Postacute Care Disposition for Total Hip and Total Knee Replacement Surgery for Asian Americans

Abstract

This study explored differences in postacute disposition for total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a focus on whether Asian Americans (AS) experience joint replacement disparities observed in other racial/ethnic minorities compared with majority white patients. We used data from the Nationwide Inpatient Sample for 2009 through 2012. We looked at disposition to home health care (HHC) and transfer to another facility for postacute care (e.g., skilled nursing facility, rehabilitation facility) for each of the 4 years under study. Findings for AS were mixed. There were differences in discharge to postacute facilities other than HHC for AS compared with whites for THA for 2011 and 2012. For TKA, there were differences in disposition to HHC for Asians compared with whites for 2009 and 2012; for disposition to postacute facilities other than HHC for TKA, there were differences for 2011 and 2012 only. Differences for AS in postacute disposition to facilities other than HHC appear to increase over the 4 years of the study. Further research with additional data is warranted.

Home Health Care to Asian Americans: a Systematic Review

“…Table 1 presents characteristics of reviewed studies, including study settings, population and sample size, data sources, and the study periods. Out of the 12 reviewed studies, two (17%) were conducted nationwide [ 12 , 15 ], and 7 (58%) were single-site study in one agency, city or a state [ 13 , 16 – 21 ]. The rest of the articles ( n =3, 25%) were conducted regionally in area overlapping multiple city/states [ 11 , 22 , 23 ].…”

“…The rest of the articles ( n =3, 25%) were conducted regionally in area overlapping multiple city/states [ 11 , 22 , 23 ]. As for study population, three (25%) articles focused on and included only Asian-American patients receiving HHC [ 17 , 18 , 22 ] or their caregivers ( n =1, 8.3%) [ 11 ], and the remaining 9 studies included both Asian Americans and participants of other racial/ethnic groups [ 12 , 13 , 15 , 16 , 19 – 21 , 23 ]. It should be noted that in one study (8.3%), Asian Americans (i.e., Chinese Americans) were identified by their speaking language at home rather than their reported race/ethnicity [ 19 ].…”

“…It should be noted that in one study (8.3%), Asian Americans (i.e., Chinese Americans) were identified by their speaking language at home rather than their reported race/ethnicity [ 19 ]. When considering the study population from the lens of admission resources (e.g., hospital, community) prior home health care, three (25%) studies particularly focused on patients admitted to home health agencies for post-acute care following hospital discharge [ 15 , 16 , 19 ] including one (8.3%) study of patients initially hospitalized for total knee or hip arthroplasty procedures [ 15 ]. The other 9 (75%) studies included HHC patients without specifying admission sources [ 11 – 13 , 17 , 18 , 20 – 23 ], of which one included those with dementia [ 20 ] and another one only included those with diabetes, hypertension, or cardiovascular disease [ 17 ].…”

“…Various data sources were used across studies, including 6 (50%) of the articles used Outcome and Assessment Information Set and/or other claim and administrative records [ 16 , 19 – 23 ], 4 (33%) articles conducted patient interviews and surveys [ 11 , 12 , 17 , 18 ]. The other two (17%) articles used data provided from specific projects conducted by either the HHA or Agency for Healthcare Research [ 13 , 15 ].…”

“…The research design and findings related to home health care to Asian Americans from the reviewed articles are presented in Table 2 . All 12 articles used an observational research design, including 8 cross-sectional studies [ 11 – 13 , 15 , 17 – 19 , 22 ] and four retrospective cohort studies [ 16 , 20 , 21 , 23 ]. It should be noted that three of the 12 studies did not explicitly state their research design but indicated the use of existing data (secondary data analysis) [ 12 , 13 , 23 ].…”