Post-discharge Feedback Evaluation of Patients who Have Received Health Care in Orthopedic Surgery

The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alternative to conventional rehabilitation services following knee arthroplasty. Five community-living elders who had knee arthroplasty were recruited prior to discharge from an acute care hospital. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (16) were conducted by two trained physiotherapists from a service center to the patient’s home using H264 videoconference CODECs (Tandberg 550 MXP) connected at 512 Kb\s. Disability (range of motion, balance and lower body strength) and function (locomotor performance in walking and functional autonomy) were measured in face-to-face evaluations prior to and at the end of the treatments by a neutral evaluator. The satisfaction of the health care professional and patient was measured by questionnaire. Results are as follows. One participant was lost during follow-up. Clinical outcomes improved for all subjects and improvements were sustained two months post-discharge from in-home telerehabilitation. The satisfaction of the participants with in-home telerehabilitation services was very high. The satisfaction of the health care professionals with the technology and the communication experience during the therapy sessions was similar or slightly lower. In conclusion, telerehabilitation for post-knee arthroplasty is a realistic alternative for dispensing rehabilitation services for patients discharged from an acute care hospital.Keywords: Telerehabilitation, Physical Therapy, Total Knee Arthroplasty, Videoconferencing

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The Effect of Hospital Ownership on Health Care Utilization in Orthopedic Surgery

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000565 ◽

2018 ◽

Vol 31 (2) ◽

pp. 73-79 ◽

Cited By ~ 2

Author(s):

Gregory D. Schroeder ◽

Mark F. Kurd ◽

Christopher K. Kepler ◽

Kris E. Radcliff ◽

Mitchell G. Maltenfort ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Orthopedic Surgery ◽

Care Utilization ◽

Hospital Ownership

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Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention: Rentabilité D’une Intervention de Contact et d’un Programme de Psychothérapie Pour la Prévention du Suicide Après le Congé de L’hôpital

The Canadian Journal of Psychiatry ◽

10.1177/0706743720980135 ◽

2020 ◽

pp. 070674372098013

Author(s):

Gonzalo Martínez-Alés ◽

José B. Cruz Rodríguez ◽

Pablo Lázaro ◽

Arce Domingo-Relloso ◽

María Luisa Barrigón ◽

...

Keyword(s):

Health Care ◽

Cost Effectiveness ◽

Suicide Prevention ◽

Cost Effective ◽

Cost Data ◽

Base Case ◽

Case Scenario ◽

Post Discharge ◽

Base Case Scenario ◽

Augmentation Strategies

Objective: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. Methods: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid’s official list of public health care prices. Indirect cost data were derived from Spain’s National Institute of Statistics. Results: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €−196 per averted attempt). Conclusions: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

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Patient Adoption and Utilization of a Web-Based and Mobile-Based Portal for Collecting Outcomes After Elective Orthopedic Surgery

American Journal of Medical Quality ◽

10.1177/1062860618765083 ◽

2018 ◽

Vol 33 (6) ◽

pp. 649-656 ◽

Cited By ~ 6

Author(s):

Kerri Bell ◽

Eugene Warnick ◽

Kristen Nicholson ◽

Sarah Ulcoq ◽

Seong Jin Kim ◽

...

Keyword(s):

Health Care ◽

Orthopedic Surgery ◽

Patient Reported Outcomes ◽

Elective Surgery ◽

Mobile App ◽

Data Capture ◽

Completion Rates ◽

Web Based ◽

Online Portal ◽

Patient Reported

Health care increasingly collects patient-reported outcomes (PROs) via web-based platforms. The purpose of this study was to evaluate how patient age influences portal engagement. Patients undergoing elective surgery at a single multispecialty orthopedic practice from September 2014 to February 2017 had access to an online portal to complete PROs, message the clinic, and view physical therapy instructions. A mobile app was optionally available. Age, sex, log-in frequency, PRO completion rates, and number of messages sent were reviewed retrospectively. Message frequency, log-in rates, and PRO compliance were highest for patients aged 41 to 50, 51 to 60, and 61 to 70, respectively. Mobile app use decreased with age ( P = .002); yet, at all ages, the mobile app group was more engaged. In particular, for patients aged 18 to 30 years, log-in frequency increased 2.5-fold and PRO compliance improved 44% ( P < .001) in the mobile app group. This study demonstrates that portal interaction varies by age and that data capture is highest in patients who choose the mobile app.

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Costs and Resource Utilization in Prolonged Critical Illness

10.1093/med/9780199653461.003.0008 ◽

2014 ◽

Author(s):

Christopher E Cox

Keyword(s):

Health Care ◽

Critical Illness ◽

Acute Care ◽

Patient Population ◽

Health Care Policy ◽

Patient Flow ◽

Prolonged Mechanical Ventilation ◽

Post Discharge ◽

Chronic Critical Illness ◽

Post Acute Care

Patients who have chronic critical illness, operationally defined as those requiring prolonged mechanical ventilation, are markedly increasing in number and commonly experience profound, persistent physical and psychological debilitation. This patient population consumes an extraordinary amount of health care resources attributed to both the acute hospitalization as well as complex post-discharge treatments provided across multiple post-acute care facilities. Currently, the US health care system incentivizes these patient flow dynamics. Health care policy changes addressing post-acute care payment are inevitable. This chapter highlights potential patient, family, physician, and systems targets for current and future interventions, designed to improve quality and reduce costs for this patient population.

