Abstract
Objectives
To determine the factors associated with acute hospital discharge to the 3 most common
postacute settings following total knee arthroplasty (TKA): inpatient rehabilitation
facilities (IRFs), skilled nursing facilities (SNFs), and directly back to the community.
Design
Retrospective cohort study.
Setting
Acute care hospitals submitting claims to Medicare.
Participants
National cohort (N=1,189,286) of 100% Medicare Part A data files from 2009-2011.
Interventions
Not applicable.
Main Outcome Measures
Observed rates and adjusted odds of discharge to the 3 main postacute settings based
on the clinical and facility level variables: amount of comorbidity, bilateral procedures,
and facility TKA volume.
Results
Using IRF discharge as the reference, patients who received a bilateral procedure
had lower odds of both SNF and community discharge, patients with more comorbidity
had lower odds for community discharge and higher odds for SNF discharge, and patients
who received their TKA from hospitals with lower TKA volumes had lower odds of SNF
and community discharge.
Conclusions
Clinical populations within Medicare beneficiaries may systematically vary across
the 3 most common discharge settings following TKA. This information may be helpful
for a better understanding on which patient or clinical factors influence postacute
care settings following TKA. Additional research including functional status, living
situation, and social support systems would be beneficial.
Keywords
List of abbreviations:
ASA (American Society of Anesthesiologists), CCI (Charlson Comorbidity Index), IRF (inpatient rehabilitation facility), LOS (length of stay), MedPAR (Medicare Provider Analysis Review), OR (odds ratio), PAC (postacute care), SNF (skilled nursing facility), TKA (total knee arthroplasty)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 15, 2020
Footnotes
Supported in part by the National Institutes of Health (grant nos. P2C-HD065702, R01-HD069443, K01-HD086290) and the National Institute on Disability and Rehabilitation Research (grant no. 90IF0071). During the time of this study, Dr Leland was funded by the Agency for Healthcare Research and Quality (K01HS022907). The content is solely the responsibility of the author and does not necessarily represent the official views of the funding agencies. The agencies did not influence the design, analysis, or interpretation of the study results.
Disclosures: none.
Identification
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© 2020 by the American Congress of Rehabilitation Medicine
