Patients are discharged to home or inpatient settings following primary unilateral total knee arthroplasty (TKA). We identified predictors of inpatient discharge and 3-month postoperative range of motion (ROM) and patient-reported physical function improvement (VR12 PCS) between these discharge settings. We studied prospectively collected cohortdata for 738 TKAs between April 2011 and April 2013. Significant adjusted predictors of inpatient discharge included older age, female gender, surgeon, comorbidity, lower PCS, and BMI >40. Only lower preoperative ROM predicted postoperative ROM. Inpatient discharge and higher preoperative PCS predicted lower PCS improvement. Home-based rehabilitation was associated with greater 3-month PCS improvement and showed no difference with 3-month ROM. TKA inpatient discharge should be based on patient care requirements rather than perceived benefit of improved ROM and physical function.
Integrating QI teaching into the routine clinical and educational systems of an inpatient service is challenging. Identifiable, concrete strategies in the setting, learner, and teacher domains helped integrate QI into the clinical and educational systems.
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