Home and Community Care Digest

Home and Community Care Digest December 2004 : 0-0

Standardized in-home discharge criteria and care pathways are needed for care recipients following joint replacement surgery


There is an increasing trend to discharge patients with home-based rehabilitation following joint replacement surgery. This trend has resulted in the need to develop appropriate care pathways in order to contain costs and enhance quality of care. The study identified the services offered by Community Care Access Centers (CCAC) in Ontario for patients following joint replacement surgery. The findings highlighted the wide regional variations in the provision of home-based rehabilitation. The authors stressed the importance for care quality by establishing standardized discharge protocols and care pathways for care recipients receiving home-based rehabilitation.
Background: There has been a significant trend increase in the uptake of home-based rehabilitation following joint replacement (JR) surgery. Two key areas of home-based rehabilitation have been identified in order to contain costs and enhance the quality of care: first, the development of critical care pathways; and second, the implementation of discharge planning from the point of admission into home care programs. The purpose of this study was to identify current practices associated with the implementation of these strategies in Community Care Access Centers (CCAC) across Ontario. The study aimed to stimulate dialogue between CCACs in Ontario regarding the need for standardized inhome discharge criteria and care pathways for care recipients following JR surgery.

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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