The Effects of a Hospitalist Comanagement Model for Joint Arthroplasty Patients in a Teaching Facility

Duplantier, Neil L.; Briski, David C.; Luce, Lindsay T.; Meyer, Mark S.; Ochsner, John L.; Chimento, George

doi:10.1016/j.arth.2015.10.010

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…To our knowledge, this is one of the largest studies evaluating the benefits of SCM over 5.8 years. Similar to our prior studies on this SCM model of care, 5,7 other studies have reported a decrease in medical complications, 8-10 LOS, [11][12][13] and cost of care 14 with SCM.…”

Section: Discussionsupporting

confidence: 86%

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Rohatgi

Weng

Ahuja

2020

Journal of Hospital Medicine

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Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.

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Section: Discussionsupporting

confidence: 86%

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Rohatgi

Weng

Ahuja

2020

Journal of Hospital Medicine

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“…In total, 54 studies, reported in 55 articles, met the inclusion criteria. 57,58,67,71,74,[81][82][83][84]86,91,96,97,100,[104][105][106]109,110,112,115,116,[119][120][121]123,125,131,133,134,145,146,151,159,162,166,179,183,184,186,210,211,215,[222][223][224]232,244,256,257,…”

Section: Study Selectionmentioning

confidence: 99%

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Nunns

Shaw

Briscoe

et al. 2019

Health Serv Deliv Res

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Background Elective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients. Objectives To evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions. Data sources Seven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence. Review methods Comparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis. Findings A total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’s d = –0.51, 95% confidence interval –0.78 to –0.24; p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’s d = –1.04, 95% confidence interval –1.55 to –0.53; p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive. Limitations Studies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis. Conclusions Enhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known. Future work Further studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes. Study registration This study is registered as PROSPERO CRD42017080637. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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“…The orthopedic surgeon does not abdicate care to the anesthesiologist, but they work closely together coordinating the care of the patient. As previously mentioned, hospitalist management of arthroplasty patients may increase cost, without any improvement in outcomes [14]. SCAMPS are an attractive alternative to clinical practice guidelines.…”

Section: Postoperative Phasementioning

confidence: 99%

“…Traditional medical comanagement models have not shown success in the management of hip and knee arthroplasty patients. Duplantier et al have shown that total joint patients co-managed by hospitalists had more medical tests ordered while hospitalized, had a higher cost of hospitalization, and were more likely to be discharged to a skilled nursing facility compared to a group that was managed by the surgeons alone [14].…”

Section: Definitionmentioning

confidence: 99%

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement

Chimento

Thomas

2017

Curr Rev Musculoskelet Med

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Purpose of Review The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. Recent Findings The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. Summary The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

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The Effects of a Hospitalist Comanagement Model for Joint Arthroplasty Patients in a Teaching Facility

Cited by 17 publications

References 21 publications

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement

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