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J Arthroplasty. 2017 Nov;32(11):3286-3291.e4. doi: 10.1016/j.arth.2017.06.007. Epub 2017 Jun 13.

Region and Insurance Plan Type Influence Discharge Disposition After Hip and Knee Arthroplasty: Evidence From the Privately Insured US Population.

Author information

1
Department of Health Policy and Management, Center for the Assessment of Pharmaceutical Practices (CAPP), Boston University School of Public Health, Boston, Massachusetts; Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; RTI International, Health Care Financing and Payment Program (HCFP), Waltham, Massachusetts.
2
Department of Health Policy and Management, Center for the Assessment of Pharmaceutical Practices (CAPP), Boston University School of Public Health, Boston, Massachusetts; Department of Pharmaceutical Outcomes and Policy, University of Florida, College of Pharmacy, Gainesville, Florida.
3
Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.
4
Ariadne Labs, Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts.
5
Department of Surgery, Boston University Medical Center, Boston, Massachusetts.
6
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospitals for Children - Boston, Boston, Massachusetts.
7
Harvard Medical School, Boston, Massachusetts; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.
8
Department of Health Policy and Management, Center for the Assessment of Pharmaceutical Practices (CAPP), Boston University School of Public Health, Boston, Massachusetts.

Abstract

BACKGROUND:

Little is known about regional variation in the use of postacute care services after elective procedures, such as total hip or knee arthroplasty (THA/TKA), and how insurance type may influence it. The goal of this study is to assess the influence of region and insurance arrangements on discharge disposition.

METHODS:

A representative sample of the privately insured US population with THA or TKA in 2009 or 2010 was obtained from the MarketScan database applying individual-level weights from the Medical Expenditure Panel Survey. Multivariate logistic regression was used to predict the odds of being discharged to an extended care facility (ECF) compared with being discharged home. The model adjusted for region, insurance plan type, sociodemographic characteristics, comorbidities, and length of stay.

RESULTS:

Large variability was observed in ECF use across the US. Patients in the Northeast were 2.5 times more likely to receive care at an ECF compared with patients in the South (odds ratio [OR] = 2.51, 95% confidence interval [CI]: 1.97-3.19). Enrollees in noncapitated plans such as fee-for-service plans or exclusive provider organizations were less likely to be discharged to an ECF compared with health maintenance organizations/preferred provider organizations with capitation enrollees (OR = 0.74, 95% CI: 0.57-0.94; OR = 0.49, 95% CI: 0.34-0.74, respectively).

CONCLUSION:

Region and private insurance plan arrangements are related to extended care use among THA and TKA patients. Understanding regional variation in discharge disposition provides policy makers with important information as to where to focus new tests of hip and knee procedures such as same day arthroplasty.

KEYWORDS:

discharge disposition; extended care facility; hip or knee replacement; insurance; region

PMID:
28712798
DOI:
10.1016/j.arth.2017.06.007
[Indexed for MEDLINE]

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