Length of Stay in Skilled Nursing Facilities Following Total Joint Arthroplasty
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- 作者：Brandon A. Haghverdian ; BSca ; David J. Wright ; MD ; MSca ; Ran Schwarzkopf ; MD ; MScb ;
- 关键词：total joint arthroplasty ; skilled nurse facility ; length of stay ; Medicare ; managed care
- 刊名：The Journal of Arthroplasty
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：32
- 期：2
- 页码：367-374
- 全文大小：582 K
- 卷排序：32
文摘
The most commonly used postacute care facility after total joint arthroplasty is a skilled nursing facility (SNF). However, little is known regarding the role of physical therapy achievements and insurance status on the decision to discharge from an SNF. In this study, we aim to compare functional outcomes and length of stay (LOS) at an SNF among patients with Medicare vs private health coverage.MethodsWe retrospectively collected physical therapy data for 114 patients who attended an SNF following acute hospitalization for total joint arthroplasty. Medicare beneficiaries were compared with patients covered by Managed Care (MC) policies (health maintenance organization [HMO] and preferred provider organization [PPO]) using several SNF discharge outcomes, including LOS, distance ambulated, and functional independence in gait, transfers, and bed mobility.ResultsLOS at the SNF was significantly longer for Medicare patients (Medicare: 24 ± 22 days, MC: 12 ± 7 days, P = .007). After adjusting for LOS and covariates, MC patients had significantly greater achievements in all functional outcomes measured. In a study subanalysis, Medicare patients were found to achieve similar functional outcomes by SNF day 14 as MC patients achieved by their day of discharge on approximately day 12. Yet, the Medicare group was not discharged until several days later.ConclusionMedicare status is associated with poor functional outcomes, long LOS, and slow progress in the SNF. Our results suggest that insurance reimbursement may be a primary factor in the decision to discharge, rather than the achievement of functional milestones.