Race, ethnicity associated with discharge to skilled nursing facility after TKA
Published results showed African American patients were more likely to be referred to inpatient rehabilitation facilities or skilled nursing facilities for postoperative care and rehabilitation after elective total knee arthroplasty compared with white patients.
Using data from the Pennsylvania Health Care Cost Containment Council Database, researchers measured discharge disposition and 90-day hospital readmission among patients who identified as either African American or white and who underwent primary TKA in 170 non-governmental acute care hospitals from April 2012 to September 2015.
Among 107,768 patients, results showed 6.8% were African American, 63.4% were women, 43.1% were younger than 65 years and 56.3% were insured by Medicare. Discharge to an inpatient rehabilitation facility or a skilled nursing facility rather than home health care or home self-care was more common among African American patients vs. white patients younger than 65 years of age, according to results of the multivariable logistic regression analysis. Researchers also found African American patients younger than 65 years of age had greater odds of 90-day hospital readmission. Results showed African American patients 65 years of age or older were more likely to be discharged to a skilled nursing facility compared with white patients. Researchers noted an association between discharge to an inpatient rehabilitation facility with greater odds of 90-day readmission in both age groups.
“Future studies are needed to evaluate the decision-making process regarding discharge destination for post-acute care and rehabilitation after elective TKA and how social determinants of health, such as patient race/ethnicity, affect these decisions,” the authors wrote. “Future studies should also examine how changing Centers for Medicare & Medicaid Services policy reforms, such as Bundled Payment for Care Improvement, affect not only cost and quality of care but also equity.” – by Casey Tingle
Disclosures: Singh reported he received personal fees from Crealta/Horizon, Medisys, Fidia, UBM, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, the NIH and the American College of Rheumatology; owns stock in Amarin and Viking therapeutics; served as a member of the executive committee of Outcome Measures in Rheumatology on the FDA Arthritis Advisory Committee, as a member of the U.S. Department of Veterans Affairs Rheumatology Field Advisory Committee and as editor and director of the University of Alabama at Birmingham Cochrane Musculoskeletal Group Satellite Center on Network Meta-Analysis; and had previously served as a member of the Annual Meeting Planning Committee, Quality of Care Committee, Meet-the-Professor, Workshop and Study Group Subcommittee and Criteria and Response Criteria subcommittee for the American College of Rheumatology. Please see the study for a list of all other authors’ relevant financial disclosures.