Effects of Skilled Nursing Facility Partnerships on Outcomes Following Total Joint Arthroplasty

Abstract

Introduction: Post-total joint arthroplasty (TJA) discharge to a skilled nursing facility (SNF) is associated with higher costs and more complications than home discharge; however, some patients still require postoperative SNF care. To improve outcomes for patients requiring postoperative SNF care, this article analyzed the effect of SNF-surgeon partnerships on TJA postoperative costs and patient outcomes. Methods: This was a retrospective study of primary TJA patients who were part of Medicare's Comprehensive Care for Joint Replacement (CJR) pilot program at our urban, academic medical center. We identified all patients discharged to SNF and designated SNFs as “preferred” if they maintained a partnership with our surgical team. SNF costs, total 90-day postoperative costs, average length of stay in SNF, 90-day readmission rates, and readmission diagnoses were recorded. Data were compared using Student t-tests. Readmission rates and the presence of a readmission diagnosis were analyzed using z-scores. Results: Our search identified 189 patients (22.9%) discharged to SNFs, with 128 (67.8%) discharged to preferred and 61 (32.2%) discharged to nonpreferred facilities. Over the 4-year CJR pilot program, SNF costs ($10,981.23 versus $7,343.34; P < 0.005) and overall postdischarge costs ($23,952.52 versus $18,339.26; P = 0.07) were higher for patients discharged to nonpreferred SNFs versus preferred SNFs. Patients discharged to nonpreferred SNFs also had increased length of stay (14.8 versus 10.1 days; P < 0.005) and increased readmission rates (19.7% versus 3.9%; P < 0.005). These differences became more pronounced across the study period. Conclusion: For patients undergoing primary TJA, hospital partnership with SNFs can improve CJR performance by cost reduction and overall outcomes for TJA patients.

Efficacy and safety of continuous nursing in improving functional recovery after total hip or knee arthroplasty in older adults: A systematic review

“…There were six studies on the continuing care of older adults after hip replacement [ [30] , [31] , [32] , [33] , [34] , [35] ], including five RCTs [ [31] , [32] , [33] , [34] , [35] ] and one cohort study [ 30 ]. Among the included literature, there were two studies [ 36 , 37 ], including THA and TKA, both of which are cohort-controlled studies. Totally, the review encompassed 15 studies [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ], comprising six cohort studies [ 24 , 26 , 27 , 30 , 36 , 37 ] and nine RCTs [ 23 , 25 , 28 , 29 , [31] , [32] , [33] , [34] , [35] ], involving 34,186 patients.…”

“…Among the included literature, there were two studies [ 36 , 37 ], including THA and TKA, both of which are cohort-controlled studies. Totally, the review encompassed 15 studies [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ], comprising six cohort studies [ 24 , 26 , 27 , 30 , 36 , 37 ] and nine RCTs [ 23 , 25 , 28 , 29 , [31] , [32] , [33] , [34] , [35] ], involving 34,186 patients. The essential characteristics of the included literature are shown in Table 1 .…”

“… Age: not mentioned F/M: 156/111 OG/CG: 168/99 Wang et al., 2019 [ 24 ] USA Cohort TKA n = 520 one year Observation: Home exercise program Control: Routinely prescribed OPPT SF-12, Knee Society Scores, complication rate Compared with the traditional outpatient rehabilitation exercise program, the self-directed home exercise program can achieve the same effect and reduce costs. Age: not mentioned F/M: 313/207 OG/CG: 269/251 Kaidi et al., 2021 [ 37 ] USA Cohort THA, TKA n = 189 90 days Observation: Receive care in a skilled nursing facility Control: Home self-care 90-day readmission rates, readmission diagnoses, total post-discharge costs A skilled nursing facility selected after discharge can improve CJR performance by cost reduction and overall outcomes Age: >60 F/M: 142/47 OG/CG: 128/61 Burnett et al., 2022 [ 26 ] USA Cohort TKA n = 31,698 3 months Observation: Home health services by a registered nurse Control: Home under self-care Hospital charges, emergency department charges, and readmission charges Home health services do not appear to provide value as they are associated with significantly increased costs and do not lower the rates of complications, emergency department visits, or readmissions following TKA. Age: >65 F/M: 19,541/12,157 OG/CG: 15,849/15,849 LeBrun et al., 2022 [ 27 ] USA …”

“…Only one of the 15 studies was conducted in 2016 [ 36 ]; the rest were after 2018 [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , 37 ]. There were six studies on postoperative hip replacement [ [30] , [31] , [32] , [33] , [34] , [35] ], four from China [ [32] , [33] , [34] , [35] ], one from Australia [ 31 ], and one from the United States [ 30 ].…”

“…Seven studies on continuing nursing care after knee replacement [ [23] , [24] , [25] , [26] , [27] , [28] , [29] ], three from the United States [ 24 , 26 , 27 ], two from South Korea [ 25 , 29 ], one from Thailand [ 23 ], and one from Finland [ 28 ]. The two studies involving both THA and TKA, are from the United States [ 36 , 37 ].…”