| The aging of the U.S. population has led to a significant increase in the demand for joint replacements. The CDC reports that 51.8 million adults are diagnosed with arthritis in the U.S. Total knee or hip arthroplasty (also called joint replacement) is indicated for relief of significant disabling pain, stiffness and muscle weakness caused by severe arthritis. Hip replacements are often performed following hip fracture. According to CDC FastStats, 719,000 total knee replacements and 332,000 hip replacements were performed in US hospitals in 2010. Costs of providing this care have skyrocketed and are a national and community concern. In 2015 the Centers for Medicare and Medicaid Services (CMS), announced the Comprehensive Care for Joint Replacement Program as a strategy to improve outcomes and reduce costs of joint replacements. Why Hip and Knee Joint Replacement Best Practices For Home Health? Home health agencies frequently care for patients after Total Hip Replacement (THR) or Total Knee Replacement (TKR) surgery. Home health agencies have the opportunity to demonstrate their value to providers and patients by adopting practices that result in good outcomes combined with high patient satisfaction. - The demand for total joint replacement is steadily increasing. There was a 101% increase in yearly hospitalizations for hip and knee replacements between the years 1997-2007. (Pereira, 2015)
- The average hospital length of stay after joint replacement has decreased from several weeks to between three to six days (Gulotta,2011), and is expected to continue decreasing. Patients are seen at home much earlier in their recovery.
- “Fast track” programs are being implemented in many hospitals to reduce hospital stays after joint replacement and return patients home rather than a post-acute care facility (Kehlet 2013, Husted 2012).
- Patient satisfaction is high in fast-track hip and knee replacement programs, while length of stay (LOS), Emergency Department (ED) use, reported pain and use of pain medication has decreased (Specht 2015, Raphael 2011).
- Medicare is strongly encouraging providers to improve efficiency of joint replacement procedures, and to improve outcomes. By bundling payment for joint procedures, the CMS CCJR program is expected to drive demand for efficient, effective home care services after joint replacement.
Increase in Fast Track Programs Fast Track programs reduce hospital stays to around two days in a safe and effective manner (Raphael 2011). Many home health agencies are reporting an increase in same-day discharges as well as two-day fast track discharges. Candidates for fast track surgery are pre-selected. They are typically under age 70 and/or have few serious co-morbidities. Ambulation with physical therapy begins typically within six hours of surgery. Fast track patients are ambulated two additional times on the day of surgery and are provided physical therapy twice daily until discharge. Post-operative pain is managed via patient-controlled analgesia (PCA) for inpatients. PCAs are discontinued on the morning of postoperative day one if the patient’s pain visual analog scale pain score is 2 or less. Patients are discharged on oral pain medications. (Gulotta, 2011). Value of Fast Track and Discharge to Home Health The CMS Comprehensive Care for Joint Replacement program will increase use of fast track programs and increase the number of patients discharged to home rather than to a facility. This can be good for patients because of decreased risk of infection and lower costs. Home health agencies can add value for hospital and physician partners and patients by implementing evidence-based, streamlined programs to prevent complications and promote healing and increased mobility.See VNAA’s Healthcare Transformation e-Toolkit for information on payment models and implementation strategies for value based purchasing. How to Use These Resources: Start by browsing through the pages of this web-based module to learn more about elements of a high value home health hip and knee joint replacement program. To explore available resources, critical interventions and measurement and evaluation tools, click on the boxes above. You can review or download our Hip and Knee Joint Replacement Best Practices Powerpoint presentation, or a PDF of all Hip and Knee Best Practice web pages. These will be helpful to use in agency trainings or presentations to staff. Contact VNAA if you have any questions!
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