Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls

Homer Yang, Geoff Dervin, Susan Madden, Ashraf Fayad, Paul Beaulé, Sylvain Gagné, Mary Lou Crossan, Kathryn Wheeler, Melody Afagh, Tinghua Zhang, Monica Taljaard, Homer Yang, Geoff Dervin, Susan Madden, Ashraf Fayad, Paul Beaulé, Sylvain Gagné, Mary Lou Crossan, Kathryn Wheeler, Melody Afagh, Tinghua Zhang, Monica Taljaard

Abstract

Background: A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements.

Objective: The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis.

Methods: After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2.

Results: A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can $5826.32 (SD 1418.89) in the POHM group and Can $9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5%) and 2 readmissions (1.9%) in the control group. No mortalities occurred in either group.

Conclusions: The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively.

Trial registration: ClinicalTrials.gov NCT02143232; https://ichgcp.net/clinical-trials-registry/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P).

Keywords: continuity of care; cost reductions; length of stay; postoperative care; postoperative emergency department visit; postoperative home monitoring; postoperative readmissions.

Conflict of interest statement

Conflicts of Interest: None declared.

©Homer Yang, Geoff Dervin, Susan Madden, Ashraf Fayad, Paul Beaulé, Sylvain Gagné, Mary Lou Crossan, Kathryn Wheeler, Melody Afagh, Tinghua Zhang, Monica Taljaard. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 05.11.2018.

References

    1. . Ottawa: Canadian Institute for Health Information; 2012. All-Cause Readmission to Acute Care and Return to the Emergency Department.
    1. Finnegan MA, Shaffer R, Remington A, Kwong J, Curtin C, Hernandez-Boussard T. Emergency Department Visits Following Elective Total Hip and Knee Replacement Surgery: Identifying Gaps in Continuity of Care. J Bone Joint Surg Am. 2017 Jun 21;99(12):1005–1012. doi: 10.2106/JBJS.16.00692.
    1. Telem DA, Yang J, Altieri M, Patterson W, Peoples B, Chen H, Talamini M, Pryor AD. Rates and Risk Factors for Unplanned Emergency Department Utilization and Hospital Readmission Following Bariatric Surgery. Ann Surg. 2016 May;263(5):956–60. doi: 10.1097/SLA.0000000000001536.
    1. Luu P, Hussain T, Chang H, Pfoh E, Pollack C. The role of continuity in hospital care for readmitted colon cancer patients. J Gen Intern Med. 2015;2015(30):S75.
    1. Brooke BS, Goodney PP, Kraiss LW, Gottlieb DJ, Samore MH, Finlayson SRG. Readmission destination and risk of mortality after major surgery: an observational cohort study. Lancet. 2015 Aug 29;386(9996):884–95. doi: 10.1016/S0140-6736(15)60087-3.
    1. Vorhies JS, Wang Y, Herndon JH, Maloney WJ, Huddleston JI. Decreased length of stay after TKA is not associated with increased readmission rates in a national Medicare sample. Clin Orthop Relat Res. 2012 Jan;470(1):166–71. doi: 10.1007/s11999-011-1957-0.
    1. Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002 May;96(5):1140–6.
    1. Crocker JB, Crocker JT, Greenwald JL. Telephone follow-up as a primary care intervention for postdischarge outcomes improvement: a systematic review. Am J Med. 2012 Sep;125(9):915–21. doi: 10.1016/j.amjmed.2012.01.035.
    1. Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database Syst Rev. 2006;(4):CD004510. doi: 10.1002/14651858.CD004510.pub3.
    1. Soong C, Kurabi B, Wells D, Caines L, Morgan MW, Ramsden R, Bell CM. Do post discharge phone calls improve care transitions? A cluster-randomized trial. PLoS One. 2014;9(11):e112230. doi: 10.1371/journal.pone.0112230.
    1. van Walraven C, Mamdani M, Fang J, Austin PC. Continuity of care and patient outcomes after hospital discharge. J Gen Intern Med. 2004 Jun;19(6):624–31. doi: 10.1111/j.1525-1497.2004.30082.x.
    1. van Walraven C, Taljaard M, Etchells E, Bell CM, Stiell IG, Zarnke K, Forster AJ. The independent association of provider and information continuity on outcomes after hospital discharge: implications for hospitalists. J Hosp Med. 2010 Sep;5(7):398–405. doi: 10.1002/jhm.716.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe