Episode-of-Care Characteristics and Costs for Hip and Knee Replacement Surgery in Hospitals Belonging to the High Value Healthcare Collaborative Compared With Similar Hospitals in the Same Health Care Markets

Weeks, William B.; Schoellkopf, William J.; Ballard, David J.; Kaplan, Gary S.; James, Brent C.; Weinstein, James Neil

doi:10.1097/mlr.0000000000000710

Cited by 12 publications

(11 citation statements)

References 14 publications

(16 reference statements)

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“…Our findings confirmed that much of the variability in total episode costs is mainly attributable to differences in post-acute care costs, particularly to rehabilitation. 44-46 Moreover, these costs are in line with the range found in the literature. 47…”

Section: Discussionsupporting

confidence: 88%

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The contribution of rehabilitation settings to the cost of integrated continuum-care episodes for hip fracture: a retrospective cohort study

Golinelli

Boetto

Mazzotti

et al. 2020

Preprint

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Background. Hip fracture (HF) requires an intensive healthcare resources utilization. Long-term morbidity related to poor fracture management is associated with a significant increase in healthcare costs. Many factors may affect the costs and outcomes in patients with HF. Using a definition of integrated Continuum-Care Episode (CCE) that encompasses the hospital phase and the post-acute rehabilitation after a surgical procedure for HF, we investigated the costs of CCEs for HF and their determinants, with particular regard to the contribution of different rehabilitation settings. Methods. We conducted a retrospective observational cohort study using data extracted from administrative databases of 5094 consecutive patients hospitalized for HF in 2017, aged ≥65 years, and resident in Emilia Romagna, Italy. To evaluate the overall costs of the CCE, we calculated the acute and post-acute costs from the date of the first hospital admission to the end of the integrated CCE. The determinants of costs were investigated using generalized linear regression models. Results. After adjusting for demographic and clinical characteristics, type of surgery (b=-0.340, p<0.001), and hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds (b=0.372, p<0.001) or not (b=0.313, p<0.001) were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs (0.163, p<0.001). Conclusions. Our findings suggest that CCE cost and its variability is mainly related to the rehabilitation settings. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with the lower cost of the overall CCE. Therefore, intermediate care settings should be privileged when planning HF rehabilitation pathways.

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Section: Discussionsupporting

confidence: 88%

“…This confirms what reported in literature and guidelines. 25,44,47,48 In fact, older patients usually undergo less complex and therefore less expensive surgery, thus reducing overall costs. 43…”

Section: Discussionmentioning

confidence: 99%

The contribution of rehabilitation settings to the cost of integrated continuum-care episodes for hip fracture: a retrospective cohort study

Golinelli

Boetto

Mazzotti

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…This may be related to the etiology of total knee replacement and the activity level in this population and is also comparable to other authors' observations 16,[45][46][47] The median of the total episode-of-care costs for TKA was USD$ 6,190, which suggests that this intervention is less expensive in Colombia than what has been reported in other countries. [48][49][50][51][52][53] In addition, large differences among regions and among insurers were found, which is very important for our health system given that these costs are incurred by the system. The multivariate analysis identified individual characteristics of the patients (age and comorbidities) and sociodemographic characteristics (insurer and geographic region) as independent predictors of total episode-of-care costs.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020

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Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299–7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

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“…Interestingly, when stratifying total and per-day costs by hospital type, we found higher costs for PJI revisions in small and rural hospitals and those located in the West. Indeed, differences in practice patterns and regional differences in care cost for total joint arthroplasty have been described as possible overall drivers of healthcare costs 30 ; nonetheless, exact mechanisms in these cost differences are difficult to elucidate. Patient variables are typically utilized to assess healthcare cost, but very few studies have assessed hospital factors as determinants in cost variation in hip and knee arthroplasty surgery.…”

Section: Discussionmentioning

confidence: 99%

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

et al. 2020

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Given increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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Episode-of-Care Characteristics and Costs for Hip and Knee Replacement Surgery in Hospitals Belonging to the High Value Healthcare Collaborative Compared With Similar Hospitals in the Same Health Care Markets

Abstract: Background:To inform consumers and restrain health care cost growth, efforts to promote transparency and to reimburse for care episodes are accelerating in the United States.

Cited by 12 publications

References 14 publications

The contribution of rehabilitation settings to the cost of integrated continuum-care episodes for hip fracture: a retrospective cohort study

The contribution of rehabilitation settings to the cost of integrated continuum-care episodes for hip fracture: a retrospective cohort study

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

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