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Comment & Response
December 2015

Genuflecting to Hospital Variation in Home Discharge—Reply

Author Affiliations
  • 1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
  • 2Department of Surgery, Henry Ford Hospital, Detroit, Michigan
  • 3Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2015;150(12):1203. doi:10.1001/jamasurg.2015.2419

In Reply In our study, we examined the risk of discharge to postacute care for several operations. We subsequently built the outcome into the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (http://riskcalculator.facs.org/) for all operations captured by the National Surgical Quality Improvement Program, not just the few included in our study. Dr Hyder questions whether the inclusion of joint arthroplasties effects the value of the calculator, given the hospital-level variation in the use of postacute care unrelated to patient factors (ie, some hospitals nearly always send patients to postacute care, while others almost never do). Understanding these influences, which may relate to practice style, resource availability, regulatory practices, and other socioeconomic factors, will play an important role in controlling Medicare spending moving forward.13

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