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

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

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.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroplasty, Replacement, Hip / standards
  • Arthroplasty, Replacement, Knee / methods*
  • Arthroplasty, Replacement, Knee / standards
  • Databases, Factual
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Discharge
  • Patient Readmission
  • Quality Assurance, Health Care*
  • Quality of Health Care
  • Retrospective Studies
  • Subacute Care / methods*
  • Subacute Care / standards