Page 12 - ANZCP Gazette May 2023

INTRODUCING DAH30
NUMBER OF DAYS A PATIENT SPENDS ALIVE AND AT HOME WITHIN 30 DAYS OF THEIR OPERATION
Rona Steel CCP, FANZCP, B.Med.Sci
Dept. of Anaesthesia, Westmead Hospital, NSW ANZCPR Data Manager; ANZSCTS Data Manager
I am thrilled to introduce DAH30 in this informal prelude article. This article contains material presented at 3SCTS in Cairns 2022. The formal scientific paper is still being drafted.
What is DAH30?
Quite simply, it is the number of Days a patient spends Alive and at Home within 30 days of their operation.
I shall illustrate using Figures 1 and 2. Meet Herlinda, let’s say she underwent an AVR and grafts at our centre. The operation went well, and she returned home 10 days later. Her Days Alive and at Home – DAH30 was 20 as represented by the green squares in Fig 1. Herlinda enjoyed 20 days out of the 30 at home after her operation.
Let’s say, that instead, Herlinda needed to go to a rehab facility for seven days after being discharged from Westmead before going home. Then unfortunately, she was readmitted to her local hospital for five days to sort an arrythmia. Her DAH30 is now eight (Figure 2). She spent eight days at home after her operation, taking into account her time in a ‘non- home’ healthcare facility and her readmission.
Should Herlinda have passed away within the 30 days following her operation, her DAH30 would, by definition, be zero whether she passed away in hospital or at home.
In the literature, DAH30 can also be referred to as: ‘Days Alive and Out of Hospital’ (DAOH), ‘composite length of stay’, ‘Days Alive and At Home’ (DAAH) or ‘home time’ days at home up to 30 days after surgery. DAH can also be expressed as DAH60 or DAH90 for values 60- or 90-days post-procedure respectably. These are well suited for treatments requiring a longer recovery to home e.g. cancer treatments.
For more details on the definition for DAH30 please refer to this link: https://europepmc.org/articles/ pmc5629653/bin/bmjopen-2017-015828supp001.pdf
Why is DAH30 exciting?
Because it is the ultimate outcome measure for quality as:
• It’s validated: it’s been well described and validated in literature (1,3,7) as an outcome measure.
• It’s patient-centred (1,3): patients care about their DAH30 value. Patients want a good recovery, to return home soon after their surgery, and to stay at home complication free. Many quality measures we currently focus on are not particularly valued by our patients nor do they reflect any tangible impact on the quality of life or recovery of our patients.
• It’s readily quantifiable (5) and definitive: the data required to calculate DAH30 uses definitive dates and a simple calculation. This data is not subjective or subject to statistical / biased analysis. It is a measure of the impact of the surgery, while also reflecting early discharges, non-home discharges, early readmissions and mortality simply in a single whole number. The data and calculation are repeatable and can be audited. This number accurately reflects a meaningful time – their time at home. Furthermore, other patient-centred outcome measures can be subjective or hard to resource e.g. questionnaires, self-reported QoL measures, cognitive tests.
• It’s readily attainable: the data required is largely sourced from routinely collected data, and additional data is easily sourced from eMR.
• Clinicians and administrators also find DAH30 valuable: clinicians want to measure and improve the patient's overall recovery. Administrators find DAH30 a useful measure of the overall impact and cost of care (5).
9 MAY 2023 | www.anzcp.org