Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Dis Colon Rectum. 2019 Apr;62(4):483-490. doi: 10.1097/DCR.0000000000001308.
Discharge to a nonhome destination (ie, skilled nursing facility, subacute rehabilitation, or long-term care facility) after surgery is associated with increased mortality and higher costs and is less desirable to patients than discharge to home.
We sought to identify modifiable hospital-level factors that may reduce rates of nonhome discharge after colorectal resection.
This was a retrospective cohort study of patients undergoing colorectal resection in the Michigan Surgical Quality Collaborative (July 2012 to June 2015). Patient- and hospital-level characteristics were tested for association with nonhome discharge patterns.
Patients were identified using prospectively collected data from the Michigan Surgical Quality Collaborative, a statewide collaborative encompassing 63 community, academic, and tertiary hospitals.
Patients undergoing colon and rectal resections were included.
The main outcome measure was hospital use patterns of nonhome discharge.
Of the 9603 patients identified, 1104 (11.5%) were discharged to a nonhome destination. After adjustments for patient factors associated with nonhome discharge, we identified variability in hospital use patterns for nonhome discharge. Designation as a low utilizer hospital was associated with affiliation with a medical school (p = 0.020) and high outpatient volume (p = 0.028). After adjustments for all hospital factors, only academic affiliation maintained a statistically significant relationship (OR = 4.94; p = 0.045).
This study had a retrospective cohort design with short-term follow-up of sampled cases. Additionally, by performing our analysis on the hospital level, there is a decreased sample size.
This population-based study shows that there is significant variation in hospital practices for nonhome discharge. Specifically, hospitals affiliated with a medical school are less likely to discharge patients to a facility, even after adjustment for patient and procedural risk factors. This study raises the concern that there may be overuse of subacute facility discharge in certain hospitals, and additional study is warranted. See Video Abstract at http://links.lww.com/DCR/A837.
手术后非居家目的地（即熟练护理机构、亚急性康复或长期护理机构）出院与死亡率增加和更高的成本相关，并且不如患者出院到居家理想。
我们试图确定可能降低结直肠切除术后非居家出院率的可修改的医院水平因素。
这是一项在密歇根外科质量协作组（2012 年 7 月至 2015 年 6 月）中接受结直肠切除术的患者的回顾性队列研究。测试了患者和医院水平特征与非居家出院模式的关联。
使用密歇根外科质量协作组前瞻性收集的数据识别患者，该协作组涵盖 63 家社区、学术和三级医院。
包括接受结肠和直肠切除术的患者。
主要观察指标是医院非居家出院模式的使用情况。
在确定的 9603 例患者中，有 1104 例（11.5%）出院到非居家目的地。在调整与非居家出院相关的患者因素后，我们发现医院非居家出院模式存在差异。被指定为低利用率医院与附属医院是医学院（p = 0.020）和高门诊量（p = 0.028）有关。在调整所有医院因素后，只有学术附属关系保持统计学显著关系（OR = 4.94；p = 0.045）。
本研究采用回顾性队列设计，对抽样病例进行短期随访。此外，通过在医院水平上进行分析，样本量减少。
这项基于人群的研究表明，医院在非居家出院方面的做法存在显著差异。具体而言，与医学院附属医院的医院更不可能将患者送往医疗机构，即使在调整患者和手术风险因素后也是如此。这项研究引起了人们的关注，即某些医院可能过度使用亚急性设施出院，需要进一步研究。在 http://links.lww.com/DCR/A837 观看视频摘要。