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Acute Kidney Injury in Critically Ill Children and Subsequent Chronic Kidney Disease

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119880188 ◽

2019 ◽

Vol 6 ◽

pp. 205435811988018 ◽

Cited By ~ 8

Author(s):

Erin Hessey ◽

Sylvie Perreault ◽

Marc Dorais ◽

Louise Roy ◽

Michael Zappitelli

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Renal Disease ◽

Critically Ill ◽

Administrative Data ◽

Kidney Injury ◽

Critically Ill Children ◽

Post Discharge

Background: The progression from acute kidney injury (AKI) to chronic kidney disease (CKD) is not well understood in children. Objectives: We aimed to develop a pediatric CKD definition using administrative data and use it to evaluate the association between AKI in critically ill children and CKD 5 years after hospital discharge. Design: Retrospective cohort study using chart collection and administrative data. Setting: Two-center study in Montreal, Canada. Patients: Children (≤18 years old) admitted to two pediatric intensive care units (ICUs) between 2003 and 2005. We a priori excluded patients with end-stage renal disease or no health care number. Only the first admission during the study period was included. We excluded patients who could not be linked to administrative data, did not survive hospitalization, or had preexisting renal disease. Measurements: Acute kidney injury was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were defined as having CKD 5 years post-discharge if they had ≥1 CKD diagnostic code or ≥1 CKD-specific medication prescription. Methods: Chart data used to define the exposure (AKI) were merged with provincial administrative data used to define the outcome (CKD). Cox regression was used to evaluate the AKI-CKD association. Results: A total of 2235 (56% male) patients were included, and the median admission age was 3.7 years. A total of 464 (21%) patients developed AKI during pediatric ICU admission. At 5 years post-discharge, 43 (2%) patients had a CKD diagnosis. Patients with both stage 1 and stage 2-3 AKI had increased risk of a CKD diagnosis, with the adjusted hazard ratios (95% confidence intervals) of 2.2 (1.1-4.5) and 2.5 (1.1-5.7), respectively ( P < .001). Limitations: Results may not be generalizable to non-ICU patients. We were not able to control for post-discharge variables; future research should try to explore these additional potential risk factors further. Conclusions: Acute kidney injury is associated with 5-year post-discharge CKD diagnosis defined by administrative health care data.

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Prevalence, Health Care Expenditures, and Orthopedic Surgery Workforce for Musculoskeletal Conditions

JAMA ◽

10.1001/jama.2009.1489 ◽

2009 ◽

Vol 302 (14) ◽

pp. 1586 ◽

Cited By ~ 28

Author(s):

Robert H. Haralson

Keyword(s):

Health Care ◽

Orthopedic Surgery ◽

Health Care Expenditures ◽

Musculoskeletal Conditions

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A comparison of health care use after severe COVID-19, respiratory syncytial virus, and influenza in children

10.1101/2021.11.22.21266522 ◽

2021 ◽

Author(s):

Vilde Bergstad Larsen ◽

Ketil Størdal ◽

Kjetil Telle ◽

Fredrik Methi ◽

Karin Magnusson

Keyword(s):

Health Care ◽

Primary Health Care ◽

Hospital Care ◽

Relative Increase ◽

Health Care Use ◽

Specialist Care ◽

Post Discharge ◽

Percentage Points ◽

Primary Health ◽

Rsv Infection

Background: We aimed to explore whether children in hospital care with COVID-19 have increased post-discharge health care use when compared to children in hospital care with 1) RSV infection, and 2) other RTIs. Methods: In 34,214 children aged 1 month to 5 years who were registered with one or more hospital contacts with COVID-19 (N=128), RSV infection (N=4,009) or other RTIs (upper- and lower unspecified RTI as well as influenza) (N=34,457) (January 1st, 2017 to September 20th, 2021), we used a pre-post study design to investigate the individual all-cause primary and specialist health care use from 12 weeks prior to hospital admission, to 12 weeks after hospital discharge, stratified on infants (1-12 months) and toddlers (1-5 years). Findings: We found a slight increase in primary health care use in the first four weeks after discharge for children aged 1-12 months with COVID-19 when compared to children with RSV infection (0.064 percentage points, 95% CI 0.02-0.126, 0.52% relative increase). For children aged 1-5 years, COVID-19 discharge was associated with a 1-4 weeks increase in primary health care use when compared to children with RSV infection (0.068 percentage points, 95% CI 0.022-0.144, 0.53% relative increase) and other RTI (0.046 percentage points, 95% CI 0.002-0.091, 0.45% relative increase). For children aged 1-12 months in hospital care with COVID-19, we found a similar-magnitude-increase in post-discharge inpatient specialist care use, which lasted for 12 weeks. Interpretation: Our findings imply no severe impact on health care use after hospitalization with COVID-19 compared to hospitalization with RSV infection or other RTIs. The etiological mechanisms for potentially worse post-hospitalization complaints or health-seeking behavior for COVID-19 than for other RTIs in children should be further explored.

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