JOINTS Study - Joint Replacement Outcome in Inpatient Rehabilitation Facilities and Nursing Treatment Sites (JOINTS)

July 9, 2007 updated by: MedStar National Rehabilitation Network

Joint Replacement Outcome in Inpatient Rehabilitation Facilities and Nursing Treatment Sites

  1. What are the characteristics of joint replacement patients (DRGs 209 & 210) served in IRFs and SNFs? How are they similar or different?
  2. How are the interventions and processes of care for joint replacement patients different in IRFs and SNFs?
  3. What specific interventions or combinations of interventions in IRFs and SNFs make the biggest difference in outcomes for joint replacement patients taking into account patient differences?
  4. Which joint replacement patients do better in an IRF and which do better in a SNF?
  5. What is the relative cost-effectiveness of IRF and SNF care for joint replacement patients?
  6. Are comorbidities among joint replacement patients an adequate indicator of additional medical need during the rehabilitation process? Can a severity-of-illness measure serve as a better indicator of medical need? Are patients with greater medical needs served better in an IRF or a SNF?
  7. Can we design a more efficient course of rehabilitation interventions for joint replacement patients in IRFs and SNFs to reduce the length of stay and costs?

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

  1. What are the characteristics of joint replacement patients (DRGs 209 & 210) served in IRFs and SNFs? How are they similar or different?

    We need to know if there are systematic differences among joint replacement patients served in both settings and take these into account when evaluating outcomes and cost effectiveness as outlined below. See also Question 6.

  2. How are the interventions and processes of care for joint replacement patients different in IRFs and SNFs?

    How can we best characterize the differences in the care received in an IRF vs. a SNF? What makes the care in an IRF and a SNF different? What do they do similarly and what do they do differently? Consider all interventions, e.g., nursing services, physician interventions, physical and occupational therapies, nutritional support, medications, passive motion exercises, weight-bearing exercises. Also consider timing, intensity, frequency, and duration of therapies.

  3. What specific interventions or combinations of interventions in IRFs and SNFs make the biggest difference in outcomes for joint replacement patients taking into account patient differences?

    The relevant outcomes for this study include: (1) the onset of complications during the course of treatment, (2) change in severity of illness from admission to discharge, (3) discharge destination (including unscheduled discharges to acute care), and (4) change in functional status from admission to discharge. We will consider (5) rehospitalizations or readmissions in the first 3-6 months following discharge from post-acute care.

  4. Which joint replacement patients do better in an IRF and which do better in a SNF?

    How can we best characterize the differences between patients who do better in one setting or the other? How can these characterizations assist in developing post-acute placement criteria and in characterizing the patient mix that should be used in defining an IRF pursuant to the 75% rule?

  5. What is the relative cost-effectiveness of IRF and SNF care for joint replacement patients?

    For which patients is it more cost-effective to be placed in an IRF and which patients in a SNF taking into account outcomes both at discharge and rehospitalizations during the first 3-6 months following discharge?

  6. Are comorbidities among joint replacement patients an adequate indicator of additional medical need during the rehabilitation process? Can a severity-of-illness measure serve as a better indicator of medical need? Are patients with greater medical needs served better in an IRF or a SNF?

    Do comorbidities or a severity of illness indicator have better predictive validity in terms of service utilization, costs, and outcomes?

  7. Can we design a more efficient course of rehabilitation interventions for joint replacement patients in IRFs and SNFs to reduce the length of stay and costs?

Study Type

Observational

Enrollment (Actual)

2384

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • District of Columbia
      • Washington, District of Columbia, United States, 20010
        • National Rehabilitation Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Are 21 years of age or older,
  • Received a hip or knee replacement of any type for any reason, and
  • Admitted from any source.

To be included in the study's database, the above enrollment criteria need to be met. In addition, patients also must:

  • Have a minimum rehabilitation length of stay (LOS) of 3 days, and
  • Have complete admission and discharge FIM data.

Exclusion Criteria:

  • Joint replacements such as shoulder and ankle replacements since the rehabilitation for these patients is quite different. For most study patients, the joint replacement will be their first, but with the aging of the population, revisions are becoming more common. According to the MedPAC-RAND report, 4.8% of IRF and 6.3% of SNF joint replacement patients had a revision.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

MedStar National Rehabilitation Network

Collaborators

HealthSouth

Investigators

  • Principal Investigator: Gerben DeJong, PhD, NRH
  • Principal Investigator: Susan Horn, PhD, ISIS/ICOR

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2005

Study Completion (Actual)

February 1, 2007

Study Registration Dates

First Submitted

July 9, 2007

First Submitted That Met QC Criteria

July 9, 2007

First Posted (Estimate)

July 11, 2007

Study Record Updates

Last Update Posted (Estimate)

July 11, 2007

Last Update Submitted That Met QC Criteria

July 9, 2007

Last Verified

July 1, 2007

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2005-271

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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