Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score

We estimated the impact of alternative discharge strategies, following join t replacement (JR) surgery, on acute care readmission rates and the total c ost of a continuum of care. Following surgery, patients were discharged to one of four destinations. Propensity scores were used to adjust costs and o utcomes for potential bias in the assignment of discharge destinations. We demonstrated that the use of rehabilitation hospitals may lower readmiss ion rates, but at a prohibitive incremental cost of each saved readmission, that patients discharged with home care had longer acute care stays than o ther patients, that the provision of home care services increased health sy stem costs, and that acute care readmission rates were greatest among patie nts discharged with home care. Our study should be seen;as one important st epping stone towards a full economic evaluation of the continuum of care fo r patients. (C) 2000 Elsevier Science B.V. All rights reserved. JEL classif ication: I10; C10.