Effects of Skilled Nursing Facility Partnerships on Outcomes Following Total Joint Arthroplasty
| Autor: | Mary G. Doucet, Jeffrey A. Geller, Alexander L. Neuwirth, Roshan P. Shah, H. John Cooper, Austin C. Kaidi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Joint arthroplasty Joint replacement medicine.medical_treatment Aftercare Medicare Patient Readmission 03 medical and health sciences 0302 clinical medicine Medicine Pilot program Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee health care economics and organizations Aged Retrospective Studies Skilled Nursing Facilities 030222 orthopedics Surgical team business.industry Retrospective cohort study 030229 sport sciences Patient Discharge United States Emergency medicine Surgery Skilled Nursing Facility business |
| Zdroj: | The Journal of the American Academy of Orthopaedic Surgeons. 29(24) |
| ISSN: | 1940-5480 |
| Popis: | INTRODUCTION Post-total joint arthroplasty (TJA) discharge to a skilled nursing facility (SNF) is associated with higher costs and more complications than home discharge; however, some patients still require postoperative SNF care. To improve outcomes for patients requiring postoperative SNF care, this article analyzed the effect of SNF-surgeon partnerships on TJA postoperative costs and patient outcomes. METHODS This was a retrospective study of primary TJA patients who were part of Medicare's Comprehensive Care for Joint Replacement (CJR) pilot program at our urban, academic medical center. We identified all patients discharged to SNF and designated SNFs as "preferred" if they maintained a partnership with our surgical team. SNF costs, total 90-day postoperative costs, average length of stay in SNF, 90-day readmission rates, and readmission diagnoses were recorded. Data were compared using Student t-tests. Readmission rates and the presence of a readmission diagnosis were analyzed using z-scores. RESULTS Our search identified 189 patients (22.9%) discharged to SNFs, with 128 (67.8%) discharged to preferred and 61 (32.2%) discharged to nonpreferred facilities. Over the 4-year CJR pilot program, SNF costs ($10,981.23 versus $7,343.34; P < 0.005) and overall postdischarge costs ($23,952.52 versus $18,339.26; P = 0.07) were higher for patients discharged to nonpreferred SNFs versus preferred SNFs. Patients discharged to nonpreferred SNFs also had increased length of stay (14.8 versus 10.1 days; P < 0.005) and increased readmission rates (19.7% versus 3.9%; P < 0.005). These differences became more pronounced across the study period. CONCLUSION For patients undergoing primary TJA, hospital partnership with SNFs can improve CJR performance by cost reduction and overall outcomes for TJA patients. |
| Databáze: | OpenAIRE |
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