scholarly journals Factors Determining Home versus Rehabilitation Discharge Following Primary Total Joint Arthroplasty for Patients Who Live Alone

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 7 ◽  
Author(s):  
Christopher Fang ◽  
Sara J. Lim ◽  
David J. Tybor ◽  
Joseph Martin ◽  
Mary E. Pevear ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Tertiary Care ◽  
Joint Arthroplasty ◽  
Future Research ◽  
Discharge Destination ◽  
Nursing Facilities ◽  
Academic Hospital ◽  
Skilled Nursing ◽  
Hip And Knee Arthroplasty ◽  
Discharge Location

Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.

scholarly journals Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 26
Author(s):  
Christopher Fang ◽  
Andrew Hagar ◽  
Matthew Gordon ◽  
Carl T. Talmo ◽  
David A. Mattingly ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Hospital Costs ◽  
Cost Effective ◽  
Joint Arthroplasty ◽  
Nursing Facilities ◽  
Activity Based Costing ◽  
Skilled Nursing ◽  
Value Based Care ◽  
Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

scholarly journals Effects of Skilled Nursing Facility Partnerships on Outcomes Following Total Joint Arthroplasty

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Austin C. Kaidi ◽  
Roshan P. Shah ◽  
Mary G. Doucet ◽  
Alexander L. Neuwirth ◽  
Jeffrey A. Geller ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Nursing Facility ◽  
Skilled Nursing

scholarly journals COVID-19 as a Catalyst for Same-Day Discharge Total Shoulder Arthroplasty

2021 ◽  
Vol 10 (24) ◽  
pp. 5908
Author(s):  
Mariano E. Menendez ◽  
Noah Keegan ◽  
Brian C. Werner ◽  
Patrick J. Denard
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Patient Characteristics ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Discharge Rates ◽  
Same Day Discharge ◽  
Discharge Location ◽  
Ed Visits ◽  
Shoulder Arthroplasties

The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total of 508 consecutive patients undergoing elective primary total shoulder arthroplasty between 2019 and 2021 were identified and divided into 2 cohorts: “pre-COVID” (March 2019–March 2020; n = 263) and “post-COVID” (May 2020–March 2021; n = 245). No elective shoulder arthroplasties were performed at our practice between 18 March and 11 May 2020. Outcome measures included LOS, same-day discharge, discharge location, and 90-day emergency department (ED) visits, readmissions and reoperations. There were no significant differences in baseline preoperative patient characteristics. Shoulder arthroplasty performed post-COVID was associated with a shorter LOS (12 vs. 16 h, p = 0.017) and a higher rate of same-day discharge (87.3 vs. 79.1%, p = 0.013). The rate of discharge to skilled nursing facilities was similarly low between the groups (1.9 vs. 2.0%, p = 0.915). There was a significant reduction in the rate of 90-day ED visits post-COVID (7.4 vs. 13.3%, p = 0.029), while there were no differences in 90-day reoperation (2.0 vs. 1.5%, p = 0.745) or readmission rates (1.2 vs. 1.9%, p = 0.724). The COVID-19 pandemic seems to have accelerated the shift towards shorter stays and more same-day discharge shoulder arthroplasties, while reducing unexpected acute health needs (e.g., ED visits) without adversely affecting readmission and reoperation rates.

scholarly journals MANAGING MANAGED CARE: PERSPECTIVES FROM KEY STAKEHOLDERS IN SKILLED NURSING FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S498-S499
Author(s):  
Andrea E Daddato ◽  
Cynthia Drake ◽  
Edward A Miller ◽  
Pamela Nadash ◽  
Denise Tyler ◽  
...  
Keyword(s):  
Managed Care ◽  
Patient Care ◽  
Decision Makers ◽  
Skilled Nursing Facilities ◽  
Future Research ◽  
Fee For Service ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Key Stakeholders ◽  
The Relationship

