Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Acute hospital-community hospital care bundle for elderly orthopedic surgery patients: A propensity score-matched economic analysis
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
Ivan En-Howe Tan, Yun Zhao, Yonghui Chen, Mave Hean Teng Soh, Chek Hun Foo, Marianne Kit Har Au, Group Finance, Singapore Health Services, Singapore 168582, Singapore
Aik Yong Chok, Yun Zhao, Chee Hoe Koo, Emile John Kwong Wei Tan, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
Junjie Aw, Post-Acute and Continuing Care, Family Medicine, Outram Community Hospital, Singapore 168582, Singapore
Kwok Ann Ang, Finance, Singapore General Hospital, Singapore 169608, Singapore
Andrew Hwee Chye Tan, Department of Orthopedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
Marianne Kit Har Au, Singhealth Community Hospital, Singapore 168582, Singapore
Author contributions: Au MKH, Ang KA, Tan AHC, and Tan EJKW conceived and planned the study; Tan IEH and Chok AY supervised the study and wrote the manuscript; Chok AY and Zhao Y performed the analysis and interpreted the results; Chen YH, Soh MHT, and Foo CH collected and verified data; Koo CH and Aw JJ participated in the review of the manuscript; Chok AY, Tan EJKW, and Au MKH provided critical revisions for final approval; all authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by Singapore Health Services (SingHealth) Institutional Review Board (approval No. 2022/2178).
Informed consent statement: Due to the study’s retrospective design using de-identified data, written informed consent collection was waived by SingHealth Centralised Institutional Review Board.
Conflict-of-interest statement: All authors declare that they have no relevant or material financial interests related to the research described in this paper.
Data sharing statement: The data supporting this study’s findings are not publicly available due to privacy and ethical restrictions.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Aik Yong Chok, FRCS (Ed), MBBS, MMed, Surgeon, Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Singapore 169608, Singapore 169608, Singapore. chokaikyong@gmail.com
Received: January 24, 2023
Peer-review started: January 24, 2023
First decision: February 8, 2023
Revised: February 18, 2023
Accepted: March 27, 2023
Article in press: March 27, 2023
Published online: April 18, 2023
ARTICLE HIGHLIGHTS
Research background
Singapore’s healthcare system has faced bed shortages and extended stays for elderly patients recovering from surgery in acute hospitals.
Research motivation
An Acute Hospital-Community Hospital (AH-CH) care bundle was created to transfer patients to CHs where they can receive specialized care and free up beds in AHs.
Research objectives
To evaluate the impact of the AH-CH care bundle on AH length of stay (LOS), costs, and savings for elderly patients aged 75 years and above who underwent elective orthopedic surgery.
Research methods
The study examined a cohort of 862 patients aged 75 years and above undergoing elective orthopedic surgery at Singapore General Hospital before (2017-2018) and after (2019-2021) the implementation of the AH-CH care bundle intervention. Patients were matched 1:1 based on their propensity scores and compared for AH LOS, CH LOS, hospitalization metrics, postoperative 30-d mortality, modified Barthel Index (MBI) scores, and costs.
Research results
Elderly patients transferred to CHs had a significantly shorter median AH LOS (7 d vs 9 d, P < 0.001), and 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 patients within the care bundle were low, with no mortality rate following orthopedic surgery. When elderly patients were discharged from CHs, their MBI scores improved significantly.
Research conclusions
The AH-CH care bundle was found to be effective and cost-saving for elderly patients undergoing elective orthopedic surgery.
Research perspectives
Collaboration between acute and community care providers can help to improve clinical service quality and achieve cost savings.
