Methods: The study was conducted in 2001. The directors of Ontario's 43 CCACs were asked to complete and return a 12-question survey. The survey specifically inquired about the services provided to home-based care recipients following JR surgery.

Findings: The response rate was high at 86% (37). Of the ones who responded, 36% had reported the use of critical care pathways. About half (54%) of the respondents had definitive discharge criteria and 32% of the CCACs indicated a predetermined length of home care services. The survey also revealed that the majority of the CCACs contracted out physical and occupational therapy services as well as home making services to private agencies, but that variation in length of service was most pronounced for home making services. Furthermore it was noted that a large majority of the CCACs utilized cliniciancentered versus client-centered outcome measures to evaluate a client's functional status and progress.

Conclusions: The study provides evidence that patients following JR surgery receive wide variations in home-based rehabilitation care. This variation makes it difficult to measure and ensure the provision of consistent quality of care. The study served to identify an urgent need to standardize home-based rehabilitation for individuals following JR surgery, but acknowledged that further studies are required. Standardized home-based rehabilitation strategies will be important as the demand for this service increases due to the recent delisting of out-patient physiotherapy services in Ontario. The establishment of standardized critical care pathways and discharge planning may be crucial to enhance the efficient and effective delivery of quality care following JR surgery.

Reference: Mahomed NN, Lau JTC, Manfred KSL, Radovan Z, Davey JR. "Significant Variation Exists in Home Care Services Following Total Joint Arthroplasty." Journal of Rheumatology, 2004; 31:973-5.

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