Improving Value in Total Joint Arthroplasty: A Comprehensive Patient Education and Management Program Decreases Discharge to Post-Acute Care Facilities and Post-Operative Complications

摘要

Abstract Background A step-by-step approach to creating a comprehensive patient education, expectation, and management program is described with the aim of reducing discharges to post-acute care centers (PACs) following total joint arthroplasty (TJA). We hypothesized that by lowering discharges to PACs, readmissions and reoperations would also decrease. Methods Following the implementation of a multi-faceted patient education and management program, we retrospectively reviewed 927 TJAs who underwent surgery 12 months before (n?= 465) and after (n?= 462) the program was implemented. To assess the exposure of the pathway on discharge disposition as well as institutional 30-day and 90-day readmissions and reoperations, a modified Poisson regression was used. Results There was a 20% absolute reduction in discharges to PACs ( Conclusion Our program led to a reduction in the number of patients being discharged to PACs following TJA, while also demonstrating a reduction in readmission and reoperations. Additionally, discharge to these facilities was an independent risk factor for these complications.