Department of Physical Therapy, University of Texas Medical Branch, Galveston, Texas.
Department of Physical Therapy, University of Texas Medical Branch, Galveston, Texas.
Arch Phys Med Rehabil. 2020 Sep;101(9):1509-1514. doi: 10.1016/j.apmr.2020.05.019. Epub 2020 Jun 16.
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.
Retrospective cohort study.
Acute care hospitals submitting claims to Medicare.
National cohort (N=1,189,286) of 100% Medicare Part A data files from 2009-2011.
Not applicable.
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.
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.
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.
确定与全膝关节置换术（TKA）后 3 种最常见的急性出院后设置相关的因素：住院康复设施（IRF）、熟练护理设施（SNF）和直接返回社区。
回顾性队列研究。
向 Medicare 提交索赔的急性护理医院。
来自 2009-2011 年 Medicare 部分 A 数据文件的全国队列（N=1,189,286）。
不适用。
根据临床和设施水平变量，观察到的 3 种主要出院后设置的出院率和调整后的出院几率：合并症的数量、双侧手术和设施 TKA 量。
以 IRF 出院为参照，接受双侧手术的患者 SNF 和社区出院的几率较低，合并症较多的患者社区出院的几率较低，SNF 出院的几率较高，接受 TKA 的医院 TKA 量较低的患者 SNF 和社区出院的几率较低。
医疗保险受益人群中的临床人群可能在 TKA 后 3 种最常见的出院设置中存在系统差异。这些信息可能有助于更好地了解哪些患者或临床因素会影响 TKA 后的康复护理设置。包括功能状态、生活状况和社会支持系统在内的进一步研究将是有益的。
