Home and Community Care Digest
Increased pre-operative and fewer post-operative home visits yield similar outcomes for total joint replacement patients than traditional home care
Method: Consenting TJR patients who were undergoing unilateral total knee replacement (TKR), bilateral TKR, or total hip replacement (THR)) were randomly assigned to the control (number=67) or intervention (number=69) protocol. Control and intervention group patients differed with respect to the number and timing of authorized nurse and physical therapist (PT) visits. Intervention protocols for THR and TKR called for an initial preoperative home visit by a nurse and PT, followed by two postoperative nurse visits and 6 (THR) or 10 (TKR) PT visits compared with 11 to 47 combined nurse/PT visits under the control protocol. All subjects were followed postoperatively for 6 months, with data collected at baseline, 1 month and 6 months post-surgery. Outcome measures included functioning, pain, self-care, quality of life, satisfaction, adverse outcomes, and the use and cost of health care.
Findings: No significant differences were seen between groups in terms of overall functional status, health-related quality of life, adverse outcomes, short-term rehabilitation hospital use, or with reported satisfaction at 6 months. Hospital readmissions did not differ by group with respect to mean days or mean reimbursement. Mean home care reimbursement was significantly lower in the intervention group, reflecting fewer visits per patient. At six months, the average reimbursement of the treatment group was approximately 55% lower than the control.
Conclusion: Few differences were found in outcomes between control and intervention groups. Although functional status, quality of life, and other satisfaction outcomes were similar for both groups, those receiving the intervention expressed higher satisfaction with access to care despite receiving fewer visits. While other health care costs remained similar between groups, intervention home health care costs were 55% lower. The findings suggest that post-surgical home care visits can be reduced without compromising outcomes in patients with TJR when provided in conjunction with a preoperative home visit. Applying these findings to a Canadian context suggests that costs may be reduced and outcomes maintained through pre-surgical home care referral and contact.
Reference: Weaver, F.M., Hughes, S.L., Almagor, O., Wixson, R., Manheim, L., Fulton, B., and Singer, S. Comparison of two home care protocols for total joint replacement. Journal of the American Geriatrics Society, 2003; 51:523-528.
Be the first to comment on this!
Personal Subscriber? Sign In
Note: Please enter a display name. Your email address will not be publically displayed