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J Arthroplasty. 2016 Mar;31(3):573-8.e2. doi: 10.1016/j.arth.2015.10.019. Epub 2015 Oct 26.

Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement.

Author information

1
Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
2
Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Orthopaedic Surgery, Dayton Veteran's Association Medical Center, Dayton, Ohio.
3
Department of Orthopaedic Surgery, Dayton Veteran's Association Medical Center, Dayton, Ohio.
4
Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
5
Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

Abstract

BACKGROUND:

Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience.

METHODS:

We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates.

RESULTS:

The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups.

CONCLUSION:

Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization.

KEYWORDS:

emergency department visits; hospital readmission; quality measurement; total hip arthroplasty; total knee arthroplasty

PMID:
26689614
DOI:
10.1016/j.arth.2015.10.019
[Indexed for MEDLINE]

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