Post-Acute Matters More Than Hospital Care?!

A new retrospective cohort study from Penn Medicine suggests that for older patients, the quality of the post-hospital care matters more than the hospital care itself. There were 42, 000 Medicare patients in the study, which compared post-acute care (nursing homes, rehabilitation facilities, at-home care, etc.) to hospital care. They found that the impact of this care on outcomes was three to eight times greater than the impact of hospital factors. Overall, says the November 4, 2016 news release, “…nursing home factors explained three times more variation in a patient’s probability of dying at 30 days than hospital factors, seven times more variation in the probability of dying at 180 days, and eight times more variation in the probability of dying or being newly unable to walk at 180 days.”

“These results highlight the major impact that post-acute care has on basic outcomes such as survival and walking ability among this patient population, ” said the study’s lead author Mark D. Neuman, M.D., M.Sc., an assistant professor of Anesthesiology and Critical Care in the Perelman School of Medicine at the University of Pennsylvania, and director of the Penn Center for Perioperative Outcomes Research and Transformation (PCORI).

Dr. Neuman told OTW, “Hip fracture is a major public health problem that occurs over 300, 000 times each year, with high rates of associated morbidity and mortality. While nearly all hip fracture patients require both acute (hospital) care and post-acute (nursing home) care, little is known about the relative impact of variations in quality in each of these settings on outcomes. Comparing the contribution of nursing home factors versus hospital factors to patient outcomes has substantial importance to health policy and practice.”

“Differences in quality across nursing homes explain three to eight times the amount of variation in outcomes between patients than do quality differences across hospitals—this points to huge opportunities to improve outcomes by focusing on post-acute care.”

“Our findings have real implications for policy, particularly in regard to emerging bundled payment models consider acute- and post-acute care together. Our work affirms that the impact of post-acute care on outcomes needs to be a major consideration for health systems and payers who are looking for ways to improve the effectiveness and efficiency of care.”