From the Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY.
J Am Acad Orthop Surg. 2021 Dec 15;29(24):e1313-e1320. doi: 10.5435/JAAOS-D-20-01378.
Post-total joint arthroplasty (TJA) discharge to a skilled nursing facility (SNF) is associated with higher costs and more complications than home discharge; however, some patients still require postoperative SNF care. To improve outcomes for patients requiring postoperative SNF care, this article analyzed the effect of SNF-surgeon partnerships on TJA postoperative costs and patient outcomes.
This was a retrospective study of primary TJA patients who were part of Medicare's Comprehensive Care for Joint Replacement (CJR) pilot program at our urban, academic medical center. We identified all patients discharged to SNF and designated SNFs as "preferred" if they maintained a partnership with our surgical team. SNF costs, total 90-day postoperative costs, average length of stay in SNF, 90-day readmission rates, and readmission diagnoses were recorded. Data were compared using Student t-tests. Readmission rates and the presence of a readmission diagnosis were analyzed using z-scores.
Our search identified 189 patients (22.9%) discharged to SNFs, with 128 (67.8%) discharged to preferred and 61 (32.2%) discharged to nonpreferred facilities. Over the 4-year CJR pilot program, SNF costs ($10,981.23 versus $7,343.34; P < 0.005) and overall postdischarge costs ($23,952.52 versus $18,339.26; P = 0.07) were higher for patients discharged to nonpreferred SNFs versus preferred SNFs. Patients discharged to nonpreferred SNFs also had increased length of stay (14.8 versus 10.1 days; P < 0.005) and increased readmission rates (19.7% versus 3.9%; P < 0.005). These differences became more pronounced across the study period.
For patients undergoing primary TJA, hospital partnership with SNFs can improve CJR performance by cost reduction and overall outcomes for TJA patients.
关节置换术后（TJA）到熟练护理机构（SNF）的出院与家庭出院相比，成本更高，并发症更多；然而，仍有一些患者需要术后 SNF 护理。为了改善需要术后 SNF 护理的患者的治疗效果，本文分析了 SNF-外科医生合作对 TJA 术后成本和患者结果的影响。
这是一项回顾性研究，研究对象为参与我们城市学术医疗中心 Medicare 综合关节置换计划（CJR）试点项目的初次 TJA 患者。我们确定了所有 SNF 出院的患者，如果 SNF 与我们的外科团队保持合作关系，则将 SNF 指定为“首选”。记录 SNF 成本、总 90 天术后成本、SNF 平均住院时间、90 天再入院率和再入院诊断。使用学生 t 检验比较数据。使用 z 分数分析再入院率和再入院诊断的存在。
我们的搜索确定了 189 名（22.9%）出院到 SNF 的患者，其中 128 名（67.8%）出院到首选 SNF，61 名（32.2%）出院到非首选设施。在 4 年的 CJR 试点项目中，与首选 SNF 相比，非首选 SNF 出院的患者 SNF 成本（10981.23 美元对 7343.34 美元；P < 0.005）和整体出院后成本（23952.52 美元对 18339.26 美元；P = 0.07）更高。与首选 SNF 相比，非首选 SNF 出院的患者住院时间更长（14.8 天对 10.1 天；P < 0.005），再入院率更高（19.7%对 3.9%；P < 0.005）。这些差异在研究期间变得更加明显。
对于接受初次 TJA 的患者，医院与 SNF 的合作可以通过降低成本和改善 TJA 患者的整体结果来提高 CJR 的绩效。
