Evaluation of the PRADO Home Discharge Support Programme for Orthopaedic Surgery in 2018.

Abstract

BACKGROUND\nBetween 2015 and 2017, nearly 80 000 hospital stays in orthopaedic surgery were entered into a home discharge support programme (PRADO) offered by the statutory health insurance system. The objective of this study was to assess the impact of the PRADO programme on enrolled stays in orthopaedic surgery over the last three years.\n\n\nHYPOTHESIS\nThe home discharge support programme used in orthopaedic surgery shortens hospital stays and decreases the rate of re-admission within 30 days.\n\n\nMATERIAL AND METHODS\nThe home discharge support programme PRADO was evaluated both quantitatively and qualitatively. The quantitative study used a multicentre retrospective cohort design with matching to controls identified in the national healthcare database. All hospital stays entered into the home discharge support programme between January 2015 and December 2017 were enrolled in the study. Follow-up was 6 months after discharge. The main outcome measure was the rate of re-admission within 30 days after discharge. The secondary outcome measures were emergency department visits, admission to rehabilitation, mean stay duration, visits to recommended healthcare professionals, medication consumption, and total healthcare expenditure at 6 months. The statistical analysis used the per protocol approach. The qualitative study involved semi-structured individual and group interviews designed to investigate adhesion of the professionals and their perceptions of programme implementation, funding, and costs.\n\n\nRESULTS\nOf 82 202 stays in the programme, 71 761 (87%) were matched and included in the analysis. Characteristics were comparable between the programme stays and the control stays. The programme stays had a significant reduction in the number of all-cause ambulatory and non-ambulatory re-admissions (4.5% vs. 4.9%, p<0.0001 and 3.9% vs. 4.2%, p=0.0009, respectively). Emergency department visits and rehabilitation admissions within 30 days were significantly less common in the programme group than in the control group (mean values, 2.1% vs. 2.3%, p=0.01 and 3.4% vs. 8.4%, p≤0.0001, respectively). Mean stay length was not significantly different between the two groups. Visits to recommended healthcare professionals occurred significantly more often and earlier in the programme group. The delivery of analgesics and heparin was significantly higher in the programme group, whereas no difference occurred in the delivery of antibiotics. Mean total health expenditures at 6 months were lower in the programme group (2248 € vs. 2485 €). The success of the PRADO programme was dependent on leadership from the medical staff within the institution and on assistance provided by the hospital throughout its implementation. The criteria for patient eligibility to the programme were not routinely shared by or clear to the healthcare staff.\n\n\nDISCUSSION\nThe PRADO programme effectively improves the care of orthopaedic surgery patients and raises the issue of whether some admissions to rehabilitation may be unnecessary.\n\n\nLEVEL OF EVIDENCE\nIII; comparative retrospective study.