year with a control cohort, who underwent surgery in the year before the initiation of ICC. Length of stay, hospital costs, readmission, and emergency room visit data were stratified by degree and approach of resection and compared using univariate logistic regression analysis. A total of 331 patients under ICC and 355 control patients were enrolled. Hospital stay was significantly shorter in patients under video-assisted thoracoscopic surgery (VATS) ICC (sublobar median 3 vs 4 days, P = 0.013; lobar median 4 vs 5 days, P = 0.051) but not for open resections. The frequency of emergency room visits within 60 days of surgery was lower for all stratification groups in the ICC cohort, except for VATS sublobar (25.7% control vs 13.9% ICC, P = 0.097). There were no significant differences in 60-day readmission frequency in any subcohort. The mean inpatient case cost was significantly lower for ICC VATS sublobar resections ($8505.39 vs $11,038.18, P = 0.007), with the other resection types trending lower for ICC but nonsignificant. In conclusion, a hospital-based, postdischarge, patient-centered program could potentially result in shorter hospital stay, fewer readmission and emergency room visits, costsavings, and no increase in adverse postdischarge outcomes after major thoracic surgery.
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada. Electronic address: shargal@mcmaster.ca.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shargall
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Wael C
authors.initials: WC
authors.lastname: Hanna
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Schneider
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Schieman
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Finley
authors.affiliation: St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Tran
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
authors.forename: Shantel
authors.initials: S
authors.lastname: Demay
authors.affiliation: St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Gosse
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James M
authors.initials: JM
authors.lastname: Bowen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gord
authors.initials: G
authors.lastname: Blackhouse
authors.affiliation: St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Smith
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017046:Cost Savings; D019033:Delivery of Health Care, Integrated / Q000191:economics; D004636:Emergency Service, Hospital; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D018802:Patient-Centered Care / Q000191:economics / Q000379:methods*; D010865:Pilot Projects; D011013:Pneumonectomy / Q000009:adverse effects; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000379:methods / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cohort study; Homecare; integrated nursing care; post-discharge management; post-discharge outcomes; readmission, ER visit reduction