Discharge Disposition After Joint Replacement and the Potential for Cost Savings: Effect of Hospital Policies and Surgeons

Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data

“…Clear clinical guidelines are an evidence‐based means for improving system performance, but there are no relevant guidelines in Australia regarding best practice for rehabilitation after TKR 17 . Adoption of a clinical protocol by one hospital improved the odds of rehabilitation in the home rather than inpatient rehabilitation by 45% 20 . Financial incentives and linking payments to outcomes are also widely promoted as methods for improving the cost‐effectiveness of service delivery 21 .…”

“…17 Adoption of a clinical protocol by one hospital improved the odds of rehabilitation in the home rather than inpatient rehabilitation by 45%. 20 Financial incentives and linking payments to outcomes are also widely promoted as methods for improving the cost-effectiveness of service delivery. 21 Linking funding to patient outcomes, or at least to compliance with guidelines based on patient need, could help improve the use of inpatient rehabilitation.…”

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty

“…London et al performed an administrative database analysis of total hip and knee arthroplasty patients to determine predictors of patient discharge location [21]. They suggest that both patient and surgeon level variables are predictive of being discharged to home after TJA.…”

Does Discharge Destination Matter after Total Knee Arthroplasty? A Single-Institution Korean Experience

“…Such results demonstrate the current pattern of discharge disposition in South Korea, which does not seem to follow the Western pattern, probably as the bundled payment system has not been introduced yet in the country. As about 55% of the cost incurred in TKA is for post-acute care and discharge to a non-home destination was reported to consume 36% of the total cost of care20), measures must be taken to reduce the number of inpatient facility discharges to mitigate the total cost of patient care after TKA.…”

“…Some of the various demographic and perioperative variables reported from the West to favor an inpatient facility as discharge destination after TKA include older age2,3,10,14,16,17, 20,21,24), female sex2,3,10,14,16,17,21), higher comorbidity index1,2,14,16,17,19,21), low socioeconomic status9,10), non-white race2,10), higher BMI16,17,21), longer operation time16,17), and longer length of stay in the acute-care hospital1,10–12,16,17,20,24). In our study, we did not find any difference in age and sex distribution between the two groups.…”