Abstract In recent years, Medicare Advantage (MA) plan enrollment has increased, a trend that is expected to continue. Many skilled nursing facilities (SNFs) rely on MA managed care insurer referrals to maintain their census in a market with high competition for post-acute care patients. This study used semi-structured interviews to describe the relationship between MA plans and SNFs from the perspective of key decision-makers in SNFs. Twenty-three interviews were conducted with key stakeholders from 11 Denver Metropolitan area SNFs. A combined purposive-snowball sampling approach was used to identify and recruit select staff from the participating facilities. Interviews focused on the relationship between MA plans and SNFs, including mechanisms of control, power dynamics, and preferences for MA versus Fee-for-Service (FFS) Medicare patients. Key findings included: 1) challenges SNF staff had navigating MA plans’ case management processes, a key mechanism used by MA plans to influence the behavior of SNF decision-makers; 2) MA plans exercising power over beneficiaries’ length of stay, potentially leading to early discharge and heightened risk for rehospitalization; 3) SNF preference for admitting Medicare FFS over MA patients due to higher rates of Medicare FFS reimbursement and greater control over patient care. SNFs are increasingly reliant on MA plans for patient referrals and revenue. The themes suggest that this growing reliance may place SNFs at odds with MA plans on how best to manage overall patient care. It is therefore important that future research investigate how MA plans’ influence over care affects patient outcomes in SNFs and other post-acute settings.

Computer-Mediated Cognitive-Communicative Intervention for Residents with Dementia in a Special Care Unit: An Exploratory Investigation

2016 ◽  
Vol 1 (15) ◽  
pp. 68-78 ◽  
Author(s):  
Whitney Anne Postman
Keyword(s):  
Leading Edge ◽  
Special Care ◽  
Future Research ◽  
Nursing Facilities ◽  
Special Care Unit ◽  
Term Care ◽  
Skilled Nursing ◽  
Negative Behaviors ◽  
People With Dementia ◽  
Exploratory Investigation

Residents of “lockdown” dementia units, also referred to as “Special Care Units” of skilled nursing facilities, constitute a population of rapidly escalating needs. These entail rising demands for speech-language pathology services to treat and manage symptoms of dementia. This article recounts an exploratory investigation of rehabilitation sessions with an elderly resident of a Special Care Unit, using a new computer-based program targeting cognitive-communicative capacities. Preliminary results suggest that this resident with moderate dementia achieved a higher degree of functional recovery and superior quality of life than would have been possible with more traditional therapeutic approaches alone. An iPad-based software platform was used to administer tasks to train attention, working memory, and executive functions. The resident demonstrated significant gains in task performance that were coupled with increased independence and safety, enhanced participation in non-computerized therapeutic tasks, adaptation to surroundings, and reduction of negative behaviors. The resident's improved cognitive-communicative performance was sufficient to warrant a transfer to a long-term care wing within the same facility. This proof of concept demonstration invites formulation of testable hypotheses, which should be pursued in future research on optimizing interventions for institutionalized people with dementia using leading-edge computerized therapies.

scholarly journals A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty

2019 ◽  
Vol 8 (3) ◽  
pp. e000664 ◽  
Author(s):  
Lyle Sorensen ◽  
Lori Idemoto ◽  
Janet Streifel ◽  
Barbara Williams ◽  
Robert Mecklenburg ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hip Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Skilled Nursing Facility ◽  
Joint Arthroplasty ◽  
Quality Improvement Intervention ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Hospital Readmission Rate ◽  
Knee And Hip Arthroplasty

Knee and hip arthroplasties vary in cost, quality and outcomes. We developed a Lean quality improvement intervention for knee and hip arthroplasty patients encompassing the recognition, readiness, restoration and recovery phases of care.The intervention included standardised, evidence-based pathways, shared decision making, patient and family member engagement, and transdisciplinary rounding, implemented successively through a series of rapid process improvement workshops. We evaluated the intervention through run charts and time series analysis for 2005–2014. Outcomes included length of stay (LOS), 30-day readmission, discharge disposition, postsurgical complications and patient satisfaction.Included were 4253 total joint arthroplasty procedures, 1659 hip and 2594 knee. LOS decreased from 3.2 to 2.4 days postintervention for both hip and knee patients (p<0.001). The 30-day hospital readmission rate for hip patients decreased from 3.1% (18/576) to 1.1% (5/446, p=0.032) with knee patients unchanged. Discharge to home (vs rehabilitation facility or skilled nursing facility) increased from 72% (415/576) to 91% (405/446) (p<0.001) for hip patients, and from 70% (599/860) to 87% (578/663) for knee patients (p<0.001).Our standardised multifaceted Lean quality improvement programme was associated with reduced LOS, decreased readmission rates and improved discharge disposition in total knee and hip arthroplasty patients.

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