Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use

OBJECTIVES: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. DESIGN: Prospective, observational cohort study. SETTING: 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). PATIENTS: One hundred and fifteen patients undergoing total hip replacement: 56 in the experimental group and 59 in the control group. MAIN MEASURES: Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services. RESULTS: 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. CONCLUSIONS: 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. DISCUSSION: The utilisation of home care after hip replacement should be critically appraised in view of the need to stimulate patients' independence.