Abstract
To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Prospective, observational cohort study. Two regions in The Netherlands where different organisational health care models have been implemented: a shared care setting (experimental group) and a care as usual setting (control group). One hundred and fifteen patients undergoing total hip replacement: 56 in the experimental group and 59 in the control group. Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services. Two weeks before hip replacement both groups were comparable concerning patient characteristics, hip function and health status. The mean improvement of the total sickness impact profile score between two weeks before hip replacement and six months after was -1.92 in the shared care group, compared to -5.11 in care as usual group, a difference in favour of the control group (p=0.02). The mean length of hospital stay was comparable in both settings: 12.8 days in the shared care group and 13.2 days in the care as usual group. After hip replacement, compared to care as usual, patients in the shared care group received more homecare, with a higher frequency, and for a longer period of time. No differences in patient satisfaction between the two groups were found. Six months after hip replacement, the health status of patients in the care as usual group, using significantly less home care, was better than the status of patients in the shared care group. The utilisation of home care after hip replacement should be critically appraised in view of the need to stimulate patients' independence.
Highlights
Total hip replacement is widely regarded as a very effective treatment for patients with hip joint failure w1x
Main measures: Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services
In the treatment of some diseases, e.g. diabetes mellitus, it is possible to change the site of care-delivery in toto from a secondary to a primary care setting without loss of quality
Summary
Total hip replacement is widely regarded as a very effective treatment for patients with hip joint failure w1x. It is generally believed that it is better to deliver health care as close as possible to the patients’ own living situation Another factor is the widely spread belief that primary care, compared to secondary care, is less expensive and not per se less effective. In many other cases, such as total hip replacement, there is no doubt that the surgical procedure itself has to be carried out in a well-equipped hospital In such cases a stronger role of primary care during the recovery phase can be realised by intensifying collaboration and communication between primary and secondary care. This alternative way of organising health care in the Netherlands is called transmural care. The aims of shared care, as summarised by Orton w4x, are an earlier and safer discharge from hospital, more support to frail and elderly people in their own homes, a better co-ordinated and more flexible community care, an efficient use of acute hospital services and greater responsiveness to the needs of patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
