Perspectives on Home Time and Its Association With Quality of Life After Inpatient Surgery Among US Veterans

Arya, Shipra; Langston, Ashley H.; Chen, Rui; Sasnal, Marzena; George, Elizabeth; Kashikar, Aditi; Barreto, Nicolas B.; Trickey, Amber W.; Morris, Arden M.

doi:10.1001/jamanetworkopen.2021.40196

Cited by 21 publications

(16 citation statements)

References 25 publications

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“…Recent studies have also shown that home time after surgery is significantly correlated with quality of life, functional status, and emotional and social recovery. 17 Overall, these observations highlight the utility of home time as a hospital performance metric that captures meaningful differences in outcomes and patient-centered measures of care quality.…”

Section: Discussionmentioning

confidence: 86%

“…[14][15][16] At the patient level, greater home time after inpatient surgery has been associated with better quality of life and functional status. 17 However, the potential utility of risk-standardized home time as a hospital-level performance metric for cardiac surgery is not well established. Accordingly, this study aimed to evaluate the association of 90-day risk-standardized home time with other measures of hospital performance and long-term outcomes.…”

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confidence: 99%

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Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States

et al. 2022

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Background: Assessing hospital performance for cardiac surgery necessitates consistent and valid care quality metrics. The association of hospital-level risk-standardized home time for cardiac surgeries with other performance metrics such as mortality rate, readmission rate, and annual surgical volume has not been evaluated previously. Methods: The study included Medicare beneficiaries who underwent isolated or concomitant coronary artery bypass graft, aortic valve, or mitral valve surgery from January 1, 2013, to October 1, 2019. Hospital-level performance metrics of annual surgical volume, 90-day risk-standardized mortality rate, 90-day risk-standardized readmission rate, and 90-day risk-standardized home time were estimated starting from the day of surgery using generalized linear mixed models with a random intercept for the hospital. Correlations between the performance metrics were assessed using the Pearson correlation coefficient. Patient-level clinical outcomes were also compared across hospital quartiles by 90-day risk-standardized home time. Last, the temporal stability of performance metrics for each hospital during the study years was also assessed. Results: Overall, 919 698 patients (age 74.2±5.8 years, 32% women) were included from 1179 hospitals. Median 90-day risk-standardized home time was 71.2 days (25th–75th percentile, 66.5–75.6), 90-day risk-standardized readmission rate was 26.0% (19.5%–35.7%), and 90-day risk-standardized mortality rate was 6.0% (4.0%–8.8%). Across 90-day home time quartiles, a graded decline was observed in the rates of in-hospital, 90-day, and 1-year mortality, and 90-day and 1-year readmission. Ninety-day home time had a significant positive correlation with annual surgical volume ( r =0.31; P <0.001) and inverse correlation with 90-day risk-standardized readmission rate ( r =–0.40; P <0.001) and 90-day risk-standardized mortality rate ( r =–0.60; P <0.001). Use of 90-day home time as a performance metric resulted in a meaningful reclassification in performance ranking of 22.8% hospitals compared with annual surgical volume, 11.6% compared with 90-day risk-standardized mortality rate, and 19.9% compared with 90-day risk-standardized readmission rate. Across the 7 years of the study period, 90-day home time demonstrated the most temporal stability of the hospital performance metrics. Conclusions: Ninety-day risk-standardized home time is a feasible, comprehensive, patient-centered metric to assess hospital-level performance in cardiac surgery with greater temporal stability than mortality and readmission measures.

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Section: Discussionmentioning

confidence: 86%

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confidence: 99%

Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States

et al. 2022

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“…32 Greater time spent at home during postsurgical recovery has been previously associated with higher quality of life in a broad surgical study. 33 For patients with hearing disabilities, telemedicine during the pandemic may improve patients' comprehension since masks prevent them from "reading the lips" of clinicians.…”

Section: Discussionmentioning

confidence: 99%

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study

Nguyen

Mason

Khanna

et al. 2023

Journal of Surgical Oncology

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Introduction The COVID‐19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care. Methods We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery‐related visits would be appropriate through telehealth versus in‐person. Results Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits. Conclusions Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high‐quality patient‐clinician communications, and a patient‐centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).

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“…48 Nonetheless, personal preferences should be considered when making arrangements for postsurgical care since some older patients, particularly those who live alone or have special medical needs, may value time recovering at a rehabilitation facility. 49 We found that nonelective surgery was significantly associated with days away from home in bivariate but not multivariable analyses. This is likely due to large differences in *Identified from the final zero-inflated negative binomial model that included all 394 observations.…”

Section: Discussionmentioning

confidence: 61%

Factors Associated With Days Away From Home in the Year After Major Surgery Among Community-living Older Persons

et al. 2022

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Objective: To identify the factors associated with days away from home in the year after hospital discharge for major surgery. Background: Relatively little is known about which older persons are susceptible to spending a disproportionate amount of time in hospitals and other health care facilities after major surgery. Methods: From a cohort of 754 community-living persons, aged 70+ years, 394 admissions for major surgery were identified from 289 participants who were discharged from the hospital. Candidate risk factors were assessed every 18 months. Days away from home were calculated as the number of days spent in a health care facility. Results: In the year after major surgery, the mean (SD) and median (interquartile range) number of days away from home were 52.0 (92.2) and 15 (0–51). In multivariable analysis, 5 factors were independently associated with the number of days away from home: age 85 years and older, low score on the Short Physical Performance Battery, low peak expiratory flow, low functional self-efficacy, and musculoskeletal surgery. Based on the presence versus absence of these factors, the absolute mean differences in the number of days away from home ranged from 31.2 for age 85 years and older to 53.5 for low functional self-efficacy. Conclusions: The 5 independent risk factors can be used to identify older persons who are particularly susceptible to spending a disproportionate amount of time away from home after major surgery, and a subset of these factors can also serve as targets for interventions to improve quality of life by reducing time spent in hospitals and other health care facilities.

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Perspectives on Home Time and Its Association With Quality of Life After Inpatient Surgery Among US Veterans

Cited by 21 publications

References 25 publications

Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States

Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study

Factors Associated With Days Away From Home in the Year After Major Surgery Among Community-living Older Persons

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