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Évaluation d'impact d'une nouvelle organisation en chirurgie orthopédique sur les parcours de soins

Author

Listed:
  • 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)

  • Zeynep Or

    (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, 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)

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.

Suggested Citation

  • Noémie Malléjac & Zeynep Or, 2019. "Évaluation d'impact d'une nouvelle organisation en chirurgie orthopédique sur les parcours de soins," Post-Print hal-04225092, HAL.
    • Handle: RePEc:hal:journl:hal-04225092
    DOI: 10.3917/jges.195.0431
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    1. Chabé-Ferret, Sylvain, 2015. "Analysis of the bias of Matching and Difference-in-Difference under alternative earnings and selection processes," Journal of Econometrics, Elsevier, vol. 185(1), pages 110-123.
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    3. Michael Spence, 1973. "Job Market Signaling," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 87(3), pages 355-374.
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    More about this item

    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;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • L23 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Organization of Production
    • D04 - Microeconomics - - General - - - Microeconomic Policy: Formulation; Implementation; Evaluation

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