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

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.