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

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 

机构地区：[1]Group Finance,Singapore Health Services,Singapore 168582,Singapore [2]Department of Colorectal Surgery,Singapore General Hospital,Singapore 169608,Singapore [3]Post-Acute and Continuing Care,Family Medicine,Outram Community Hospital,Singapore 168582,Singapore [4]Finance,Singapore General Hospital,Singapore 169608,Singapore [5]Department of Orthopedic Surgery,Singapore General Hospital,Singapore 169856,Singapore [6]Singhealth Community Hospital,Singapore 168582,Singapore

出　　处：《World Journal of Orthopedics》2023年第4期231-239,共9页世界骨科杂志（英文版）

摘　　要：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 hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The 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 AHs.AIM 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 surgery.METHODS 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 analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS 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 groups.Patients 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 surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiate

关 键 词：Care bundle Community hospital Orthopedic surgery COST-EFFECTIVENESS Care transition INTERVENTION 

分 类 号：R473.6[医药卫生—护理学]