Adult Reconstructive Division, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1616, New York, NY 10003, USA.
Department Network Integration, NYU Medical Center, 360 Park Avenue South, New York, NY 10010, USA.
Int J Surg. 2017 Feb;38:119-122. doi: 10.1016/j.ijsu.2016.12.038. Epub 2016 Dec 26.
The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool (RAPT) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement, spine fusion and cardiac valve surgery patients.
Between April 2014 and April 2015, RAPT scores of 767 patients (535 primary unilateral total joint arthroplasty; 150 cardiac valve replacement; 82 spinal fusions) were prospectively captured. Total RAPT scores were grouped into three levels for risk of complications: <6 = 'high risk', between 6 and 9 = 'medium risk', and >9 = 'low risk' for discharge to a post-acute facility. Associations between RAPT categories and patient discharge to home versus any facility were conducted. Multivariate analysis was performed to determine if there was any correlation between RAPT score and discharge to any facility.
70.5% of total joint patients, 80.7% of cardiac valve surgery patients and 70.7% of spine surgery patients were discharged home rather than to a post-acute facility. RAPT risk categories were related to discharge disposition as 72% of those in the high risk group were discharged to a facility and 91% in the low risk group were discharged to home in the total joint replacement cohort. In the cardiac cohort, only 33% of the high risk group was discharged to a facility, and 94% of the low risk group was discharged to home. In the spinal fusion cohort, 60% of those in the high risk group were discharged to a facility and 86% in the low risk group were discharged to home. Multivariate analysis showed that being in the high risk category versus low risk category was significantly associated with substantially increased odds of discharge to a facility.
The RAPT tool has shown the ability to predict discharge disposition for total joint and spine surgery patients, but not cardiac valve surgery patients, where the majority of patients in all categories were discharged home, at an institution participating in a bundled payment program. The ability to identify discharge disposition pre-operatively is valuable for improving care coordination, directing care resources and establishing and maintaining patient and family expectations.
本研究旨在评估在参与捆绑支付计划的机构中，风险评估和预测工具（RAPT）与全关节置换、脊柱融合和心脏瓣膜手术患者出院处置之间的关系。
在 2014 年 4 月至 2015 年 4 月期间，前瞻性采集了 767 例患者的 RAPT 评分（535 例单侧初次全关节置换术；150 例心脏瓣膜置换术；82 例脊柱融合术）。总 RAPT 评分按并发症风险分为三组：<6=“高风险”，6-9=“中风险”，>9=“低风险”，以便出院至康复机构。对 RAPT 类别与患者出院回家与任何机构之间的关系进行了分析。进行了多变量分析，以确定 RAPT 评分与任何机构出院之间是否存在相关性。
70.5%的全关节置换术患者、80.7%的心脏瓣膜手术患者和 70.7%的脊柱手术患者出院回家，而非康复机构。RAPT 风险类别与出院处置相关，高风险组 72%的患者出院至机构，低风险组 91%的患者出院回家。在心脏组中，高风险组只有 33%的患者出院至机构，低风险组 94%的患者出院回家。在脊柱融合组中，高风险组 60%的患者出院至机构，低风险组 86%的患者出院回家。多变量分析显示，高风险组与低风险组相比，出院至机构的可能性显著增加。
RAPT 工具已显示出预测全关节和脊柱手术患者出院处置的能力，但对心脏瓣膜手术患者则不然，该组所有类别的大多数患者均出院回家，在参与捆绑支付计划的机构中。术前识别出院处置的能力对于改善护理协调、指导护理资源以及建立和维持患者和家属的期望都具有重要意义。
