Selecting post-acute care settings after abdominal surgery: Are we getting it right?

Background We investigated whether variation in post-acute care (PAC) services could be explained by surgeons discharging clinically similar patients to different PAC destinations, including home health (HH), skilled nursing facilities (SNF), and inpatient rehabilitation (IR). Methods We studied patients having colectomy, pancreatectomy or hepatectomy in the 2008–2011 Nationwide Inpatient Sample. We used propensity matching to determine: 1. Proportion of patients discharged to SNF/IR who could be matched to clinically similar patients discharged with HH. 2. Potential cost savings from greater use of HH. Results 30,843 patients were discharged with HH and 23,172 to SNF or IR. 14,163 (61%) SNF/IR patients could be matched to similar patients discharged with HH. Potential cost savings from increasing use of HH as an alternative to SNF/IR ranged from $2.5-$438 million annually. Conclusions There is considerable potential for reducing variation in PAC use and costs by better understanding how surgeons make decisions about PAC placement. Summary Many surgical patients discharged to inpatient rehabilitation or skilled nursing facilities have similar pre- and postoperative characteristics as individuals discharged home with home health. In order to reduce variation and deliver cost-effective care after discharge, it is important to understand how surgeons make decisions about post-acute care, and to develop processes to identify which type of post-acute care is best for each patient.