Background Events occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research.
Objective To quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission.
Methods Patients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006–2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge.
Results The cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario’s 14 administrative health regions (range 16%–84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92.
Conclusion Home care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.
- quality improvement
- healthcare quality improvement
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Contributors CdM: design of the work; acquisition, analysis and interpretation of data; drafted the work. GRN: design of the work; acquisition and interpretation of data. AK, MAO: design of the work and interpretation of data. KS, MAH: interpretation of data. CdM, AK, MAO, KS, MAH, GRN: revised the work critically for important intellectual content. CdM, AK, MAO, KS, MAH, GRN: final approval of the version published. All authors agree to be accountable for all aspects of the work.
Funding The study was supported by the Blair Foundation Vascular Surgery Innovation Fund jointly established with the University of Toronto
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval ICES is a prescribed entity under section 45 of the Personal Health Information Protection Act of Ontario. Under section 45, ICES is allowed to collect and use personal health information from health information custodians for the purposes of evaluation, planning and monitoring of the health system. The approval of a research ethics board was therefore not legally required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available.