Background

Value is defined as outcome/cost. The purpose of this study was to analyze differences in the lengths of care, outcomes, and costs between skilled nursing facilities (SNFs) and home with health services (HHS) for patients treated with arthroplasty for femoral neck fracture (FNF).

Methods

Between October 2018 and September 2020, 192 patients eligible for the Comprehensive Care for Joint Replacement bundle program treated for a displaced FNF with total hip arthroplasty (THA) or hemiarthroplasty (HA) and discharged to SNF or HHS were analyzed for demographics, comorbidities, postoperative outcomes, costs of care, and discharge rehabilitation details. Variables were compared using chi-squared or t-tests as appropriate. There were 60 (31%) patients discharged to HHS (37% THA and 63% HA) and 132 (69%) patients discharged to SNF (14% THA and 86% HA). Patients discharged to SNF were older (P < .01), had lower Risk Assessment and Prediction Tool scores (P < .01), had higher comorbidity scores (P = .011), and had longer posthospitalization care (P < .01).

Results

There were no differences in rates of inpatient minor complications (P = .520), inpatient major complications (P = .119), Intensive Care Unit admissions (P = .193), or readmissions within 30 (P = .690) and 90 days (P = .176). Costs of care at a SNF were higher than HHS (P < .01). In multivariate regressions, a lower Risk Assessment and Prediction Tool score was associated with discharge to SNF (odds ratio 0.69, 95% confidence interval 0.58-0.83, P < .001).

Conclusion

Among Comprehensive Care for Joint Replacement bundle patients treated for a displaced FNF with arthroplasty, discharge with HHS may be a more cost-effective option than discharge to a SNF that does not increase risk of readmission in medically appropriate patients.

中文翻译：

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髋关节骨折关节置换术后熟练的护理设施降低了护理“价值”

背景

价值被定义为结果/成本。本研究的目的是分析接受关节置换术治疗股骨颈骨折 (FNF) 的患者在专业护理机构 (SNF) 和家庭医疗服务 (HHS) 之间的护理时间、结果和成本方面的差异。

方法

2018 年 10 月至 2020 年 9 月期间，对 192 名符合关节置换综合护理计划的患者进行了人口统计学、合并症、术后因移位 FNF 进行全髋关节置换术 (THA) 或股骨头置换术 (HA) 治疗并出院至 SNF 或 HHS 的患者分析结果、护理费用和出院康复细节。酌情使用卡方或t检验比较变量。有 60 名 (31%) 患者出院至 HHS（37% THA 和 63% HA），132 名（69%）患者出院至 SNF（14% THA 和 86% HA）。出院到 SNF 的患者年龄较大 ( P < .01)，风险评估和预测工具评分较低 ( P < .01)，合并症评分较高 ( P = .011)，并且有更长的出院后护理时间 ( P < .01)。

结果

住院轻微并发症 ( P  = .520)、住院主要并发症 ( P  = .119)、重症监护室入院率 ( P  = .193) 或 30 ( P  = .690) 和 90内再入院率没有差异天（P  = .176）。SNF 的护理成本高于 HHS ( P < .01)。在多变量回归中，较低的风险评估和预测工具评分与 SNF 出院相关（比值比 0.69，95% 置信区间 0.58-0.83，P < .001）。

结论

在接受置换 FNF 关节置换术治疗的关节置换束综合护理患者中，HHS 出院可能比 SNF 出院更具成本效益，因为 SNF 不会增加医学上合适的患者再入院的风险。