Improving Value in Total Joint Arthroplasty: A Comprehensive Patient Education and Management Program Decreases Discharge to Post-Acute Care Facilities and Post-Operative Complications

• Published in: The Journal of arthroplasty Vol. 33; no. 1; pp. 14 - 18
• Main Authors: Pelt, Christopher E., Gililland, Jeremy M., Erickson, Jill A., Trimble, Dory E., Anderson, Mike B., Peters, Christopher L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2018
• Subjects: arthroplasty; discharge; post-acute care; readmission; reoperation; value; discharge; reoperation; post-acute care; readmission; value; arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.08.003

A step-by-step approach to creating a comprehensive patient education, expectation, and management program is described with the aim of reducing discharges to post-acute care centers (PACs) following total joint arthroplasty (TJA). We hypothesized that by lowering discharges to PACs, readmissions and reoperations would also decrease. Following the implementation of a multi-faceted patient education and management program, we retrospectively reviewed 927 TJAs who underwent surgery 12 months before (n = 465) and after (n = 462) the program was implemented. To assess the exposure of the pathway on discharge disposition as well as institutional 30-day and 90-day readmissions and reoperations, a modified Poisson regression was used. There was a 20% absolute reduction in discharges to PACs (<0.001). The frequency of 30-day readmissions was greater in patients who underwent TJA before implementation (incidence rate ratio [IRR] 1.93, 95% confidence interval [CI] 1.01-3.69). The risk for 90-day readmissions (IRR 1.70, 95% CI 1.20-2.40) and reoperations (IRR 1.67, 95% CI 1.12-2.53) was greater prior to implementation. Discharge to PACs was associated with 2.4 and 3.10 times greater risk for 30-day readmissions (95% CI 1.28-4.56) and 30-day reoperations (95% CI 1.40-7.0), respectively. Patients discharged to PACs were also at greater risk for both 90-day readmissions (IRR 1.59, 95% CI 1.08-2.32) and 90-day reoperations (IRR 1.75, 95% CI 1.12-2.73). Our program led to a reduction in the number of patients being discharged to PACs following TJA, while also demonstrating a reduction in readmission and reoperations. Additionally, discharge to these facilities was an independent risk factor for these complications.