Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions
| Autor: | Ryan Charles, Andrew G. Urquhart, Michael A. Masini, Bonita Singal, Brian R. Hallstrom |
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| Rok vydání: | 2017 |
| Předmět: |
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Michigan medicine.medical_specialty Quality management medicine.medical_treatment Extended care facility Patient Readmission 03 medical and health sciences Patient Admission 0302 clinical medicine Odds Ratio medicine Humans Orthopedics and Sports Medicine Registries 030212 general & internal medicine Arthroplasty Replacement Knee Aged Quality of Health Care Retrospective Studies Skilled Nursing Facilities 030222 orthopedics Information Dissemination business.industry Absolute risk reduction Discharge disposition Odds ratio Length of Stay Middle Aged Quality Improvement Arthroplasty Patient Discharge Nursing Homes Hospitalization Cohort Emergency medicine Physical therapy Female Nursing homes business |
| Zdroj: | The Journal of Arthroplasty. 32:1418-1425 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2016.11.041 |
| Popis: | Background The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. Methods The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. Results This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. Conclusion Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions. |
| Databáze: | OpenAIRE |
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