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Comment & Response |

Genuflecting to Hospital Variation in Home Discharge—Reply

Sanjay Mohanty, MD1,2; Mark Cohen, PhD1; Karl Y. Bilimoria, MD, MS3
[+] 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.
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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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December 1, 2015
Joseph A. Hyder, MD, PhD
1Department of Anesthesiology, Division of Critical Care Medicine, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
JAMA Surg. 2015;150(12):1203. doi:10.1001/jamasurg.2015.2416.
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