Home health care is associated with an increased risk of readmission and cost of care without reducing risk of complication following shoulder arthroplasty: a propensity-score analysis

Home health services provide patients with additional professional care and supervision following discharge from the hospital to theoretically reduce the risk of complication and reduce health care utilization. The aim of this investigation was to determine if patients assigned home health services...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2024-07, Vol.33 (7), p.1563-1569
Main Authors: Wieland, Mark D., Sequeira, Sean B., Imbergamo, Casey, Murthi, Anand M., Wright, Melissa A.
Format: Article
Language:English
Subjects:
anatomic total shoulder arthroplasty
cost of care
emergency department
Home health care
hospital readmission
medical complications
reverse shoulder arthroplasty
shoulder arthroplasty
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Summary:Home health services provide patients with additional professional care and supervision following discharge from the hospital to theoretically reduce the risk of complication and reduce health care utilization. The aim of this investigation was to determine if patients assigned home health services following total shoulder arthroplasty (anatomic [TSA] and reverse [RSA]) exhibited lower rates of medical complications, lower health care utilization, and lower cost of care compared with patients not receiving these services. A national insurance database was retrospectively reviewed to identify all patients undergoing primary TSA and RSA from 2010 to 2019. Patients who received home health services were matched using a propensity score algorithm to a set of similar patients who were discharged home without services. We compared medical complication rates, emergency department (ED) visits, readmissions, and 90-day cost of care between the groups. Multivariate regression analysis was performed to determine the independent effect of home health services on all outcomes. A total of 1119 patients received home health services and were matched to 11,190 patients who were discharged home without services. There was no significant difference in patients who received home health services compared with those who did not receive home health services with respect to rates of ED visits within 30 days (OR 1.293; P = .0328) and 90 days (OR 1.215; P = .0378), whereas the home health group demonstrated increased readmissions within 90 days (OR 1.663; P 
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2023.10.034