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Acute hospital-community hospital care bundle for elderly orthopedic surgery patients:A propensity score-matched economic analysis

引用

World Journal of Orthopedics 2023年第4期14卷 231-239页

作者： Ivan En-Howe Tan Aik Yong Chok Yun Zhao Yonghui Chen Chee Hoe Koo Junjie Aw mave hean teng soh Chek Hun Foo Kwok Ann Ang Emile John Kwong Wei Tan Andrew Hwee Chye Tan Marianne Kit Har Au Group Finance Singapore Health ServicesSingapore 168582Singapore Department of Colorectal Surgery Singapore General HospitalSingapore 169608Singapore Post-Acute and Continuing Care Family MedicineOutram Community HospitalSingapore 168582Singapore Finance Singapore General HospitalSingapore 169608Singapore Department of Orthopedic Surgery Singapore General HospitalSingapore 169856Singapore Singhealth Community Hospital Singapore 168582Singapore

BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute *** Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative *** core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in *** To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic *** A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was *** measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)*** costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore *** Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both *** transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic *** elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.

关键词： Care bundle Community hospital Orthopedic surgery Cost-effectiveness Care transition Intervention

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