Évaluation d'impact d'une nouvelle organisation en chirurgie orthopédique sur les parcours de soins
Noémie Malléjac and
Zeynep Or
Additional contact information
Noémie Malléjac: LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique
Post-Print from HAL
Abstract:
Coordination of care provided before and after a hospitalization is essential for improving the quality of patient care and efficiency of health system. Various patient-centered care protocols have been developed in the medical literature for improving patient care pathways. They are increasingly promoted and employed in healthcare facilities. In this study, we evaluate the impact of an enhanced recovery after surgery (ERAS) protocol in orthopaedic surgery on patients' care pathways and on resource utilisation.The data used in the analyses come from the French hospital episodes database (PMSI-MCO) and cover all patients who were admitted to a private hospital for hip or knee prosthesis. We assess the impact of ERAS on the patient length of stay (LOS), the discharge destination (home or rehabilitation facility) and the probability of readmission at 30 and 90 days after discharge. Using difference-in-difference regressions (DID), we compare the results of patients treated in hospitals certified as ERAS with those patients treated in comparable control hospitals. In DID estimations, we control for a number of confounding factors including patient's age, gender, social origin, case-mix and surrounding care supply in patients' residence area.Patients operated in departments that practices ERAS have, on average, a shorter length of stay than those who are operated in a conventional surgery department (-0.4 days). These patients have a higher probability of returning home (OR 1.15), without having a greater risk of readmission. Raac appears to induce also an increase in the volume of surgical procedures for hip or knee replacement in these hospitals, since the label seems to give a quality signal to patients.
Keywords: Health system efficiency; Care pathways; Enhanced recovery after chirurgy; Orthopaedic surgery; Efficience du système de santé; parcours de soins; Réhabilitation améliorée après chirurgie (RAAC); chirurgie orthopédique (search for similar items in EconPapers)
Date: 2019
References: Add references at CitEc
Citations:
Published in Journal de gestion et d'économie de la santé, 2019, 2019/5 (5), pp.431. ⟨10.3917/jges.195.0431⟩
There are no downloads for this item, see the EconPapers FAQ for hints about obtaining it.
Related works:
Working Paper: évaluation d’impact d’une nouvelle organisation en chirurgie orthopédique sur les parcours de soins (2019) 
This item may be available elsewhere in EconPapers: Search for items with the same title.
Export reference: BibTeX
RIS (EndNote, ProCite, RefMan)
HTML/Text
Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04225092
DOI: 10.3917/jges.195.0431
Access Statistics for this paper
More papers in Post-Print from HAL
Bibliographic data for series maintained by CCSD ().