Introduction

Routine use of home health care after prostatectomy is a potential source of practice pattern variation and adds costs with unclear benefits. We evaluated the relationship between home health care use after prostatectomy and deviations from the usual care pathway and costs.

Methods

We identified all men who underwent a laparoscopic radical prostatectomy from 04/01/2014 through 10/31/2015 in the Michigan Urological Surgery Improvement Collaborative (MUSIC) with insurance from Medicare or a large commercial payer. We determined variation in home care use after prostatectomy by urology practice. We then compared the rates of ED visits and readmissions within 16 days of discharge, prolonged catheter use, catheter reinsertion rates, and price-standardized 90 day episode costs for those who did and did not receive home care. Routine home care was defined as home care initiated within 4 days of discharge among patient discharged without a drain.

Results

We identified 647 patients meeting our inclusion criteria, of whom 13% received home health care. Patient and cancer characteristics were similar between cohorts (Table 1). Use of routine home care after prostatectomy varied from 0 to 53% across 33 practices in MUSIC (p=0.05). Unadjusted, patients with home care had increased rates of ED visits within 16 days (15.5% vs 6.9%, p<0.01), similar rates of catheter duration > 16 days (3.6% vs 3.0%, p=0.79) and need for catheter replacement (1.2% vs 2.5%, p=0.46), and a trend toward decreased readmissions rates (0 vs 4.1%, p=0.06). After controlling for patient and cancer characteristics, only the increased rate of ED visits remained significant (p<0.01). . Home health care cost an average of $1,000 per episode. Average total episode cost were $15,556 with home care and $13,788 without it. There were no differences in index hospitalization costs.

Conclusions

Routine home health care does not decrease ED visits or catheter complication rates. Its use is associated with increased 90-day episode costs. These data suggest that careful patient selection for home health care is necessary to improve the value of the service, as measured by cost, quality, and appropriateness.

Funding

Blue Cross and Blue Shield of Michigan.